Home Visitation Programs for At-risk Young Families

Abstract

Background: This systematic literature review is stimulated by the perceived need of investigator, practice and policy stakeholders for a complete but parsimonious summary of key elements of programs that use home visitation for at-risk young families as the major delivery method. Objectives: To describe the program components, practices, outcomes, and reliability of the evaluation approaches. Methods: Computer and hand searches of literature were carried out. Reports of established programs, from the last five years, that describe home visitation services to atrisk families were included. A comprehensive data collection tool was used in the analysis of the findings. Findings: Improvements over the previous five years were seen in the following areas: use of early intervention model, inclusion of comparison groups and adequate sampling. Discussion: Challenges remain in development, targeting and reporting of home visitation practice, overall lack of impact, differential effects by program site, retention of participants and appropriate measurement. METHODS Computerized searches of CINAHL, ERIC and MEDLINE were carried out. Key search terms included home visitation, healthy families, nurse visitor, paraprofessionals, and child abuse. Reports to funders and journal manuscripts published between 1995 and 2000 were included. 1-7, 9,10,12-15,17-19,21-33 Descriptions of programs and home visitation practices, not included in the recent publications, 8,11,16,20 were sought in past literature. Government documents, program reports, published bibliographies, and reference lists from six previously published literature reviews on aspects of home visitation were hand searched. 1-7 Conferences and workshops focusing on home visitation were attended and relevant abstracts and papers reviewed. Key informants were contacted to locate both published and unpublished papers. These sampling methods yielded 33 published program evaluations and 3 evaluation reports to government and/or funding agencies. Of the 36 program evaluations, 10 articles describe aspects of the Nurse Home Visitation Program. Of those 10, 3 were selected since they include: the most complete description of the program and original evaluation; 8 the most recent

Effective Early Childhood Programs: Turning Knowledge Into Action

“…• Consideration of cultural and social factors; 304 • Direct facilitation of change in parents' interaction and behaviors with their children in ways that are sensitive to cultural and social practices; 305 • Attention to influences from children's larger social context; 306 • Adoption of change models and measurement procedures that account for the child's influence on the parent as well as the parent's influence on the child; 307 • Ensuring that interventions have a clear focus; • Linking intervention to a theoretical orientation that justifies its selection of particular goals and techniques; 308 (on next page). • Addressing whether it is feasible to expect change in parenting beliefs, 309 knowledge, and/or behavior for the target population being served; and • Ensuring that home visit facilitators understand and accept their role as agents of change.…”

The ethics of relation: public health nurses and child protection clients

“…In their systematic review of literature on home visitation programmes in Canada, Drummond et al (2002) report that client conditions (such as individual differences, culture and the nature of risk) need to be accounted for in designing intervention practices, as these conditions probably contribute most to significant attrition rates and large discrepancies between planned and achieved visits. Unspoken, yet probably a factor in home visiting programmes, particularly to families with social risk factors, is the notion of public health nurses as health police.…”

“…There has been a recent resurgence of interest in home visiting as an intervention targeting the developmental needs of infants and young children living in risky situations (Drummond et al. 2002).…”

“…There has been a recent resurgence of interest in home visiting as an intervention targeting the developmental needs of infants and young children living in risky situations (Drummond et al 2002). Evolving from the roots of women's voluntary services at the turn of the 20th century, public health nurses have historically carried out monitoring and regulating of parenting in the home to ensure the health and appropriate socialization of children (Maxwell 1997).…”

Limited Access to Care and Home Healthcare

“…The most effective home visitation programs, as demonstrated by program evaluations and published outcomes, usually combine an ecologic perspective, an empowerment or strength-based approach, a social support component, a high level of participant involvement, and/or one or more program aspects addressing specific parent and child characteristics, parent-child interactions, and/or environmental factors. 28,[45][46][47] These programs include case management and practical support, for example, to help women establish insurance coverage; keep prenatal appointments; prepare for childbirth and breastfeeding; obtain special supplemental nutrition for women, infants, and children (WIC) services; and maintain a medical home for mother and infant. After birth, they help mothers identify the signs and symptoms of illness in their infant and recognize when to seek emergency department care, support their infant's growth and development, and complete the required immunization schedule.…”