Reducing Risks of Child Abuse and Neglect through Home Visiting--Marcia Wessels, MPH

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This presentation will describe how early childhood home visiting programs can support the reduction of family risk factors and the strengthening of protective factors to reduce the likelihood of child abuse and neglect.

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Reducing Risks of Child Abuse and Neglect through Home Visiting--Marcia Wessels, MPH

  1. 1. 2nd Annual Conference September 4, 2013
  2. 2. Reducing Risks of Child Abuse and Neglect through Home Visiting This project was supported in part by the Governor’s Office for Children and Families through U.S. Department of Health and Human Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505). Points of view or opinions stated in this document are those of the author(s) and do not necessarily represent the official position or policies of the Governor’s Office for Children and Families or the U.S. Department of Health and Human Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505).
  3. 3. Objectives To increase knowledge of early childhood home visiting:  Program design, goals and outcomes.  Program practices leading to outcomes related to reducing the risk of child abuse and neglect.  Evidence of effectiveness in achieving outcomes.  Best practices for implementing home visiting programs in communities to achieve intended outcomes.
  4. 4. Home Visiting Programs  Provide home visits as the primary service delivery strategy.  Offer services on a voluntary basis.  Offer services to pregnant women or children birth to 5 years.  Target participant outcomes that include:  Maternal and child health.  Child injuries, child maltreatment, and reduction of ER visits.  Improvements in school readiness and achievement.  Reduction in crime or domestic violence.  Improvements in family economic self-sufficiency.  Improvements in coordination/referrals for resources/support. DHHS, HRSA, ACA, MIECHV FOA (HRSA-10-275)
  5. 5. Components of Home Visiting Programs  Program standards/requirements  Defined points of program entry  Home visits of specified frequency  Trained home visitors and supervisors  Regular supervision  Use of curriculum
  6. 6. Home Visiting Eligibility  Expectant parents/families with children birth to five  First time parent  Less than 28 weeks pregnant  Low income  Lack of housing  Less than age 21  Less than 12 years of education,  Unemployed  Parent alcoholism, drug abuse, depression  Parental history of child abuse or neglect  Children with developmental delays/disabilities
  7. 7. Home Visiting Program Model Goals/Focus  Early Head Start-Home Based (EHS-HB)  Enhance the development of infants and toddlers while strengthening families. Provide culturally competent child development and parent support services, emphasizing the role of the parent-child relationship.  Healthy Families America (HFA/HFG)  Build and sustain community partnerships to systematically engage overburdened families in home visiting services prenatally or at birth. Cultivate and strengthen nurturing parent-child relationships. Promote healthy childhood growth and development. Enhance family functioning by reducing risk and building protective factors.
  8. 8. Home Visiting Program Model Goals/Focus  Nurse Family Partnership (NFP)  Improved pregnancy outcomes. Improved child health & development. Improved maternal life course development.  PAT (PAT)  Increase parent knowledge of early childhood development and improve parenting practices. Provide early detection of developmental delays and health issues. Prevent child abuse and neglect Increase children’s school readiness and school success  SafeCare  Provide direct skill training to parents in child behavior management and planned activities training, home safety training, and child health care skills to prevent child maltreatment.
  9. 9. Home Visiting Model Standards for Service Program Point of Entry Duration of Service Intensity of Service EHS-HB Pregnancy – child 3 yrs. Pregnancy – 3 yrs. 1 visit /wk. HFG Pregnancy – child 2 wks./3 mos. Pregnancy – 5 yrs. 1 visit /wk. – 1 visit/qtr. NFP Prior to 28th week of pregnancy Pregnancy – 2 yrs. 1 visit/wk. – 1 visit/2 wks. PAT Pregnancy – child 3 yrs. Pregnancy - 5 yrs. 1 visit/2 wks. SafeCare Birth – child 5 years Program 18 – 20 wks. 1 visit/wk.
  10. 10. Home Visiting Activities  Offering parenting and child development information  Promoting parent-child interaction  Providing observation, feedback and support  Offering information on health and safety and addressing health and safety concerns  Conducting assessments and screenings  Providing referrals/linkages to resources based on family needs  Supporting parent in setting and accomplishing goals  Providing opportunities to participate in parent group activities
  11. 11. Home Visiting Principles  Family Centered  Culturally Competent  Strength Based  Relationship Based
  12. 12. Risk Factors for Child Abuse and Neglect  Children younger than 4 years of age  Parent’s lack of understanding child’s needs, child development and parenting skills  Substance abuse and/or mental health issues  Parental characteristics: young age, low education, single parenthood, low income  Social isolation  Family disorganization, dissolution and violence  Parenting stress http://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html
  13. 13. Strengthening Families Protective Factors  Parental resilience  Social Connections  Concrete Support in Times of Need  Knowledge of Parenting and Child Development  Social Emotional Competence of Children http://www.cssp.org/reform/strengthening-families/the-basics/protective-factors
  14. 14. Reducing Risks – Building Protective Factors Risk Factors Activities Protective Factors Parent’s lack of understanding child’s needs and development Parenting and child development information Assessments & screening Promote PCI Knowledge of parenting and child development SE competence of child Substance abuse/mental health issues Assessments & screening Information on health and safety Referrals/linkages Parental resilience Concrete support Low education/low income Goal setting Referrals/linkages Parental resilience Concrete support Social isolation Home visits Parent group activities Referrals/linkages Social Connections
  15. 15. Georgia Home Visiting Video Home Visiting Program Promotional Video MIECHV This project was supported in part by the Governor’s Office for Children and Families through U.S. Department of Health and Human Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505). Points of view or opinions stated in this document are those of the author(s) and do not necessarily represent the official position or policies of the Governor’s Office for Children and Families or the U.S. Department of Health and Human Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505).
  16. 16. HV Program Positive Parenting Maternal Health Child Health Reduce CAN Child Development /School Readiness Family Economic Self Sufficiency Reduce DV Linkages Referrals EHS - HB X X X X HFG X X X X X X X X NFP X X X X X X X PAT X X SafeCare Augmented X X SafeCare Home Safety X Evidence of Effectiveness www.homvee.acf.hhs.gov
  17. 17. Research Findings for Child Abuse and Neglect HomVee (www.homvee.acf.hhs.gov)  EHS-HB: Physical punishment  HFA: Psychological aggression frequency, mild physical assault frequency, common corporal/verbal punishment, neglect, frequency very serious physical abuse, frequency harsh parenting, frequency non-violent discipline  NFP: # ER visits for accidents & poisonings, # injuries & ingestions in physicians record, substantiated reports CAN, # health care encounters injuries/ingestions, # days hospitalized for injuries, onset of neglect  SafeCare Augmented: Non-violent discipline, post-enrollment referral to child welfare for domestic violence
  18. 18. Research Findings for Child Abuse and Neglect California Evidence Based Clearinghouse for Child Welfare (www.cebc4cw.org)  Ratings: Strength of Research Evidence 1-5 and Child Welfare Relevance 3 Levels – High Medium Low  EHS: 3 Promising Research Evidence /Medium - Child Welfare  HFA: 1 Well-Supported by Research/ Medium – Child Welfare  NFP: 1 Well-Supported by Research/ Medium – Child Welfare  SafeCare: 2 Supported by Research/ High – Child Welfare
  19. 19. Implementing Home Visiting Programs  Community – Program Fit  Program model evidence of effectiveness.  Synergy between model’s outcomes and community needs.  Community resources to maintain model fidelity.  Qualified applicant’s to meet model’s staff qualifications.  Approximate cost per family per year. www.zerotothree.org Home Visiting Community Planning Tool  Program Model Fidelity  Adherence to service model.  Service exposure or dosage.  Quality/manner of service delivery.  Participant response to engagement.  Understanding of essential program elements. http://www.implementationscience.com/content/2/1/40
  20. 20. Home Visiting Model Websites  EHS-HB: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ ehsnrc/Early%20Head%20Start/home-based-model  HFA: www.healthyfamiliesamercia.org  NFP: www.nursefamilypartnership.org  PAT: www.parentsasteachers.org  SafeCare: http://publichealth.gsu.edu/968.html
  21. 21. Marcia Wessels, MPH Director of TA and Training Great Start Georgia Center for Family Research The University of Georgia marciaw@uga.edu
  22. 22. 2nd Annual Conference September 4, 2013

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