Home visting programs help promote positive parenting behaviors in order to promote a healthy home environment. These programs can help prevent child neglect or abuse. In Memphis specifically, the Nurse-Family Partnership home visiting program has reduced health care encounters by 28% and hospitalizations for injuries of young children by 79%. The Nurse-Family Partnership program is just one of many home visiting programs.
Bringing home an infant is almost a guarantee of chaos and confusion for new parents. Sleep deprivation, financial troubles, and learning to juggle work and home obligations can make the most joyous and loving parents frazzled. When families are already stressed and when their social supports are tentative, children are at particular risk of being neglected or abused.1 Of course, it shouldn’t be this way. After all, the first three years of a child’s life are the most crucial to their emotional and physical development, and what we would all wish for all children would be a safe, stable, nurturing and loving home.
Interventions with parents during this vulnerable period can reduce child maltreatment and improve parents’ effectiveness. Home visiting is one specific form of intervention that shows positive results. Home visiting programs can take many forms, but all exhibit certain characteristics. They are based on the belief that services delivered to families in their homes can improve parenting behaviors and positively impact children’s development.1 Home visitors can be nurses, paraprofessionals, social workers, or other individuals trained to provide such services and can focus services on various interventions. These interventions include:
Providing good role models and social support for parents
Connecting families to community resource providers
Training parents to effectively nurture and discipline their children
Educating parents about healthy practices during pregnancy, infant care, and family planning1
Much of what we know about the effectiveness of home visiting programs comes from evaluations of The Nurse-Family Partnership (NFP). For example, the program has been shown to reduce child maltreatment by nearly half (48%), and is considered the premier intervention program for preventing child maltreatment.2 In Memphis, NFP has been shown to reduce health care encounters and hospitalizations for injuries of young children by 28% and 79%, respectively. Further, children in the NFP program in Memphis were 4.5 times less likely to die from prematurity, sudden infant death syndrome, or injuries before their ninth birthday than a comparable cohort of children.3 Additionally, NFP was found to be particularly effective for disadvantaged families with fewer resources and greater stress.2,3
Due to complications in acquiring accurate data about child maltreatment, many programs have not evaluated and/or have not identified enough support to declare that child maltreatment has actually been reduced as a result of the program. However, many programs have been found to improve parenting behaviors.1 Since ineffective and inappropriate parenting behaviors are associated with child maltreatment, promoting positive parenting behaviors is argued to reduce rates of child maltreatment among families.1
Further, new initiatives to also address domestic violence in home visiting programs are being implemented as part of the Affordable Care Act. Witnessing domestic violence negatively impacts young children and increases their risk for maltreatment.5 As such, these issues also need to be addressed in the context of home visiting interventions. However, many home visitors may not feel equipped to handle these sorts of situations. To aid this problem, Futures without Violence has created a curriculum for training home visitors to address domestic violence in homes that they serve. The curriculum is intended to foster competency among home visitors to assess domestic violence in the home, discuss the issues with victims, and initiate safety planning.6 Employing this sort of curriculum in already existing home visiting programs may add additional protection to the families and children served.
Home Visiting Programs in Memphis and Shelby County
Young children who are maltreated are more likely to have learning difficulties, exhibit physical and mental health issues, and are more likely to become involved in criminal activity. In Memphis and Shelby County a number of best practice programs are working with new parents to reduce rates of child maltreatment in our community. These include:
Kitzman, H., Olds, D. L., Henderson, C. R. Jr., Hanks, C., Cole, R., Tatelbaum, R., McConnochie, K. M., Sidora, K., Luckey, D. W., Shaver, D., Engelhardt, K., James, D., Barnard, K (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: a randomized controlled trial. Journal of the American Medical Association, 278(8), 644-652.
Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., Luckey, D. W., Henderson, C. R. Jr., Holmberg, J., Tutt, R. A., Stevenson, A. J., Bondy, J. (2007). Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial. Pediatrics, 120(4):e832-845.