Home Visiting Programs for Prevention of Child Abuse and Neglect

Nurse-Family Partnership® (NFP) is an intensive, strengths-based, trauma- and violence-informed community health program whose goals are to improve the health and lives of first-time moms and their children living in poverty. Specially trained registered nurses regularly visit first-time moms-to-be (adolescents and adults), starting early in pregnancy and continuing through children's second birthday. NFP nurses aim to leverage their clinical expertise in applying behavior change and human ecology theories to deliver this client-centered program. Ideally, NFP participants develop close relationships with their nurse. It is hoped that the nurse becomes a trusted resource for advice on everything from safely caring for their child to taking steps to provide a stable, secure future for their family. In addition to living in poverty, NFP moms also often are experiencing, or at risk of experiencing, homelessness; addiction or substance misuse; involvement with child welfare or juvenile or criminal justice systems; intimate partner violence; severe developmental disabilities; behavioral or mental health needs; or a high-risk pregnancy.

Child First is a two-generation, home-based mental health intervention for the most vulnerable young children (prenatal through age five years) and their families, who likely have current or past Child Welfare Services involvement. It is designed for young children who have usually experienced trauma and/or have social-emotional, behavioral, developmental, and/or learning problems. Most live in environments where there is violence, neglect, mental illness, substance abuse, or homelessness. The goals of Child First are to help them heal from the effects of trauma and adversity; improve child and parent mental health; improve child development; and reduce abuse and neglect.

The model uses two team members:

• A Clinician provides a psychotherapeutic, two-generation intervention designed to build a nurturing, responsive, protective parent-child relationship, fostering the child's cognitive and social-emotional development and improving parent mental health.
• A Care Coordinator facilitates connections to broad community-based services and supports for all family members with the aim of achieving family stabilization, decreased parental stress, and improved executive functioning.

Early Start is a home visitation program that originated in New Zealand. It focuses on providing tamariki (children) in whānau (families) facing multiple disadvantages with supports and practical assistance.

The key features of the program are:

• Families are enrolled when their child is under one year, and ideally during the antenatal period. The primary focus is the child, providing family support and education to ‘nurture the baby early’ and encourage improvements in lifelong experiences.
• Families receive a comprehensive program which is provided by trained Family Support Workers with qualifications in Nursing, Social Work, Education, Early Childhood Education, or an allied profession.
• The service consists of a modular program of home visiting which may last up to five years.
• The frequency of home visiting varies according to family need and ranges from Level 1 home visiting (weekly) to Level 4 home visiting (one visit every four months).
• The aims of the program are to address a range of issues relating to the well-being of the enrolled child and their family.

SafeCare® is an in-home parent training program that targets risk factors for child neglect and physical abuse in which parents are taught skills in three module areas: (1) how to interact in a positive manner with their children, to plan activities, and respond appropriately to challenging child behaviors, (2) to recognize hazards in the home in order to improve the home environment, and (3) to recognize and respond to symptoms of illness and injury, in addition to keeping good health records. All three modules should be used in the implementation of SafeCare®; any modifications to or elimination of modules need to be discussed with the program developers.

Building Healthy Children (BHC) is designed to provide concrete support and manualized interventions to young families at heightened risk for maladaptive parenting practices, child maltreatment, and poor developmental outcomes. BHC is designed to be a preventive intervention that addresses enhanced risks of young and socioeconomically disadvantaged parents and their children. Three intervention models (Interpersonal Psychotherapy for Depressed Adolescents [IPT-A], Child-Parent Psychotherapy [CPP], and Parents as Teachers [PAT]) were incorporated into BHC to address additional risk factors associated with child maltreatment, poor parenting practices, and maladaptive outcomes in children. These risk factors include:

• Parent–child insecure attachment
• Parental insensitivity
• Parental trauma history
• Child trauma history
• Maternal depression and low social support
• Limited knowledge of appropriate developmental expectations.

Exchange Parent Aide program consists of trained, professionally supervised individuals (volunteer or paid) who provide supportive and educational in-home services to families at risk of child abuse and neglect. Agencies elect to use paid and/or volunteer Parent Aides to provide services based on their community needs and resources. Services are strength-based and family-centered. Auxiliary services enhance service delivery (e.g., group-based parenting classes). Model components include:

• An Initial Needs Assessment (INA) describing family dynamics, patterns of coping, abuse histories, and immediate needs
• A family treatment plan focusing on the program’s four goal areas:
• Child safety
• Problem solving skills
• Parenting skills
• Social support
• Matching families with a professionally trained and supervised Parent Aide who provides weekly home visits.

Programs select parenting curricula based on the needs of the families with a priority on using curricula with an evidence-base, when available. An extensive accreditation process is required of Exchange Parent Aide programs.

Parents as Teachers™ is a home visiting model that promotes the optimal early development, learning, and health of children by supporting and engaging their parents and caregivers. The home visiting model can be offered prenatally through kindergarten and can be replicated by various types of organizations including health departments, nonprofit organizations, hospitals, and school districts.

The Parents as Teachers model offers a cohesive package of services for families with young children and is framed around four dynamic components: Personal Visits, Group Connections, Child Screenings, and Resource Network. These components are guided by explicit fidelity and quality standards that guide program service delivery and replication of the program.

Parents as Teachers home visiting professionals meet families where they are comfortable; each personal visit includes a focus on parent-child interaction, development-centered parenting, and family well-being.