Home Visitation Trial for Urban Women
overview
The Home Visitation Trial for Urban Women is designed to give women skills they need to care for their children and to find the assistance they need. Women at risk of losing their newborns to out-of-home placement are assigned a peer home-visitor, a social worker, and a nurse.
In this evaluation, women were randomly assigned to the intervention or to receive regular facility-based services. The program has been found to have an impact on the satisfaction of the mothers with certain services, but not that the program helps women regain custody of their children. Many findings that were nonsignificant. There were no differences in psychological distress or self-esteem. The experimental group increased in social support more sharply than the control group but the significance was not reported and the impact did not last to 16 months. An observational survey of the home environment showed that women in the control group tended to be more organized than women in the experimental group.
description of program
Target Population: Women at risk of out-of-home placement of their newborns.
If women had a history of substance abuse, homelessness, domestic violence, psychiatric illness, incarceration, HIV infection, or lack of social support, they were considered at risk for child placement.
The program follows a home-visitation model set out in a separate study, but adds on to this prior model. This program has a nurse, a social worker, and a peer home-visitor as opposed to a nurse home-visitor alone. The three service providers assisted women in gaining the skills to seek and to sign up for assistance that would help them adequately care for their children. The home visitors accompanied women to appointments, helped them complete forms, and advocated for them at the welfare office. Home visitors received a month of training on nutrition, family violence, substance abuse, and child development. Social workers identified and managed service needs, provided individual and family counseling, and held group meetings about issues such as parenting, child development, and relationships with partners. Nurses helped coordinate health care services, assessed developmental progress of children, implemented health education activities, and addressed family planning issues
Home visitors go with the mothers to appointments, help them fill out forms, and advocate for them at the welfare office. Social workers manage service needs, provide counseling, and hold group meetings on various topics. Nurses coordinate health care services, assess needs of children, implement health education activities, and address family planning issues.
The control group received regular facility-based services of their outpatient obstetrics and gynecology clinic. Available to them was comprehensive prenatal, postpartum, family planning, and gynecological services, on-site anonymous HIV testing, and social services. The experimental group had these same services; however, their social services were provided through the treatment condition.
evaluation of program
Marcenko, M. O., M. Spence, et al. (1996). Outcomes of a Home Visitation Trial for Pregnant and Postpartum Women At-Risk for Child Placement. Children and Youth Services Review 18(3), 243-259.
Evaluated Population: Nearly all of the women were African American in their early twenties, though ages ranged from 14-42. On average, the mothers were not high school graduates and most received public benefits.
Approach:
Women at risk for out-of-home placement of their newborns were identified at their first or second prenatal care visit and were randomly assigned to either the control or treatment group after the baseline interview was conducted. If women had a history of substance abuse, homelessness, domestic violence, psychiatric illness, incarceration, HIV infection, or lack of social support, they were considered at risk for child placement.
The authors measured out-of-home placement, home environment, help accessing services, service satisfaction, social support, and psychological measures. Child out-of-home placement included placement through CPS and informal family arrangements. Women were also asked whether any children had returned to live with them in the previous six months. Home environment was measured by The Home Observation for Measurement of the Environment (HOME) Inventory. The scale measures the appropriateness of the mother’s interaction with the child and the stimulation available to the child in the environment. Service use and satisfaction included 11 questions about how satisfied they were with agency help and a question asking how satisfied they were with the experimental services (the home visitor, social worker, and nurse) or control services (the regular services through the outpatient obstetrics and gynecology clinic, but without the home visitor, social worker, or nurse). Social support was measured with the Norbeck Social Support Questionnaire (NASSQ). The respondent lists significant people, length of association, availability, and the degree to which each person provides positive affect, affirmation, and aid.
Psychological functioning was measured by the Brief Symptom Inventory (BSI). It is meant to give an overall measure of the level of psychological distress the respondents have experienced in the last seven days, as well as somatization, obsessive-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.
Self-esteem was measured with the Rosenberg Self-Esteem Scale. It has ten items measuring self-worth, self-respect, and expectations of self-improvement.
Results: At 10 months, child placement was higher in the experimental group; but this was not statistically significant and was not found at 16 months.
Only one subscale of the HOME showed a significant difference between the treatment and control groups; women in the control group scored significantly higher on organization of environment than women in the treatment group.
For help accessing services, 78% of women in the experimental group and 62% of women in the control group indicated they were very satisfied with services. The experimental group was significantly more satisfied with help accessing transportation, support groups and parenting classes, and help with finding baby furniture and toys than women in the control group.
There were no significant differences between the treatment and control groups for either social support, self-esteem, or measures of psychological distress.
sources for more information
References
Marcenko, M. O., M. Spence, et al. (1996). "Outcomes of a Home Visitation Trial for Pregnant and Postpartum Women At-Risk for Child Placement." Children and Youth Services Review 18(3), 243-259.
Program Categorized in this guide according to the following:
Evaluated participant ages: Adolescents (12-17); Youth (16+); Young adults (18-24); Infants (0-12 months)
Program components: Child Care/Early Childhood Education; Clinic-based; Home Visiting; Mentoring/Tutoring
Measured outcomes: Out-of-home Placement; Mental Health; Social Support
KEYWORDS: Adolescents (12-17); Youth (16+); Young adults (18-24); Infants (0-12 months); Home-based; Clinic-based; Child Care; Child Maltreatment; Self Esteem; Black or African American; Hispanic or Latino; White or Caucasian; High-Risk; Urban; Anxiety Disorders/Symptoms; Phobia; Depression/Mood Disorders
Program information last updated 9/8/09
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© Child Trends 2003 |
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