Program

Sep 08, 2009

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(S) 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.

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;
Depression/Mood Disorders; Other Mental Health

Program information last updated 9/8/09