Impact of a statewide home visiting program on parenting and on child health and development

OBJECTIVES: To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors. METHODS: This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to HFAK and control groups, interviewed mothers at baseline, and followed families until children were 2 years old (85% follow-up). Child outcomes included health care use, development and behavior. Parent outcomes included knowledge of infant development, parenting attitudes, quality of the home environment, and parent-child interaction. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure knowledge, perceived effectiveness and perceived training adequacy. RESULTS: There was no overall impact on child health, but HFAK group children had more favorable developmental and behavioral outcomes. HFAK and control mothers had similar parenting outcomes except that HFAK mothers had greater parenting self-efficacy (35.1 vs. 34.6 based on the Teti Self-Efficacy Scale, p<.05). Fewer HFAK families had a poor home environment for learning (20% vs. 31%, p<.001). HFAK families were more likely to use center-based parenting services (48% vs. 39%, p<.05). The impact was greater for families with lower baseline risk (Family Stress Checklist scores<45). There was little evidence of efficacy for families with a higher dose of service. CONCLUSIONS: The program promoted child development and reduced problem behaviors at 2 years. Impact could be strengthened by improving home visitor effectiveness in promoting effective parenting. Future research is needed to determine whether short-term benefits are sustained.     

Parents’ PTSD symptoms and child abuse potential during the perinatal period: Direct associations and mediation via relationship conflict

BackgroundPosttraumatic stress disorder (PTSD) symptoms are associated with parental aggression towards children, but little is known about the relation between parents’ PTSD symptoms and their risk for perpetrating child physical abuse during the early parenting years, when the potential for prevention of abuse may be highest.ObjectiveTo examine direct associations between mothers’ and fathers’ PTSD symptoms and child abuse potential, as well as indirect effects through couple relationship adjustment (i.e., conflict and love) in a high-risk sample of parents during the perinatal period, most of whom were first-time parents.Participants and settingFrom March 2013 to August 2016, data were collected from 150 expecting or new parental dyads in which the mother was participating in a home visiting program.MethodsData were analyzed using the Actor-Partner Interdependence Mediation Model.ResultsFor mothers and fathers, there were direct associations between PTSD symptom severity and child abuse potential (βs = .51, ps <.001), and this association for fathers was stronger at higher levels of mothers’ PTSD symptoms (β = .15, p = .03). In addition, parents’ own and their partners’ PTSD symptoms were each indirectly associated with parents’ own child abuse potential through parents’ report of interparental conflict (standardized indirect effects = .052–.069, ps = .004) but not love.ConclusionsAddressing parents’ PTSD symptoms and relationship conflict during the perinatal period using both systemic and developmental perspectives may uniquely serve to decrease the risk of child physical abuse and its myriad adverse consequences.     

Healthy Families New York (HFNY) randomized trial: effects on early child abuse and neglect

OBJECTIVE: To evaluate the effects of a home visiting program modeled after Healthy Families America on parenting behaviors in the first 2 years of life. METHODS: A sample of 1173 families at risk for child abuse and neglect who met the criteria for Healthy Families New York (HFNY) was randomly assigned to either an intervention group that was offered HFNY or a control group that was given information and referrals to other services. Data were collected through a review of CPS records, and maternal interviews at baseline and the child's first birthday (90% re-interviewed) and second birthday (85% re-interviewed). RESULTS: HFNY mothers reported committing one-quarter as many acts of serious abuse at age 2 as control mothers (.01 versus .04, p<.05). Two sets of interactions were tested and found to have significant effects (p<.05). At age 2, young, first-time mothers in the HFNY group who were randomly assigned at 30 weeks of pregnancy or less were less likely than counterparts in the control group to engage in minor physical aggression in the past year (51% versus 70%) and harsh parenting in the past week (41% versus 62%). Among women who were "psychologically vulnerable," HFNY mothers were one-quarter as likely to report engaging in serious abuse and neglect as control mothers (5% versus 19%) at age 2. CONCLUSIONS: These findings suggest that who is offered home visitation may be an important factor in explaining the differential effectiveness of home visitation programs. Improved effects may be realized by prioritizing the populations served or by enhancing the model to meet program objectives for hard-to-serve families.     

Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect

OBJECTIVES: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. METHODS: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records. RESULTS: HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency. CONCLUSIONS: The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.     

Child welfare services involvement among the children of young parents in foster care

Despite the high rate of early parenthood among youth in foster care as well as the increased risk of child maltreatment among children whose adolescent parents have been neglected or abused, very little is known about child welfare services involvement among children whose parents were in foster care when they were born. This study uses administrative data from the Illinois Department of Children and Family Services (DCFS) to examine the occurrence of child abuse and neglect investigations, indicated reports and out of home care placements among the children of youth in foster. Thirty-nine percent of the children were the subject of at least one CPS investigation, 17 percent had at least one indicated report and 11 percent were placed in out of home care at least once before their 5th birthday. Cox proportional hazard models are also estimated to identify characteristics of parenting foster youth and their placement histories associated with the risk of child welfare services involvement. Implications of the findings for policy and practice are discussed.     

Links between parenting styles,parent–child academic interaction,parent–school interaction,and early academic skills and social behaviors in young children of English-speaking Caribbean immigrants

This study examined the influence of parenting styles, parent–child academic involvement at home, and parent–school contact on academic skills and social behaviors among kindergarten-age children of Caribbean immigrants. Seventy immigrant mothers and fathers participated in the study. Hierarchical regression analyses revealed that fathers’ authoritarian parenting style was negatively associated with and father–school contact was positively associated with receptive skills, vocabulary, and composite scores over and above that of mothers’ contributions in these areas. Fathers’ authoritative parenting style and father–child academic interaction at home were positively related to children's social behaviors. Mothers’ authoritarian parenting style was negatively and mother–school contact was positively associated with children's social behaviors. Analyses indicated that fathers’ parenting carried the weight of influence over mothers’ parenting for facilitating both child academic skills and social behaviors. The roles of parenting styles, parent–academic activities, and parent–school contacts in early schooling are discussed.     

Paternity establishment at birth and early maltreatment: Risk and protective effects by maternal race and ethnicity

BackgroundMinority race/ethnicity, low socioeconomic status, and lack of established paternity have been identified in previous research as risk factors for child maltreatment. However, given vastly different patterns of income distribution, single parenting and co-parenting across racial and ethnic populations, it is difficult to know which of these factors contribute most to maltreatment risk.ObjectiveThe current study explores whether the odds of maltreatment differ across race/ethnicity when paternity is not established at birth after controlling for maternal socioeconomic status.MethodsUsing merged birth certificate and child protective services records for children born between 2009 and 2011 in Texas (N = 1,175,804), we conducted multiple logistic regression analyses testing the main effects of maternal race and lack of established paternity, as well as the interaction of the two, on substantiated maltreatment.ResultsResults show that children of black mothers were less likely to have established paternity and more likely to experience maltreatment compared with other groups. However, the odds of maltreatment were lower for children of black mothers without established paternity compared to children of white mothers without established paternity (OR = .71, 95% CI [0.67,0.75]). Alternatively, the odds of maltreatment were higher when paternity was not established at birth for Hispanic mothers (OR = 1.13, 95% CI [1.08,1.18]) and mothers of other race/ethnicities (OR = 1.35, 95% CI [1.11,1.65]) compared to white mothers.ConclusionResearch and prevention programming must consider that the processes and pathways linking paternity establishment and maltreatment may differ within and between racial/ethnic groups.     

Impact of a statewide home visiting program to prevent child abuse

OBJECTIVES: To assess the impact of a voluntary, paraprofessional home visiting program in preventing child maltreatment and reducing the multiple, malleable psychosocial risks for maltreatment for which families had been targeted. METHODS: This collaborative, experimental study focused on 6 Healthy Families Alaska (HFAK) programs; 325 families were enrolled in 2000-2001, randomized to intervention and control groups, and interviewed to measure baseline attributes. Follow-up data were collected when children were 2 years old (85% follow-up rate). Outcomes included maltreatment reports, measures of potential maltreatment and parental risks, for example, poor mental health, substance use, and partner violence. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure perceived effectiveness and training adequacy. RESULTS: Parental risks were common at baseline, and one-sixth of families had a substantiated child protective services report in the child's first 2 years of life. There was no overall program effect on maltreatment reports, and most measures of potential maltreatment. Home visited mothers reported using mild forms of physical discipline less often than control mothers. The groups were similar in their use of more severe forms of physical discipline. There was no program impact on parental risks. There was no impact on outcomes for families with a 'high dose' of home visiting. Home visitors often failed to address parental risks and seldom linked families with community resources. Contradictions in the model compromised effectiveness. CONCLUSIONS: The program did not prevent child maltreatment, nor reduce the parental risks that had made families eligible for service. Research is needed to develop and test strategies to improve the effectiveness of home visiting.     

Defining reasonable force: Does it advance child protection?

Fifty-two countries have abolished all physical punishment of children, yet Canada has retained its criminal defense to ‘reasonable' corrective force. In 2004, Canada's Supreme Court attempted to set limits on punitive acts that can be considered reasonable under the law. In the present study, we examined the validity of these limits. If the court's limits provide adequate protection to children, most substantiated child maltreatment cases should exceed those limits. We operationalized each limit and applied it to a provincially representative sample of substantiated child physical maltreatment cases. We found that the majority of substantiated physical abuse cases fell within each of the court's limits. In more than one in four substantiated physical abuse cases, not even one of the court's limits was exceeded. The best predictor of whether a report was substantiated was whether spanking was typical in the child's home. The findings suggest that abolition of physical punishment would provide greater protection to children than attempts to set limits on its use.     

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

BackgroundChildren exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers’ perceptions of what helps their children cope throughout this experience.ObjectiveThe aim of the study was to explore mothers’ perceptions of their children’s resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience.MethodsIn depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience.ResultsWomen discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children’s resilience. Mothers also spoke about the ways they tried to reduce their child’s direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress.ConclusionsThis study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.     

The Value of New Parent Groups in Child and Family Health Nursing

A reorganization of child and family health nursing services followed policy changes in New South Wales, Australia, in the late 1990s. However, the introduction of universal and sustained home visiting to all new parents limited resources available to provide support groups for new parents. This qualitative research study used a case study approach to examine the impact of new parents'' group attendance on mothers and on mothers'' interactions with their baby. Key findings demonstrated that attendance at a group created an opportunity, the overarching theme, for both the mothers and infants. New Parent groups appear to be as important as other modes of nursing service delivery to children and parents and serve a different purpose to center-based or home visits.     

A Person-Centered Approach to Child Temperament and Parenting

The aim of this study was to examine how variations in children's temperamental reactivity and mothers’ parenting stress relate to parenting behavior. A sample of 3,001 mother–child dyads was assessed when children were 14, 24, 36, and 54 months. Latent profile analysis identified a group of temperamentally “easy” children whose mothers experienced little parenting stress, along with two groups of highly reactive children differentiated by mothers’ stress levels. Maternal negative regard over time was highest in the group of reactive children with highly stressed mothers. Mothers in this group also perceived more child behavior problems and had less knowledge of child development. Results are discussed relative to Person × Environment interactions and the complex interplay between parent and child characteristics.     

Mother's age at arrival in the United States and early cognitive development

This paper focuses on the cognitive development of young children from diverse backgrounds with a particular focus on ethnic and nativity differences in home environments. Hypotheses are developed addressing the extent to which home environment and parenting practices mediate the relationship between mother's age at arrival and cognitive development in early childhood. Data from the first two waves of the Early Childhood Longitudinal Study-Birth cohort are employed. Children whose mothers arrived in the United States at the youngest ages (0–7 years) have similar cognitive scores to children whose mothers are born in the United States once socioeconomic status and family background are considered. Multivariate analyses indicate parenting practices and home environment are associated with cognitive development and act as partial mediators between cognitive scores and mother's age at arrival. Overall, the results highlight the need to consider parental migration experiences and differences in the home environments of children of immigrants in the United States as sources of variation in outcomes for the second-generation.     

Mothers’ self-reported violence toward their children: A multifaceted risk analysis

The universal aim of decreasing parental violence against children requires the detection of risk factors associated with violent behavior among parents. Although research has identified a number of such risk factors, these findings are scattered and a comprehensive picture is lacking. In the present study, 20 child-, parent- and family-related factors have been included in a combined analysis to assess which of these may pose as risk factors for mothers’ severe violent behavior toward their children. The study is based on a representative sample of 2,716 Finnish mothers with 0–12-year-old children and was conducted as an anonymous survey. Analyses were carried out using logistic regression models. 6% of the mothers had committed severe violent acts, i.e. slapped, hit, punched (with a fist), kicked, bit, hit/try to hit the child with an object or shook (under 2 year old) child at least once during the 12 months preceding the survey. Corporal punishment experienced by the mother as a child (OR 2.45, CI 1.55–3.88) or used by the mother as a method of discipline (OR 11.14, CI 5.95–20.87), strongly increased the likelihood of severe violent acts. Additionally, work- or family-related stress (OR 1.83, CI 1.24–2.73) and lack of help in dealing with parenting problems (OR 2.55, CI 1.66–3.90) were detected as risk factors for severe violent acts toward one's own child. The findings suggest that prevention of corporal punishment may be an important hinder to the transmission of experiences of violence from one generation to another, and that contextual and situational factors may overlap the influence of individual-related risk factors.     

Understanding Associations Between Low-Income Mothers' Participation in Education and Parenting

Maternal education is one of the strongest predictors of children's academic outcomes. One possible explanation for this is that more highly educated mothers more frequently engage in parenting practices that may promote children's later cognitive development; however, most of this evidence is correlational. This study uses Head Start Impact Study data (N = 1,953) to explore whether low-income mothers' participation in education affects their parenting practices and beliefs. Principal scores, which predict maternal educational participation based on covariates, were used for analysis. Principal score matching was used to identify mothers who we predicted participated in education because their children were randomly assigned to Head Start. We compared these mothers' outcomes to those of mothers we predicted would have participated in education if they were assigned to Head Start. For these mothers, participation in maternal education was associated with children watching fewer hours of TV, having more types of printed media at home, and more frequent participation in cultural activities, but it was not associated with a host of other parenting outcomes. Changing parenting is one potential pathway by which maternal educational participation may influence children's later academic outcomes.     

Home visiting intervention for vulnerable families with newborns: follow-up results of a randomized controlled trial

OBJECTIVE: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child's environment that predict poor adjustment to the parenting role. METHOD: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. RESULTS: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. CONCLUSIONS: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, thestudy not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period. and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.     

County-level socioeconomic and crime risk factors for substantiated child abuse and neglect

Rates of substantiated child abuse and neglect vary significantly across counties. Despite strong cross-sectional support for links between social-contextual characteristics and abuse and neglect, few longitudinal studies have tested relations between these risk factors and substantiated rates of abuse/neglect. The goal of this study was to identify county-level socioeconomic and crime factors associated with substantiated abuse/neglect rates over 13 years (2004–2016). Annual county-level data for Tennessee, obtained from the KIDS COUNT Data Center, included rates of substantiated child abuse and neglect, children’s race and ethnicity, births to unmarried women, teen birth rate, children in families receiving Supplemental Nutrition Assistance Program (SNAP) benefits, and children in families receiving Temporary Assistance for Needy Families. Annual county-level crime report data, obtained from the Tennessee Incident Based Reporting System, included sexual offenses, non-sexual assaults, stalking incidents, thefts, property damage, and drug-related offenses. Bayesian spatio-temporal models indicated that substantiated child abuse and neglect rates were independently and positively associated with teen birth rates, percentages of births to unmarried mothers, drug-related offenses, and percentages of children receiving SNAP benefits. In contrast, substantiated child abuse and neglect rates were negatively associated with percentages of African-American youth. The findings highlighted distinct demographic, socioeconomic, and crime factors associated with substantiated child abuse and neglect rates and have the potential to enhance identification of high-risk counties that could benefit from targeted abuse and neglect prevention efforts.     

Caregiving Practices of Low-Income Adolescent Mothers and the Academic Competence of Their First-Grade Children

Objective. This study examines the relation between the caregiving practices of teenage mothers and the academic performances of their children in first grade. Design. The teenage mothers were involved in a family support program, and data were collected on the sample for 7 years (the prenatal period through first grade). The sample included 89 children who participated in the first-grade follow-up and who resided with their biological mothers. Children's school performance was assessed with an achievement test in the fall semester of first grade and with teachers' ratings of academic performance at the end of the spring semester. Caregiving practices were assessed by both the research team and the family advocates who worked with the young mothers during the 5-year family support program; mothers also reported on home support for academic achievement during the first-grade interview. Results. Measures of home environment, advocates' ratings of parenting, and mothers' self-report of support for achievement were positively correlated with children's achievement in first grade. Conclusions. Results from multiple regression analyses were consistent with the view that differences in parenting prior to school entry and in maternal support for achievement once the child enters school are predictive of individual differences in first-grade achievement among children born to low-income adolescent mothers.     

A randomized controlled trial of an intervention program to Brazilian mothers who use corporal punishment

This study evaluated a positive parenting program to Brazilian mothers who used corporal punishment with their children. The intervention was conducted in four agencies serving vulnerable children, and at a home replica laboratory at the University. Mothers who admitted using corporal punishment were randomly assigned between experimental (n = 20) and control group (n = 20). The program consisted of 12 individual sessions using one unit from Projeto Parceria (Partnership Project), with specific guidelines and materials on positive parenting, followed by observational sessions of mother-child interaction with live coaching and a video feedback session in the lab. The study used an equivalent group experimental design with pre/post-test and follow-up, in randomized controlled trials. Measures involved: Initial Interview; Strengths and Difficulties Questionnaire (SDQ) – parent and child versions; Beck Depression Inventory (BDI); observational sessions with a protocol; and a Program Evaluation by participants. Analysis of mixed models for repeated measures revealed significant positive effects on the BDI and SDQ total scores, as well as less Conduct problems and Hyperactivity in SDQ measures from the experimental group mothers, comparing pre with post-test. Observational data also indicated significant improvement in positive interaction from the experimental group mothers at post-test, in comparison with controls. No significant results were found, however, in children’s observational measures. Limitations of the study involved using a restricted sample, among others. Implications for future research are suggested.