• Dec 2010/Jan 2011
  • Vol. 11, No. 10

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Evidence-Based Home Visitation in Rochester

Evidence-based home visitation (EBHV) has become an increasingly important model of improving families' outcomes in numerous areas, including child maltreatment, school readiness, self-sufficiency, and overall health. In 2008, the Children's Bureau awarded 17 cooperative agreements to implement EBHV programs. The Society for the Protection and Care of Children (SPCC), in Rochester, NY, received an award to study an integrated approach to EBHV that combines home-visiting programs with other services.

SPCC, in partnership with Mt. Hope Family Center, the University of Rochester Medical Center Social Work and Pediatrics Departments, the Monroe County Departments of Human Services and Public Health, and the United Way, is just beginning its program to serve low-income, young mothers through two home-visiting programs: Nurse-Family Partnership (NFP) and Parents as Teachers (PAT). Pregnant teens eligible for NFP services will be encouraged to enroll in that program, and, based on the needs identified by experienced NFP nurses, they will also receive the following additional services: 

  • Child Parent Psychotherapy (CPP) to address parent-child attachment
  • Interpersonal Psychotherapy (IPT) to address maternal depression
  • Incredible Years for group-based parent education

To determine if receiving the additional services has a significant impact, the project will compare outcomes for NFP participants receiving additional supports to previous NFP participants who did not have access to these additional services. (The project is awaiting approval from its institutional review board, the NFP National Service Office, and the Children's Bureau before enrolling families into the NFP component of the project.)

Families not meeting the eligibility criteria for NFP will receive PAT home visitation, which is provided by social workers. For families receiving PAT home visitation, the project will evaluate the impact of receiving the additional CPP, IPT, and Incredible Years services in conjunction with the home visitation. Currently, a pediatric social worker randomly assigns these families into a treatment group that receives PAT services paired, when needed, with the additional services, or a comparison group that receives referrals to other community-based services. PAT services may also be made available to mothers who graduate from the NFP program and are in need of aftercare services.

Another project goal is to establish a comprehensive, coordinated infrastructure in the community that supports EBHV. A critical aspect of this has been helping professionals from different backgrounds and disciplines, such as social workers, nurses, therapists, medical professionals, outreach workers, and local funders, to understand and value each partner's expertise within the project and to incorporate that knowledge into their practice. Laurie Valentine, the project director, noted, "Reaching that level of understanding was a noteworthy accomplishment in and of itself."

Project staff are working closely with the medical community, especially pediatricians and obstetricians, to improve their awareness of EBHV, the range of services available, how to refer families, the best methods for sharing information on enrolled families, and strategies for integrating preventive health care with EBHV. The project based a social worker at the University of Rochester's Strong Pediatric Clinic, which has the largest pediatric practice in Monroe County, to review medical records, conduct assessments, make referrals, and document family participation. Additionally, when project staff realized that there was a shortage of community mental health services that effectively engaged the target population, Mt. Hope Family Center modified the CPP and IPT approaches to become more teen-friendly. Since the modifications, teen parents with mental health concerns are more likely to engage in and follow through with evidence-based mental health treatment. 

The project's services and systems work have yielded promising results thus far, enrolling 303 families in the PAT branch, with 170 families in the treatment group. The mothers receiving enhanced services have made significant progress toward educational and career goals (e.g., enrolling in or completing high school or GED programs and obtaining employment) and have demonstrated reductions in parenting stress and depression as well as increases in parenting knowledge.

For more information about the project, contact Laurie Valentine at lvalentine@spcc-roch.org.

Many thanks to Laurie Valentine of SPCC for providing the information for this article.
 

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