Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients

Abstract

Perinatal maternal depression (MD), substance use (SU), and intimate partner violence (IPV) are critical public health concerns with significant negative impacts on child development. Bolstering the capacity of home visiting (HV) programs to address these significant risk factors has potential to improve child and family outcomes. This study presents a description and mixed-methods feasibility evaluation of the “Home Visitation Enhancing Linkages Project (HELP),” a screen-and-refer approach to addressing MD, SU, and IPV within HV aimed at improving risk identification and linkage to treatment among HV clients. HELP was a three-phase intervention that included three evidence-based interventions: screening, motivational interviewing (MI), and case management (CM). This study presents quantitative fidelity data from 21 home visitors reporting on 116 clients in 4 HV programs, as well as qualitative data from structured interviews with 14 home visitors. Nearly all clients were screened and 22% screened positive on at least one risk domain. Rates of MI and CM implementation were lower than expected, however home visitors implemented general supportive interventions at high rates. Home visitor interviews revealed the following factors that may have impacted HELP implementation: client disclosure of risk, barriers to treatment access, systems integration, home visitor role perception, and integration of HELP into the broader HV curriculum. Implications of study findings for the design of future attempts to address maternal risk within HV are discussed.

Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network

“…A growing body of research highlights the importance of integrating into HV programs those interventions that are efficacious in both treating [35][36][37] and preventing [38,39] postpartum depression. Building on work conducted in other early childhood settings [40], HV programs have employed mental health consultants to build the capacity of home visitors to support the mental health needs of perinatal women and their children [41,42] and to promote practices that enhance depression screening and referral [43].…”

Motivational Interviewing in Child Welfare Services: A Systematic Review

“…First, as Shah et al provided the first review of MI in CW, they reasonably utilized an inclusive approach to study selection. Some studies in their review included only a small portion of families in CW—for example, only 20% of the sample were CW-involved in Dauber et al (2017). Additionally, some studies included in Shah et al (2018) focused on prevention of maltreatment and excluded families currently involved with CW services (e.g., Silovsky et al, 2011).…”

A Promising Approach in Home Visiting to Support Families Affected by Maternal Substance Use

“…Home-based family support programs are a key intervention to promote positive parenting and attachment, prevent child maltreatment, and facilitate linkage to community resources for high-risk families (Azzi-Lessing 2013 ). Home visiting models typically target pregnant and postpartum women with risk factors known to disrupt the parent–child relationship, such as history of trauma; intimate partner violence; mental health issues, including maternal depression; low academic achievement, often leading to low income; and a limited support network (Ammerman et al 2015 ; Dauber et al 2017a , b ). Maternal substance use is another known risk factor for child maltreatment and may be a comorbidity among at-risk populations (Connelly et al 2013 ; Dauber et al 2017a , b ; Michalopoulos et al 2015 ).…”

“…Few home visiting models, however, are equipped to address the complex needs of families affected by maternal substance use. Substance use among families receiving home visiting services has been associated with reduced program engagement and diminished outcomes (Azzi-Lessing 2013 ; Dauber et al 2017a , b ; Green et al 2018 ). Many home visiting programs do not conduct systematic data collection related to substance use indicators, and few focus on substance use-related outcomes.…”

“…Research findings indicate that even when maternal substance use is identified, home visitors report feeling ill-prepared to effectively respond to the needs of these mothers and their infants (S. Dauber et al 2017a , b ; Schreier et al 2018 ; Tandon et al 2008 ). Home visitors in these studies indicate a need for specialized training to address issues related to alcohol and other drug use (Schreier et al 2018 ; Tandon et al 2008 ).…”