Impact of a Child Abuse Primary Prevention Strategy for New Mothers
First Steps (FS) is a brief obstetrics-based primary prevention strategy that aims to strengthen protective factors to prevent child maltreatment. This randomized controlled trial assessed how well FS services aligned with family interests and needs, how FS providers used communication strategies to build partnership with mothers, and the impact of FS on mothers’ parenting knowledge in core content areas and access to services. Mothers completed a baseline survey and were randomly assigned to FS and control conditions (n = 374 and 375, respectively). The parenting education services provided to mothers were assessed by independent participant report immediately postintervention for the full FS group and by analysis of audio-recordings of the FS encounter for a subsample (n = 150). Outcomes were measured at 4 months via maternal survey. Compared to controls at follow-up, FS mothers had significantly higher knowledge scores in some areas but similar access to needed services. Few mothers lacked access to most services at baseline, and FS content was similar to that provided by other hospital personnel. FS providers’ communication style promoted rapport, but providers did not tailor content to mothers’ educational and service access needs. Implications of the findings for similar services are discussed.
KeywordsProtective factors Primary prevention of child maltreatment Universal parenting support program
This study is the product of strong partnerships with leaders of Prevent Child Abuse Georgia, the Georgia Governor’s Office for Children and Families, the Center for Family Research at the University of Georgia, and First Steps local sites statewide. Special thanks go to Carole Steele, Marcia Wessels, Anita Brown, and Lynda Brown.
Conflict of Interest
The authors declare that they have no conflict of interest.
This study was funded by Grant 90CA1784 from the Office of Child Abuse and Neglect, Children’s Bureau, Administration for Children and Families, Department of Health and Human Services.
Compliance with Ethical Standards
All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study methods were approved by the institutional review boards of the Johns Hopkins University and participating hospitals prior to implementing the study. We secured written informed consent from all First Steps mothers and providers.
- Bidmead, C., & Cowley, S. (2005). Evaluating family partnership training in health visitor practice. Community Practice, 78, 239–245.Google Scholar
- Center for the Study on Social Policy. (2003). Protective factors literature review: Early care and education programs and the prevention of child abuse and neglect. Retrieved from Center for the Study on Social Policy website: http://www.cssp.org/reform/strengtheningfamilies/resources/body/LiteratureReview.pdf. Accessed June 2018.
- Cluxton-Keller, F., Burrell, L., Crowne, S., McFarlane, E., Tandon, S. D., Leaf, P. J., & Duggan, A. (2014). Maternal relationship insecurity and depressive symptoms as moderators of home visiting impacts on child outcomes. Journal of Child and Family Studies, 23, 1430–1443.CrossRefPubMedGoogle Scholar
- Duggan, A. K., Berlin, L. D., Cassidy, J., Burrell, L., & Tandon, S. D. (2009). Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. Journal of Consulting and Clinical Psychology, 77, 788–799.CrossRefPubMedPubMedCentralGoogle Scholar
- First Steps (2015). Retrieved from https://www.greatstartgeorgia.org/home-visiting-resource-center/first-steps. Accessed June 2018.
- Georgia Department of Public Health, Maternal and Child Health Section, Office of Family and Community Health, Perinatal Health Unit. (2013) Core requirements and recommended guidelines for designated regional perinatal centers. Retrieved from http://dph.georgia.gov/sites/dph.georgia.gov/files/MCH/Core_Requirements_and_Guidelines._5.16.13_revised.pdf. Accessed June 2018.
- Home Visiting Research Network. (2013) National Home Visiting Research Agenda.). Retrieved from http://www.hvresearch.org/precision-home-visiting/research-agenda/. Accessed June 2018.
- MacPhee, D. (1981). Manual for the knowledge of infant development inventory (Unpublished manuscript). Wilmington: University of North Carolina.Google Scholar
- McFarlane, E., Crowne, S. S., Burrell, L., & Duggan, A. (2014). Home visiting service delivery and outcomes for depressed mothers. Zero to Three, 34, 53–60.Google Scholar
- Protective Factors Survey. (2004). Retrieved from http://friendsnrc.org/protective-factors-survey. Accessed June 2018.
- Repucci, N., Britner, P., & Woolard, J. (Eds.). (1997). Preventing abuse and neglect through parent education. Baltimore: Paul Brookes Publishing.Google Scholar
- Roter, D. (1993). The Roter method of interaction process analysis. Baltimore: Johns Hopkins University.Google Scholar
- U.S. Department of Health and Human Services, Administration for Children and Families, Children’sBureau. (2011). Child Maltreatment. Retrieved from http://www.acf.hhs.gov/cb/research-datatechnology/statistics-research/child-maltreatment. Accessed June 2018.
- U.S. Department of Health and Human Services, Administration for Children and Families, Children'sBureau, Office on Child Abuse and Neglect. (2003). Emerging practices in the prevention of child abuse and neglect. Retrieved from http://www.childwelfare.gov/pubPDFs/emerging_practices_report.pdf. Accessed June 2018.