Addressing Maternal Depression, Substance Use, and Intimate Partner Violence in Home Visiting: a Quasi-Experimental Pilot Test of a Screen-and-Refer Approach
This quasi-experimental pilot study describes preliminary impacts of the “Home Visitation Enhancing Linkages Project (HELP),” a pragmatic screen-and-refer approach for promoting identification of and linkage to treatment for maternal depression (MD), substance use (SU), and intimate partner violence (IPV) within early childhood home visiting. HELP includes screening for MD, SU, and IPV followed by a menu of motivational interviewing and case management interventions aimed at linking clients to treatment, designed for delivery within routine home visiting. HELP was piloted within four counties of a statewide home visiting system that were implementing Healthy Families America. HELP clients (N = 394) were compared to clients in five demographically matched counties that received usual Healthy Families services (N = 771) on whether their home visitors (1) identified MD, SU, and IPV risk; (2) discussed MD, SU, and IPV during home visits; and (3) made referrals for MD, SU, and IPV. All data were extracted from the program’s management information system. A significant impact of HELP was found on discussion of risk in home visits for all three risk domains with large effect sizes (MD OR = 4.08; SU OR = 15.94; IPV OR = 9.35). HELP had no impact on risk identification and minimal impact on referral. Findings provide preliminary support for HELP as a way of improving discussion of client behavioral health risks during home visits, an important first step toward better meeting these needs within home visiting. However, more intensive intervention is likely needed to impact risk identification and referral outcomes.
KeywordsHome visiting Maternal depression Substance use Intimate partner violence
Preparation of this article was supported by grant 1R01DA034108 from the National Institute on Drug Abuse. Additional Support was received from the New Jersey Department of Children and Families; the New Jersey Division of Family Development; and the New Jersey Department of Health. We gratefully acknowledge the home visitors and supervisors who generously devoted their time to participate in this study in the hopes of advancing the clinical science in their field.
Funding for this study was received from the National Institute on Drug Abuse (1R21DA034108). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. Additional support for this project was provided by the New Jersey Department of Children and Families, the New Jersey Department of Human Services: Division of Family Development, and the New Jersey Department of Health.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The study was approved by the institutional review board of The Center on Addiction. All procedures performed in studies involving human participants were in accordance with the ethical standards of The Center on Addiction and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study used administrative data collected by the Healthy Families New Jersey program. All program participants provide consent for their administrative data to be used for research purposes.
- Beasley, L., Ridings, L., Smith, T., Shields, J., Silovsky, J., Beasley, W., & Bard, D. (2018). A qualitative evaluation of engagement and attrition in a nurse home visiting program: From the participant and provider perspective. Prevention Science, 19, 528–537. https://doi.org/10.1007/s11121-017-0846-5.CrossRefPubMedGoogle Scholar
- Dauber, S., Ferayorni, F., Henderson, C., Hogue, A., Nugent, J., & Alcantara, J. (2017a). Substance use and depression in home visiting clients: Home visitor perspectives on addressing clients' needs. Journal of Community Psychology, 45, 396–412. https://doi.org/10.1002/jcop.21855.CrossRefPubMedPubMedCentralGoogle Scholar
- Dauber, S., John, T., Hogue, A., Nugent, J., & Hernandez, G. (2017b). Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients. Children and Youth Services Review, 81, 157–167.CrossRefGoogle Scholar
- Duggan, A., Fuddy, L., Burrell, L., Higman, S., McFarlane, E., Windham, A., & Sia, C. (2004). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse and Neglect, 28, 623–643. https://doi.org/10.1016/j.chiabu.2003.08.008.CrossRefPubMedGoogle Scholar
- Guo, S., & Fraser, M. (2010). Propensity score analysis: Statistical methods and applications. Los Angeles, CA: Sage.Google Scholar
- Health Resources and Services Administration. (2016). The Maternal infant and early childhood home visiting program: Partnering with parents to help children succeed. Washington, DC: HRSA.Google Scholar
- HRSA Maternal and Child Health. (2016). Federal home visiting program: Performance indicators and systems outcome measures-summary. Washington, DC: HRSA.Google Scholar
- Manz, P., Power, T., Roggman, L., Eisenberg, R., Gernhart, A., Faison, J., et al. (2017). Integrating the little talks intervention into early head start: An experimental examination of implementation supports involving fidelity monitoring and performance feedback. Children and Youth Services Review, 79, 87–96. https://doi.org/10.1016/j.childyouth.2017.05.034.CrossRefGoogle Scholar
- McFarlane, E., Burrell, L., Duggan, A., & Tandon, D. (2017). Outcomes of a randomized trial of a cognitive behavioral enhancement to address maternal distress in home visited mothers. Maternal and Child Health Journal, 21(3), 475–484. https://doi.org/10.1007/s10995-016-2125-7.CrossRefPubMedGoogle Scholar
- Michalopoulos, C., Lee, H., Duggan, A., Lundquist, E., Tso, A., Crowne, S., et al. (2015). The mother and infant home visiting program evaluation: Early findings on the Maternal, infant, and early childhood home visiting program. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.Google Scholar
- Michalopoulos, C., Faucetta, K., Hill, C., Portilla, X., Burrell, L., Lee, H., et al. (2019). Impacts on family outcomes of evidence-based early childhood home visiting: Results from the mother and infant home visiting program evaluation. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, US. DHHS.Google Scholar
- Muthen, L., & Muthen, B. (1998-2017). Mplus User's Guide (Seventh ed.). Los Angeles, CA: Muthen & Muthen.Google Scholar
- Sharps, P., Bullock, L., Campbell, J., Alhusen, J., Ghazarian, S., Bhandari, S., & Schminkey, D. (2016). Domestic violence enhanced perinatal home visits: The DOVE randomized clinical trial. Journal of Women's Health, 25(11), 1129–1138. https://doi.org/10.1089/jwh.2015.5547.CrossRefPubMedPubMedCentralGoogle Scholar
- Smith, P., Earp, J., & DeVellis, R. (1995). Measuring battering: Development of the women's experience with battering (WEB) scale. Women's Health: Research on Gender, Behavior, and Policy, 1(4), 273–288.Google Scholar
- Stata Corp. (2009). Stata 11.2. College Station, TX: Stata Corp LP.Google Scholar
- Tandon, S., Parillo, K., Jenkins, M., & Duggan, A. (2005). Formative evaluation of home visitors' role in addressing poor mental health, domestic violence, and substance abuse among low-income pregnant and parenting women. Maternal and Child Health Journal, 9(3), 273–283. https://doi.org/10.1007/S10995-005-0012-8.CrossRefPubMedGoogle Scholar
- Tandon, S., Leis, J., Ward, E., Snyder, H., Mendelson, T., Perry, D., et al. (2018a). Adaptation of an evidence-based postpartum depression intervention: Feasibility and acceptability of mothers and babies 1-on-1. BMC Pregnancy and Childbirth, 18, 93–102. https://doi.org/10.1186/s12884-018-1726-0.CrossRefGoogle Scholar
- Teti, D., Cole, P., Cabrera, N., Goodman, S., & McLoyd, V. (2017). Supporting parents: How six decades of parenting research can inform policy and best practice. Social Policy Report, 30(51).Google Scholar
- West, A., Duggan, A., Gruss, K., & Minkovitz, C. (2018a). Creating a measurement framework for service coordination in maternal and early childhood home visiting: An evidence-informed expert process. Children and Youth Services Review, 89, 289–297. https://doi.org/10.1016/j.childyouth.2018.04.037.CrossRefGoogle Scholar
- West, A., Gagliardi, L., Gatewood, A., Higman, S., Daniels, J., O'Neill, K., & Duggan, A. (2018b). Randomized trial of a training program to improve home visitor communication around sensitive topics. Maternal and Child Health Journal, 22, 70–78. https://doi.org/10.1007/s10995-018-2531-0.CrossRefPubMedPubMedCentralGoogle Scholar