Prevention Science

, Volume 20, Issue 8, pp 1233–1243 | Cite as

Addressing Maternal Depression, Substance Use, and Intimate Partner Violence in Home Visiting: a Quasi-Experimental Pilot Test of a Screen-and-Refer Approach

  • Sarah DauberEmail author
  • Aaron Hogue
  • Craig E. Henderson
  • Jessica Nugent
  • Gina Hernandez


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.


Home 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.

Ethical Approval

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.

Informed Consent

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.

Supplementary material

11121_2019_1045_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)
11121_2019_1045_MOESM2_ESM.docx (33 kb)
ESM 2 (DOCX 33 kb)


  1. Abrams, L., Dornig, K., & Curran, L. (2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qualitative Health Research, 19, 535–551.CrossRefGoogle Scholar
  2. Ammerman, R., Putnam, F., Altaye, M., Stevens, J., Teeters, A., & Van Ginkel, J. (2013). A clinical trial of in-home CBT for depressed mothers in home visitation. Behavior Therapy, 44, 359–372.CrossRefGoogle Scholar
  3. Asparouhov, T. (2005). Sampling weights in latent variable modeling. Structural Equation Modeling, 12(3), 411–434.CrossRefGoogle Scholar
  4. 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. Scholar
  5. Burke, L., & Hutchins, H. (2007). Training transfer: An integrative literature review. Human Resources Development, 6, 263–296.CrossRefGoogle Scholar
  6. Campbell, T., Hoffman, N., Hoffmann, T., & Gillaspy, J. (2005). UNCOPE: A screen for substance dependence among state prison inmates. The Prison Journal, 85, 7–17.CrossRefGoogle Scholar
  7. Chaiyachati, B., Gaither, J., Hughes, M., Foley-Schain, K., & Leventhal, J. (2018). Preventing child maltreatment: Examination of an established statewide home visiting program. Child Abuse and Neglect, 79, 476–484.CrossRefGoogle Scholar
  8. Cox, J., Holden, J., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. British Journal of Psychiatry, 150, 782–786.CrossRefGoogle Scholar
  9. 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. Scholar
  10. 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
  11. 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. Scholar
  12. Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse and Neglect, 31, 801–827. Scholar
  13. Durlak, J., & DuPre, E. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350. Scholar
  14. Fixsen, D., Blase, K., Naoom, S., & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19, 531–540.CrossRefGoogle Scholar
  15. Folger, A., Brentley, A., Goyal, N., Hall, E., Sa, T., Peugh, J., et al. (2015). Evaluation of a community-based approach to strengthen retention in early childhood home visiting. Prevention Science, 17(1), 52–61. Scholar
  16. Goldberg, J., Greenstone Winestone, J., Fauth, R., Colon, M., & Mingo, M. (2018). Getting to the warm hand-off: A study of home visitor referral activities. Maternal and Child Health Journal, 22, 22–32. Scholar
  17. Guo, S., & Fraser, M. (2010). Propensity score analysis: Statistical methods and applications. Los Angeles, CA: Sage.Google Scholar
  18. 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
  19. HRSA Maternal and Child Health. (2016). Federal home visiting program: Performance indicators and systems outcome measures-summary. Washington, DC: HRSA.Google Scholar
  20. Latimore, A., Burrell, L., Crowne, S., Ojo, K., Cluxton-Keller, F., Gustin, S., et al. (2017). Exploring multilevel factors for family engagement in home visiting across two national models. Prevention Science, 18(5), 577–589. Scholar
  21. Loudon, K., Treweek, S., Sullivan, F., Donnan, P., Thorpe, K., & Zwarenstein, M. (2015). The PRECIS-2 tool: Designing trials that are fit for purpose. BMJ, 350, 1–11. Scholar
  22. 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. Scholar
  23. 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. Scholar
  24. 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
  25. 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
  26. Muthen, L., & Muthen, B. (1998-2017). Mplus User's Guide (Seventh ed.). Los Angeles, CA: Muthen & Muthen.Google Scholar
  27. Paradis, H., Belknap, A., O'Neill, K., Baggett, S., & Minkovitz, C. (2018). Coordination of early childhood home visiting and health care providers. Children and Youth Services Review, 85, 202–210. Scholar
  28. Powell, B., McMillen, C., Proctor, E., Carpenter, C., Griffey, R., Bunger, A., et al. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review, 69, 123–157.CrossRefGoogle Scholar
  29. 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. Scholar
  30. 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
  31. Stata Corp. (2009). Stata 11.2. College Station, TX: Stata Corp LP.Google Scholar
  32. Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health and Justice, 3, 2–16. Scholar
  33. Supplee, L., Parekh, J., & Johnson, M. (2018). Principles of precision prevention science for improving recruitment and retention of participants. Prevention Science, 19(5), 689–694. Scholar
  34. 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. Scholar
  35. 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. Scholar
  36. Tandon, S., Ward, E., Hamil, J., Jimenez, C., & Carter, M. (2018b). Perinatal depression prevention through home visitation: A cluster randomized trial of mothers and babies 1-on-1. Journal of Behavioral Medicine, 41(5), 641–652.CrossRefGoogle Scholar
  37. 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
  38. 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. Scholar
  39. 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. Scholar
  40. Yonkers, K., Smith, M., Lin, H., Howell, H., Shao, L., & Rosenheck, R. (2009). Depression screening of perinatal women: An evaluation of the healthy start depression initiative. Psychiatric Services, 60, 322–328.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.Center on AddictionNew YorkUSA
  2. 2.Department of PsychologySam Houston State UniversityHuntsvilleUSA
  3. 3.Prevent Child Abuse New JerseyNew BrunswickUSA

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