Substance misuse, mental health problems and recurrent child maltreatment

Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method

BACKGROUND

Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021.

OBJECTIVE

To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida.

METHODS

This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation.

RESULTS

Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes.

CONCLUSIONS FOR PRACTICE

Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.

Family Risk Factors That Jeopardize Child Development: Scoping Review

The obligation to protect children is defined by law. However, there is fragility in identifying actual or potential situations that jeopardize their development. This review aims to identify the family risk factors that jeopardize child development. A scoping review was conducted following the Joanna Briggs Institute for Evidence-Based Practice framework and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, CINAHL, Nursing & Allied Health Collection: Comprehensive, MEDLINE Complete, and MedicLatina, with a time limit of 2010 to 2021. The search was restricted to documents written in Portuguese, English, and French. A total of 3998 articles were initially identified. After selecting and analysing, 28 risk factors were extracted from 29 articles. Four categories of risk factors were identified—namely, patterns of social and economic interaction, family characteristics, caregiver’s characteristics, and parenting. The results of this review allow the identification of family risk factors that jeopardize child development. This is significant for Child Protective Services workers as they carry out their risk assessments. This assessment is the first step in avoiding an accumulation of harm to at-risk children and allowing the development of interventions for minimising harm’s impact on children’s development.

KODY, an all-of-family response to co-occurring substance use and domestic violence: protocol for a quasi-experimental intervention trial

Background

The co-occurrence of domestic violence with alcohol and other drugs significantly increases the severity of abuse and violence experienced by family members. Longitudinal studies indicate that substance use is one of few predictors of men’s continued use of, or desistance from, violence. Recent developments in men’s behaviour change programs have focused on men’s attitudes and behaviour towards their children, and the exploration of interventions that address the needs of all family members. However, the research evidence is limited on the most effective elements of men’s behaviour change programs in promoting the safety and wellbeing of child and women victim survivors.

This study aims to build on the existing evidence by trialling the KODY program which addresses harmful substance use by men who also perpetrate domestic violence; the safety and wellbeing of women and children; the needs of children in their own right, as well as in relationship with their mothers; and the development of an ‘all-of-family’ service response. The evaluation of these innovations, and the ramifications for policy development to support less fragmented service system responses, provide the rationale for the study.

Methods/Design

A quasi-experimental design will be used to assess the primary outcomes of improving the safety and wellbeing of mothers and children whose (ex)partners and fathers respectively participate in KODY (the trial program), when compared with ‘Caring Dads standard’ (the comparison group). Psychometric tests will be administered to fathers and mothers at baseline, post-program and at 3-month follow up. Data collection will occur over three years.

Discussion

By building the evidence base about responses to co-occurring domestic violence and substance use, this study aims to develop knowledge about improving safety outcomes for women and children, and to better understand appropriate support for children in families living at the intersection of domestic violence and substance use. It is anticipated that study findings will point to the ramifications for policy development to support less fragmented service system responses.

Trial registration

An application for registration with the Australian and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/) was lodged on 20 December 2021 (Request number: 383206)—prospectively registered.

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011-12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.