Preventing Child Abuse and Neglect Through Nurse Home Visitation

In September 2007, the Children’s Bureau funded three Nurse Home Visitation grants that combined home visiting, responsible fatherhood, and healthy marriage/relationships services to prevent child abuse and neglect.

Nurses for Newborns Foundation, Yakima Valley Farm Workers Clinic, and the Spokane Regional Health District engaged in 5-year cooperative agreements that required them to select evidence-based models and/or curricula across all three areas. They had the option of establishing their own responsible fatherhood and healthy marriage/relationships programs or referring families to other community agencies for these services. This report synthesizes findings from the grantees’ process and outcome evaluations, as presented in their final evaluation reports.

Key Process Evaluation Findings

Most participants were low income, unemployed, young single mothers with limited education. The stress and uncertainty that characterized their daily lives created barriers to program enrollment, participation, and completion, and made it more difficult to collect complete and accurate information (e.g., income levels, reports of domestic violence).

In response to these challenges, all three grantees adapted their interventions to better serve and engage participants. For example, the Spokane Regional Health District modified both its responsible fatherhood and healthy relationships interventions to deliver them one-on-one during home visits. Yamika Valley Farm Workers Clinic modified its healthy marriages project component by allowing nurse home visitors to deliver the curriculum in participants’ homes rather than in a classroom setting through a subcontracted service provider. Nurses for Newborns also demonstrated flexibility with all three project components by allowing participants to choose the times, locations (i.e., center- or home-based), and content of classes in response to their needs, interests, and schedules.

Each project either approached or successfully met its enrollment goal and implemented its core program components with high to moderate fidelity.

Key Outcome Evaluation Findings

All three grantees demonstrated some positive results across a variety of child and family outcome domains. Statistically significant findings included the following:

• All three grantees demonstrated significant improvements in some aspects of the home environment (e.g., improved organization, more nurturing milieu).
• The program implemented by the Yakima Valley Farm Workers Clinic demonstrated significant improvements in parent-child interactions, reduced levels of depressive symptoms among project participants, and increased fatherhood skills and engagement.
• The program implemented by the Spokane Regional Health District demonstrated significant improvements in healthy relationship knowledge and behaviors among project participants.