Aboriginal children and families Expert cultural guidance that includes elders from language groups local to the area Aboriginal Maternal and Infant Care (AMIC) worker position in a leadership role; trained in antenatal, and postnatal care, as appropriate Intercultural partnerships and skill exchange Commitment to continuity of care and primary health care principles Management group for program support; Aboriginal Family Partnership Workers and flexibility in the location of visits Services matched to and family needs; Staff develop trusting relationships and partnerships with family members Service provision includes a mix of practical, educational, and therapeutic supports for children and families Families participate in decision making and case planning Services delivered in a culturally competent and respectful manner Comprehensive initial and ongoing assessments at the individual, family, and structural levels that are open-minded and non-judgemental Incorporation of parental and perspectives in interventions, case planning and goal Specific and well-communicated goals that instil positivity and commitment in parents Delivery of services within a case management framework Locally and culturally appropriate assessment tools Use of a wide range of assessments (targeted and specialist), referrals and other services Services have good working relationships at all levels with statutory agencies Adequate organisational support, low caseloads, and “hands-on” case work to allow enhanced service delivery Provision of a range of practical, educational, therapeutic, and advocacy supports A clear, documented two-way practice model Service delivery congruent with practice values and ethos Intensive cultural orientation for new practitioner Maternal confidence and competence Mother-child attachment and interaction Confidence and ability to enact positive change Manage behaviour and problems getting them to attend school regularly Leave violent relationships Ask for help Manage household budget and establish daily routines. Better family relationships and more communication within the family Getting the statutory agency “out of their life” and having children returned to their care. trial trial
Appendix 4. Common program elements Table A6. Successful outcomes and corresponding program elements: Home visiting programs PROGRAM SUCCESSFUL OUTCOME Manual/ Protocol Parenting intervention development Link to matched need services Supervision Research informed curricula Training Fidelity monitoring Periodic child/family outcomes assessment Measurable outcome indicators Home visitors culturally matched to clients Target adolescent mothers Prenatal Hawaii Healthy Decreased Maternal IVP (physical assault) perpetration and victimization. Y Y Y Y Y N Y N Y N N N N Cognitively based extension to the Healthy Start home visitation program use of corporal punishment, greater safety maintenance in the home, and fewer reported child injuries. Y Y Y Y Y Y Y Y N N Y N N Healthy Families Alaska (HFAK) Better developmental and behavioural outcomes. Greater parenting self-efficacy. Greater use of mild forms of physical punishment. Among non-depressed mothers decreased maternal stress and increased sensitivity to infants’ cues. Among depressed mothers with low to moderate attachment insecurity decreased depression and partner violence. Y Y Y Y Y N Y N Y Y N N Y
Healthy Families New York At Year 1 fewer acts of very serious physical abuse, minor physical aggression, and psychological aggression in the past year, and harsh parenting in the past week. Lower risk of delivering an LBW baby. Y Y Y Y Y N Y N N Y Y N Y Early Head Start Long term impacts on child’s social-emotional functioning, parenting, and family self-sufficiency outcomes. N Y Y Y N Y N Y N Y N N Y "Nurse Family Partnership (NFP). First-time reports of neglect ceased by time child reached age of 8 whereas comparison group continued to receive first reports through age 15. No differences noted prior to age 5. Y N Y Y Y Y N N Y N N y y VoorZorg, the NFP Victimization and perpetration due to IPV lower during pregnancy and two years after birth Y N Y N N Y N N N N N Y Y Family spirit Mothers had greater parenting knowledge, parenting self-efficacy, and home safety attitudes, fewer externalizing behaviors. Children had fewer externalizing problems. Decreased illicit drug use. Y Y Y N Y Y Y Y N N Y Y Y
Program Element Overall, greater reduction in AUDIT scores for IG (only significant for confirmed drinkers) Overall, decreased IPV incidence during pregnancy. babies born with very LBW and at very preterm delivery. Greater gestational age. Improved maternal general and social self-efficacy, relationship with baby and parenting stress. Improved tangible and total support, family functioning, and reduced maternal moodiness/ emotional lability and social isolation/ withdrawal (grandmother reported) Decreased depression and state anxiety and increased overall full mindfulness, particularly "acting with awareness" and "describing". Significance testing not conducted. Moderate positive effects: reflective functioning, caregiving behaviour. Small positive effects: maternal coherence and sensitivity (quality of representations of child) and psychiatric symptoms (depression and global distress). Significance testing not conducted. All infants remained safely in home with no removals or child protection investigations. Reduced risk in 80% of families. Meta-analytic review findings Improved infant attachment security. Manual/protocol ? ? Y Y Y ? Y/? Targeted issue Y Y Y Y Y N Y Trained/qualified deliverers Y Y Y Y Y ? Y (EI) ? Y Y (adapted from EI program) ? ? ? Y/? Fidelity monitoring ? ? Y ? Y ? Y/? Delivery during routine visits ? Y N N N N N/? Risk assessment/ screening Y Y N Y Y Y ? Individualised approach* Y Y ? N Y Y Y Therapeutic component † Y Y Y Y Y Y Y Pre- and natal support N Y N N N N N/? Tangible support N ? ? ? Y Y N/? Ongoing support N N Y N N Y Y/N Individual session Y Y N N Y Y (plus and community context) Y/N
ANEW program Self-rated improvements in approaches towards psychosocial issues, and confidence, competence and satisfaction for a range of skills and abilities for providing care for pregnant women. ? Y ? Y Y N Y Y Y Y ? ? FAS screening and counselling program Significant improvements in practitioner confidence in four skills indicators, knowledge of the link between alcohol consumption in pregnancy and FAS, provision of pregnancy care advice and alcohol specific advice, and family planning (counselling and offering). Both within IG and between IG and CG. ? Y Y ? N Y Y ? N Y N N * In the form of teaching how to use standardised tools.