Improving the quality of home visitation: An exploratory study of difficult situations

• Published in: Child abuse & neglect 2005-09, Vol.29 (9), p.1003-1013
• Main Authors: LeCroy, Craig Winston, Whitaker, Kate
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Child Abuse; Child abuse & neglect; Child Abuse - prevention & control; Child Health Services - organization & administration; Child Health Services - standards; Child Neglect; Child Welfare; Clinical Competence; Competence; Competencies; Difficult situations; Domestic Violence; Domiciliary visits; Ecobiological assessment; Ecological assessment; Educational Needs; Evaluation; Factor Analysis; Families & family life; Family (Sociological Unit); Family - psychology; Family Environment; Family Programs; Female; Focus Groups; Health staff related problems. Vocational training; Home Environment; Home visitation; Home Visits; Humans; Intervention; Medical sciences; Mental Disorders; Mental Health; Parenting; Problem Solving; Professional Training; Professional-Family Relations; Program Implementation; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social psychiatry. Ethnopsychiatry; Social services; Substance Abuse; Supervision; Supervision and training; Training; Training needs; Visitation; Visitors
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2005.04.003

The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors who implement the Healthy Families America model of child abuse and neglect prevention. The results of the focus groups were used to design a survey. The survey had 91 Healthy Families home visitors rate situations according to frequency and difficulty. The results revealed that situations that were ranked most difficult included working with families where there are limited resources, where family mental illness is present (e.g., threatening suicide), where there is substance use in the home, and where families are unmotivated. A factor analysis of the situations produced five factors that reflect the difficulty of doing home visitation: having a lack of clinical skill, addressing family difficulties, addressing parenting difficulties, resolving personal difficulties, and having a lack of experience. The situations identified in this study can assist in developing the competencies needed by home visitors. The factor analysis results can be conceptualized into an inventory for staff supervision, with workers completing the inventory to identify individual areas of training needs. El principal objetivo del estudio fue utilizar un modelo de evaluación ecológico para alcanzar una mejor comprensión de las situaciones difíciles que los educadores familiares deben afrontar cuando desarrollan su trabajo en el domicilio familiar. Se llevaron a cabo grupos de trabajo focalizados para identificar las situaciones específicas con las que se enfrentan los educadores familiares que llevan a cabo los programas basados en el modelo Healthy Families America para la prevención del maltrato y el abandono infantil. Los resultados de estos grupos de trabajo se utilizaron para diseñar una encuesta. La encuesta presentaba 91 situaciones que los educadores familiares del programa Healthy Families America puntuaban de acuerdo a su frecuencia y dificultad. Los resultados muestran que las situaciones que fueron señaladas como más frecuentes eran las de tener que trabajar con familias con recursos limitados, con familias que presentan problemas de salud mental (p.e. amenaza de suicidio) o consumo de drogas en el hogar y con familias desmotivadas. En un análisis