Apr 7, 2011
Linda Chamberlain, PhD, MPH
Home visitation holds great promise as an intervention and prevention strategy for domestic violence (DV). Years ago, I did not make that connection. At the time, I was working for a visionary public health leader who, in the face of consideration resistance, was supportive of me starting a domestic violence training initiative in a maternal and child health program. At the same time, she was considering the potential of home visitation to prevent child maltreatment and asked me to be involved during the initial stages of gathering information and program development. During the implementation phase of the paraprofessional home visitation model that was selected, I urged the program managers to consider expanding their training and protocol to include assessment and intervention for DV but the program followed a specific protocol and the program developers were not supportive of adaptations or changes. I was quickly consumed with our domestic violence initiative and paid little attention to what was happening with this home visitation program as it expanded to several sites.
Less than a decade later, I would be extensively involved with in the intersection between delivering home visitation services and addressing DV both on the national level and in my home state of Alaska. A randomized controlled trial of the Alaska-based home visitation program produced disappointing results and the failure to systemically address domestic violence was identified as one of the key factors limiting program effectiveness. We responded with an intensive plan to provide training and technical assistance. Program management and staff were very receptive but the highly publicized evaluation results and missed opportunities to address prevalent risk factors such as domestic violence put a quick end to funding before changes could be implemented and evaluated. Subsequent analyses of the evaluation data examined how maternal levels of depression, attachment anxiety, and discomfort with trust/dependence moderated program impacts. Interestingly, findings indicated that program impacts were moderated by both maternal depression and attachment insecurity for several outcomes including DV (Duggan et al, 2009).
My next experience of working with programs offering home visitation services truly shaped the work and resource development that I have been doing since on this issue. I joined Rebecca Levenson of the Family Violence Prevention Fund on a nationwide trek to provide training and technical assistance to Healthy Start sitesâ€” this federally funded program utilizes a variety of home visitation/case management models to promote their goals and these range from the Nurse Family Partnership and Healthy Families America to Parents As Teachers and other community worker models of care. From Hawaii to Oregon to Pennsylvania to Alabama, we witnessed firsthand the unique window of opportunity that home visitation programs have to promote healthy relationships and the ongoing challenges that home visitors faced working with families experiencing domestic violence. We quickly realized that what worked in clinical settings was not necessarily a good fit for home visits and that training and assessment for domestic violence had to be tailored to the â€˜relationshipâ€™ based framework of home visitation which looks very different that a clinical checklist during a brief visit. It became clear that all sites needed core competencies to respond to domestic violence benchmarks to measure their progress and to create a universal standard of care in the field.
In this issue of Family Violence Prevention and Health Practice, we hear from leading experts in the field who are evaluating the impact of existing home visitation programs on DV and designing innovative home visitation initiatives to address DV. The challenges of responding to childrenâ€™s exposure to violence in home visitation programs are examined. This issue also provides the opportunity to highlight new resources that the Family Violence Prevention Fund has developed for home visitation programs. With increased attention and funding to implement home visitation services across the United States, we have an extraordinary opportunity to advocate for integration of screening and intervention for DV into all home visitation services and support both proven and innovative practices that address DV within the context of home visits.
Duggan AK, Berlin LJ, Cassidy J, Burrell L, Darius Tandon S. Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. J Consult Clin Pyschol. 2009; 77(4):788-799.