By Linda Chamberlain, PhD, MPH
This issue of Family Violence Prevention and Health Practice addresses intimate partner violence (IPV) within the context of home visitation. We solicited reports from colleagues in the field to share their experiences, perspectives, and lessons learned. This issue features brief reports from four diverse programs that offer home visitation services: DOVE, a multi-site, collaborative project between Johns Hopkins University and the University of Missouri-Columbia, to reduce maternal and infant/toddler exposure to IPV; Arizona Healthy Families, a paraprofessional home visitation initiative to reduce child abuse and neglect that is addressing IPV with families; a demonstration project with the Pennsylvania Coalition Against Domestic Violence to enhance services for children and youth exposed to IPV through home- and community-visits, and a demonstration project to reduce IPV among pregnant and postpartum women in Multnomah County, Oregon.
One-third or more of home-visited families have disclosed current or past IPV (Duggan et al, 2004; El-Kamary et al, 2004; Fergusson et al, 2005; Olds et al, 2004). An evaluation of the impact of IPV on home visitation services by Eckenrode and colleagues (2000) suggests that IPV reduces the effectiveness of home visitation services. For the few studies that have evaluated the effects of home visitation on IPV, the results are conflicting. One model, the Nurse-Family Partnership, documented a reduction in IPV among nurse-visited families at follow-up occurring two years after the intervention had ended (Olds et al, 2004), while other studies, including an evaluation of another Nurse-Family Partnership site, have reported no impact of home visitation on IPV (Duggan et al, 2004; Eckenrode et al, 2000; Ferguson et al, 2006; Olds et al, 2004). By clicking here, you can review a series of literature tables that I have compiled on IPV and home visitation.
My interest in this topic stems from several years of work in the field. Rebecca Levenson, Senior Policy Analyst at the FVPF, and I have provided technical assistance on IPV to more than thirty perinatal home visitation programs nationwide through a special initiative with the U.S. Department of Health and Human Services, Health Resources and Services Administration the Health Resource and Services Administration (HRSA). From Hilo, Hawaii to New York City to Mobile, Alabama, we traversed the U.S. over a two-year period conducting needs assessments, providing training and technical assistance, and learning about the complexities of developing a coordinated response to IPV for home-visited families. This extraordinary opportunity spawned an enduring interest and involvement in this topic.
Towards the close of the HRSA initiative, I was asked to work with Healthy Families Alaska (HFAK) on developing a coordinated response to IPV. HFAK offered home visitation services to at-risk families that were identified around the time of pregnancy. An external evaluation of AKHF pin-pointed the lack of a systematic response to IPV as a leading barrier to the success of the program. During the two years I worked with AKHF, I observed key issues that were consistent with my experiences of working with other home visitation programs. Many home visitors had received basic training on IPV. What they needed was more hands-on, skill-based training that provides the tools and strategies to integrate assessment and intervention into home visits. I found that incorporating early childhood exposure to violence and traumatic brain development was an important training strategy to help home visitors recognize the impact of IPV on the whole family and see the broader range of opportunities for intervention and prevention.
Home visitors expressed their frustrations with assessment tools that were designed for the clinical setting versus home visits. Standard questions were often too confrontational with clients, and were problematic in terms of translation and culturally relevancy. Certain practices such as conducting assessments with all family members present raised major barriers to asking clients about IPV. A consistent theme was that building trust with clients was the first priority and that it may not be appropriate to ask about IPV during the first few visits. It also became apparent that many home visitors were struggling with their own histories of childhood victimization and/or IPV.
My recommendations for AKHF included:
We have continued to pursue this complex topic. Feedback from focus groups with home visitors in Oregon and California echoed our earlier experiences in Alaska and across the nation. Compelled to delve deeper, we organized a pre-conference on home visitation and IPV at the Family Violence Prevention Fund’s 2007 conference on health and IPV in San Francisco. Leading home visitation experts and evaluators, including Drs. David Olds, Harriet MacMillan, Phyllis Sharps, and Anne Duggan, shared their latest findings and promising practices on IPV and home visitation.
We are committed to advancing knowledge and practices on addressing IPV within the context of home visitation. As part of a joint initiative between the Association of Maternal and Child Health Programs and the Family Violence Prevention Fund to address IPV as a perinatal health disparity, we developed a pilot assessment tool that home visitation programs can use to evaluate and track their progress in developing a coordinated response to IPV. You can download this tool by clicking here. We look forward to your feedback on this issue and suggestions of thought-provoking, practical topics for future issues that are relevant to the work you do.
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