Findings suggest need for program modification to address domestic violence
CHICAGO - A nurse home visitation program may not be effective at preventing child abuse and neglect in households with high number of incidents of domestic violence, according to an article in the September 20 issue of The Journal of the American Medical Association (JAMA).
John Eckenrode, PhD, from Cornell University in Ithaca, N.Y., and colleagues investigated whether the presence of domestic violence limits the effects of the nurse home visitation program to prevent child abuse and neglect. The researchers looked at the number of substantiated maltreatment reports by Child Protective Service (CPS) over a 15-year follow-up period for children who were participating in the study of a nurse home visitation program in a semi-rural community in upstate New York. There were 324 mothers and their children that participated in the follow-up study.
The researchers found that overall there were significantly fewer reports of mothers who received nurse home visits during the prenatal period through to the child's second birthday as perpetrators of maltreatment to their children compared to mothers in the comparison group (not assigned to receive nurse home visits). There were also significantly fewer reports of maltreatment to study children (first live births for participating mothers) who received nurse home visits during the prenatal period through to the child's second birthday compared to those study children not receiving nurse home visits.
The researchers found that for a subgroup of women who reported experiencing domestic violence, the effect of the nurse home visit program to prevent child maltreatment decreased as the number of incidents of domestic violence increased since the birth of the study child. Women who reported 28 or fewer incidents of domestic violence since the birth of the study child (79 percent of sample) had significantly fewer reports of child maltreatment than those in the comparison group during the 15 year follow-up period. Participant mothers who reported more than 28 incidents of domestic violence since the birth of the study child (21 percent of sample) did not have significantly fewer reports of child maltreatment than those in the comparison group.
The researchers found that 48 percent of the women included in this study reported experiencing some form of domestic violence since the birth of the study child. For all women in the sample, the mean number of incidents over the 15 years of the study was 22.2, and for those reporting any domestic violence, the mean number of incidents was 43.1. Home visitation had no impact on the incidence of domestic violence.
"While issues of domestic violence have been addressed more systematically as the program evolved during the years, the current findings have led to the incorporation of even more explicit methods of addressing domestic violence and partner relationships in the most recent generation of program protocols," the authors write. "The promotion of partner communication is designed to strengthen the mother-partner relationship, while a domestic violence assessment and education program is designed to address domestic violence effectively if it emerges. Whether such modifications will strengthen the impact of the program on child abuse and neglect will not be known until future trials of this program are conducted."
Citing a government report, the authors note that: "Annually, about 1 million abused children - 15 of every 1,000 children - are identified in the United States."
(The Journal of the American Medical Association. 2000;284:1385-1391)
Editor's Note: This work was supported in part by grants from the Prevention Research Branch of the National Institute of Mental Health (to co-author Dr. Davis L. Olds), the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (to Dr. Olds), the Children's Bureau, U.S. Department of Health and Human Services (to Dr. Eckenrode), and a Senior Research Scientist Award (to Dr. Olds).
For more information about the Journal of the American Medical Association or to obtain a copy of the study, please contact the American Medical Association's Brian Pace at 312/464-4311 E-mail: Brian_Pace@ama-assn.org.
Posted by the Center for the Advancement of Health <http://www.cfah.org>. For information about the Center, call Petrina Chong, <pchong@cfah.org> (202) 387-2829.
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