DESIRED OUTCOMES:
Child:
Initial Child Outcomes
1. Daily living needs
a) Adequate housing
b) Adequate clothing
c) Adequate nutrition
2. Medical care
a) Receives well baby checkups
b) Up to date immunizations
c) receives follow-up for "red flags" identified by first home visitor
d) Receives special needs services if needed
Expected Long-Term Child Outcomes
1. Reduced incidence of child neglect and abuse/remains in home
2. School readiness
3. Receives routine medical care
Parent:
Initial Parent Outcomes
1. Daily living needs
a) Adequate housing
b) Adequate clothing
c) Adequate nutrition
2. Knowledge of Child Development
a) Have appropriate developmental expectations of child
b) Knows developmental milestones
c) Understands results of child's assessment done by home visitor
3. Parenting skills
a) Provides safe household
b) Provides nurturing/stimulation activities to encourage healthy development
c) Provides stable child care
4. Medical Care
a) Medical home
b) Knows where & when for child to receive up to date immunizations and well-baby visits
c) Receives postnatal checkup/interspacial counseling
d) Receives follow-up for "red flags" identified by first home visitor
Expected Long-Term Parent Outcomes
1. Increase in birth spacing
2. Decrease in incidence of unplanned subsequent pregnancies
3. High school education/employment obtained
Family:
Initial Family Outcomes
1. Family skills
a) Effective problem solving
b) Can identify signs of alcohol/drug abuse and seek services if needed
c) Can recognize family violence and seek services if needed
2. Social support
a) Access & utilize social support
b) Strengthened social support system
c) Participate in community/social connections
d) Reduction of parenting and family stress
3. Social services integration
a) Follow-through with referrals and receipt of services
Expected Long-Term Family Outcomes
1. Healthier family lifestyles
2. Self-sufficiency/goals and needs of the family are met
3. Families stay together
Community:
1. Integrated service delivery system
STRATEGY: IMPLEMENT A RELATIONSHIP-BASED EARLY INTERVENTION WITH THESE PARENTS AND CHILDREN
I. PROMOTE THE SUPERVISOR-VISITOR RELATIONSHIP
WHY: 1) Reflective supervision provides a model for the kind of relationship visitors should establish with families.
Visitors need support, encouragement, reassurance, and restoration of morale to work effectively with families experiencing high levels of risk and stress. Reflective supervision promotes motivation, learning, and performance in visitors and helps supervisors better understand the specific situations visitors experience (Almonte, 1994).
If paraprofessionals have lowered expectations for themselves and their own children, they are unlikely to have higher expectations for their clients, both parents and children. If they do not believe that an intervention can make a difference, they may not be able to implement techniques to help parents promote growth and development (Musick & Stott, 1990).
HOW: See Core Competencies for Supervisors – still need to address issues related to the measurement of supervisor and visitor performance
II. PROMOTE THE VISITOR-PARENT RELATIONSHIP
WHY: Developing a trusting relationship with parents is central to the success of service delivery (Hiatt, Sampson & Baird, 1997; Musick & Stott, 1990). Because this may be the first trusting relationship a parent has experienced, it is a vital model for parents in establishing the desired relationship with the child. It may also be the crucial support that enables parents to invest in their continued development and increases the likelihood of attaining the desired long-term goals for both parent and child. Special effort and significant time must be expended to build relationships with parents who have never experienced a trusting relationship.
HOW: See Core Competencies for Paraprofessional and Professional Visitors – still need to address measurement issues related to performance of visitors
III. PROMOTE THE PARENT-CHILD RELATIONSHIP
WHY: Caregiving and nurturing are an interrelated continuum of behaviors which promote positive development of the child.
Caregiving ------------------------------------------------------------------------------- Nurturing
keeping safe feeding diapering bathing holding responding to cues talking singing soothing
"Children grow and thrive in the context of close and dependable relationships that provide love and nurturance, security, responsive interaction, and encouragement for exploration. Without at least one such relationship, development is disrupted and the consequences can be severe and long-lasting. If provided or restored, however, a sensitive caregiving relationship can foster remarkable recovery" (National Research Council and Institute of Medicine, 2000, pg. 389).
The evidence that secure attachment is significant for human development supports a focus on relationship building in early interventions with high-risk populations (National Research Council and Institute of Medicine, 2000).
Factors which negatively affect parental attachment behaviors
No prior close relationship
Young age
Postpartum depression
Substance use/abuse
Insufficient social support
High levels of stress due to environmental conditions
b) Children especially vulnerable to insecure attachment
Premature infants
Children with difficult temperaments – ultimately depends upon the fit between parent and child
Children with disabilities such as autism and Downs syndrome
"The most reliable outcome of a secure attachment in infancy is a more harmonious parent-child relationship in the immediate years to come." Secure attachment promotes exploratory play that contributes "to early learning and seems to bolster parents’ efforts to support learning" (National Research Council and Institute of Medicine, 2000, pg. 236). Caregiver sensitivity promotes secure attachment, emotional competency and self-regulation, which support social and cognitive competency.
"A secure attachment in infancy is the beginning of what Maccoby (1984) has called a ‘mutual interpersonal orientation of positive reciprocity’ between parent and child. This is a relationship characterized by mutual cooperation, in which a child is intrinsically and eagerly receptive to the caregiver’s socialization incentives because of the general harmony of their interactions. In this mutually responsive relationship, the parent is sensitive to the child’s interest, and the child in turn is committed to the relationship with the parent. To the extent that the reciprocally cooperative orientation inaugurated by a secure parent-infant attachment endures, therefore, it is likely to promote many positive features of psychosocial growth by heightening the child’s receptivity to many other socialization influences concerned with achieving competence, behavioral compliance, or other developmental goals" (Thompson, 1999, pg. 270).
Secure attachment in infancy does not guarantee later positive developmental outcomes because (a) parent-child relationships may change, (b) other developmental events may intervene, and/or (c) development is influenced by many factors. However, attached children generally have an easier time developing positive, supportive relationships with teachers, friends, and others--and may respond more positively to unfamiliar people. Parental interaction which supports emotional and social growth, as well as cognitive development, contributes to school readiness (National Research Council and Institute of Medicine, 2000).. Avoiding problems in school significantly reduces the likelihood that adolescents in all ethnic/racial groups will participate in or experience substance abuse, suicidal ideation, violence involving guns, and early sexual activity (Blum, Beuhring, & Rinehard, 2000). The most consistently protective factor for adolescent development identified in this study was a positive parent-youth relationship (which may have its origins in infancy).
HOW: See Core Competencies for Visitors
