The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia: A community trial

Background Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services. Methods The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively. Results There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites. Conclusion These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities

Estimating the number of children exposed to parental psychiatric disorders through a national health survey

<p>Abstract</p> <p>Objective</p> <p>Children whose parents have psychiatric disorders experience an increased risk of developing psychiatric disorders, and have higher rates of developmental problems and mortality. Assessing the size of this population is important for planning of preventive strategies which target these children.</p> <p>Methods</p> <p>National survey data (CCHS 1.2) was used to estimate the number of children exposed to parental psychiatric disorders. Disorders were diagnosed using the World Psychiatric Health Composite International Diagnostic Interview (WMH-CIDI) (12 month prevalence). Data on the number of children below 12 years of age in the home, and the relationship of the respondents with the children, was used to estimate exposure. Parent-child relations were identified, as was single parenthood. Using a design-based analysis, the number of children exposed to parental psychiatric disorders was calculated.</p> <p>Results</p> <p>Almost 570,000 children under 12 live in households where the survey respondent met criteria for one or more mood, anxiety or substance use disorders in the previous 12 months, corresponding to 12.1% of Canadian children under the age of 12. Almost 3/4 of these children have parents that report receiving no mental health care in the 12 months preceding the survey. For 17% of all Canadian children under age 12, the individual experiencing a psychiatric disorder is the only parent in the household.</p> <p>Conclusion</p> <p>The high number of children exposed causes major concern and has important implications. Although these children will not necessarily experience adversities, they possess an elevated risk of accidents, mortality, and of developing psychiatric disorders. We expect these estimates will promote further research and stimulate discussion at both health policy and planning tables.</p

Home visits by neighborhood Mentor Mothers provide timely recovery from childhood malnutrition in South Africa: results from a randomized controlled trial

Abstract Background Child and infant malnourishment is a significant and growing problem in the developing world. Malnourished children are at high risk for negative health outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve childhood nourishment. The objective of this study is to evaluate whether the Philani program can rehabilitate malnourished children in a timely manner. Methods Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536) or a control condition (n = 252). Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups. Results By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages) than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536) of children in the intervention condition were rehabilitated while 31% (n = 78 of 252) of children in the control condition were rehabilitated. Conclusions Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk

Prenatal Prediction of Poor Maternal and Offspring Outcomes: Implications for Selection into Intensive Parent Support Programs

This study examined the predictive ability of mother’s age, antenatal depression, education, financial difficulties, partner status, and smoking for a range of poor maternal and offspring outcomes assessed up to 61 months postnatally. Outcomes obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) were maternal postnatal depression at 8 weeks (n = 10,070), never breastfeeding (n = 7,976), feelings of poor attachment (n = 8,253) and hostility (n = 8,159) at 47 months, and not in employment, education or training (NEET, n = 8,265) at 61 months. Only a small proportion of women with each outcome were aged less than 20 years when they were pregnant. At least half of the women experiencing these outcomes, and up to 74.7% of women with postnatal depression, could be identified if they had at least one of the predictors measured during pregnancy (age < 20, depression, education less than O level, financial difficulties, no partner, or smoking). Model discrimination was poor using maternal age only (area under the receiver operator characteristic (AUROC) curve approximately 0.52), except for never breastfeeding (0.63). Discrimination improved (AUROC: 0.80, 0.69, 0.62, 0.60, 0.66 for depression, never breastfeeding, poor attachment, hostility and NEET, respectively) when all six predictors were included in the model. Calibration improved for all outcomes with the model including all six predictors, except never breastfeeding where even age alone demonstrated good calibration. Factors other than young maternal age, including education, smoking and depression during pregnancy should be considered in identifying women and their offspring likely to benefit from parenting support interventions

Retaining women in a prenatal care randomized controlled trial in Canada: implications for program planning

<p>Abstract</p> <p>Background:</p> <p>Challenges to retention in prenatal care seem to exist under both universal systems of care, as in Canada, and non-universal systems of care, as in the United States. However, among populations being served by a system of publicly funded health care, the barriers are less well understood and universal uptake of prenatal services has not been realized. Determining the characteristics of women who dropped out of a prenatal care randomized controlled trial can help identify those who may need alternate retention and service approaches.</p> <p>Methods:</p> <p>In this study, pregnant women were randomized to: a) current standard of care; b) 'a' plus nursing support; or c) 'b' plus a paraprofessional home visitor. 16% of 2,015 women did not complete all three telephone interviews (197 dropped out and 124 became unreachable). Responders were compared to non-responders on demographics, lifestyle, psychosocial factors, and life events using chi-squared tests. Logistic regression models were constructed using stepwise logistic regression to determine the probability of not completing the prenatal program.</p> <p>Results:</p> <p>Completion rates did not differ by intervention. In comparison to responders, non-responders were more likely to be younger, less educated, have lower incomes, smoke, have low social support, have a history of depression, and have separated or divorced parents (all p < 0.05). Unreachable women were more likely to be single, use drugs, report distress and adverse life events (all p < 0.05). Non-Caucasian women were more likely to drop out (p = 0.002). Logistic regression modeling indicated that independent key risk factors for dropping out were: less than high school education, separated or divorced parents, lower social support, and being non-Caucasian. Pregnant women who were single/separated/divorced, less than 25 years old, had less than high school education, earned less than $40,000 in annual household income, and/or smoked had greater odds of becoming unreachable at some point during pregnancy and not completing the study.</p> <p>Conclusion:</p> <p>Women at risk due to lifestyle and challenging circumstances were difficult to retain in a prenatal care study, regardless of the intervention. For women with complex health, lifestyle and social issues, lack of retention may reflect incongruence between their needs and the program.</p> <p>Trial registration:</p> <p>Current Controlled Trials ISRCTN64070727</p

From evidence-base to practice: implementation of the Nurse Family Partnership programme in England

The aims of this article are to highlight the issues that are relevant to the implementation of a rigorously evidence-based programme of support, the Nurse Family Partnership programme, into a national system of care. Methods used are semi-structured interviews with families in receipt of the programme in the first 10 sites, with the nursing staff, with members of the central team guiding the initiative and with other professionals. Analyses of data collected during programme delivery evaluate fidelity of delivery. The results indicate that the programme is perceived in a positive light and take-up is high, with delivery close to the stated US objectives. Issues pertaining to sustainability are highlighted - in particular, local concerns about cost set against long-term rather than immediate gains. However, local investment is predominantly strong, with creative methods being planned for the future. Overall, the study shows that within an NHS system of care it is possible to deliver a targeted evidence-based programme

Smoking during Pregnancy Affects Speech-Processing Ability in Newborn Infants

BACKGROUND: Tobacco smoking during pregnancy is known to adversely affect development of the central nervous system in babies of smoking mothers by restricting utero–placental blood flow and the amount of oxygen available to the fetus. Behavioral data associate maternal smoking with lower verbal scores and poorer performance on specific language/auditory tests. OBJECTIVES: In the current study we examined the effects of maternal smoking during pregnancy on newborns’ speech processing ability as measured by event-related potentials (ERPs). METHOD: High-density ERPs were recorded within 48 hr of birth in healthy newborn infants of smoking (n = 8) and nonsmoking (n = 8) mothers. Participating infants were matched on sex, gestational age, birth weight, Apgar scores, mother’s education, and family income. Smoking during pregnancy was determined by parental self-report and medical records. ERPs were recorded in response to six consonant–vowel syllables presented in random order with equal probability. RESULTS: Brainwaves of babies of nonsmoking mothers were characterized by typical hemisphere asymmetries, with larger amplitudes over the left hemisphere, especially over temporal regions. Further, infants of nonsmokers discriminated among a greater number of syllables whereas the newborns of smokers began the discrimination process at least 150 msec later and differentiated among fewer stimuli. CONCLUSIONS: Our findings indicate that prenatal exposure to tobacco smoke in otherwise healthy babies is linked with significant changes in brain physiology associated with basic perceptual skills that could place the infant at risk for later developmental problems

Outcomes of a Comparison Study into a Group-Based Infant Parenting Programme

This paper reports on a quantitative evaluation of a group-based programme designed to promote parent-infant attachment and child development. Whilst group-based parenting programmes are recommended for treating and preventing conduct disorder in older children, there is, as yet, little evidence as to whether they have a positive effect on very young children and their carers’. Recent UK Government initiatives to support families and improve parenting skills in the first 2 years of children’s lives have increased the demand for the delivery and evaluation of community-based programmes. Eighty mother–child dyads were recruited from nine areas to intervention (n = 54) and control condition (n = 26). Baseline measures were collected in the children’s home when the infants were on average 3-months-old, and follow-up measures were collected 6 months post-baseline (N = 63). Mothers’ positive play behaviours were independently coded from video recordings taken in the home. Other measures included self-reported maternal confidence and mental well-being, assessed infant development and home environment. Socio-demographic data was collected once at baseline. After controlling for baseline scores, control mothers were observed to be significantly less sensitive during play with their baby at the 6 months follow-up with a significant increase in confidence. No differences were found between the groups on the other measures. This paper provides limited evidence for the effectiveness of the Incredible Years Parents and Babies group-based programme delivered in the first year of life. Further evaluation, particularly with parents at increased risk of poorer outcomes is needed to confirm and extend these results

Development of a nurse home visitation intervention for intimate partner violence

<p>Abstract</p> <p>Background</p> <p>Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.</p> <p>Methods</p> <p>Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.</p> <p>Results</p> <p>Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.</p> <p>Conclusions</p> <p>NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.</p