Enhancing Home Visiting Programs to Address Maternal Mental Health, Substance Use, and Domestic Violence: Model Development and Implementation

Home visiting programs targeting at-risk new parents are the most widely implemented child maltreatment prevention strategy in the United States. Programs typically include a structured curriculum delivered by paraprofessionals aimed at preventing child maltreatment by teaching parenting skills and increasing access to medical and early intervention services. Recent studies have supported the success of several models, including Healthy Families America (HFA), in improving parenting attitudes and practices, however the evidence for program success in actually preventing child maltreatment is inconclusive. A key area of weakness in these programs that may contribute to their inconsistent effectiveness is their failure to systematically address maternal mental health problems, substance use, and domestic violence, known risk factors for child maltreatment.  Directly addressing maternal behavioral health risks within the context of home visiting, prior to their negatively impacting parenting and child outcomes, has the potential to significantly enhance program impact. This study describes the development and implementation of a standardized behavioral health screening and linkage to treatment protocol designed to increase access to services for mental health, substance use, and domestic violence among at-risk mothers enrolled in home visiting. The standardized protocol, named HELP (Home Visitation Enhancing Linkages Project), was adapted from an evidence-based case management model and is currently being piloted in four New Jersey counties within the HFA program. HELP is a three-phase model implemented by home visitors, which includes standardized screening to identify clients with an unmet service need related to substance use, mental health, and/or domestic violence (Identify Phase), motivational interviewing and case management interventions to link clients to a service provider (Connect Phase), and supportive interventions aimed at maintaining clients in treatment, overcoming barriers, and re-engaging as needed (Support Phase). A detailed description of the HELP model will be presented, along with quantitative and qualitative data on implementation fidelity, feasibility, and barriers to effective implementation. Data sources include a quantitative fidelity checklist completed weekly by home visitors, qualitative interviews of home visitors, supervisors, and clients assessing feasibility and acceptability of the HELP model, and quantitative surveys assessing barriers to engaging in treatment. Study findings provide important information on the extent to which standardized screening and linkage to treatment interventions can be feasibly integrated into an existing home visiting program and implemented with fidelity by paraprofessional home visitors.