Early Head Start Home Visitor's Identification of Risk for Maltreatment

Child maltreatment has a profound impact on healthy child and family development and is associated with numerous detrimental outcomes that persist across the lifespan (Cicchetti & Toth, 2005; Shonkoff & Garner, 2012).  Infants and toddlers enrolled in Early Head Start (EHS) are at increased risk for maltreatment due to the presence of numerous risk factors, such as poverty, parental mental health problems, and developmental disability (e.g., Belsky, 1993; Bronfenbrenner, 1979).  It is critical to identify and ameliorate these risk factors prior to the occurrence of maltreatment.

Within EHS, home visitors are in a unique position to identify the families most likely to experience maltreatment, given their access to at-risk families in their homes.  While the goals of EHS aim to promote healthy family functioning, prevention of maltreatment is not a primary program outcome; thus, there is limited knowledge on how EHS and its home visitors identify and prevent risk for maltreatment.  Research has demonstrated that home visitors are often ill-equipped to identify and address risk factors that are highly associated with maltreatment, such as parental mental health concerns, substance abuse, and domestic violence (Azzi-Lessing, 2011; Tandon et al., 2008).  Further, little is known about whether home visitors recognize the association between those risk factors and maltreatment.

Home visitation has been identified as an effective strategy for reducing child maltreatment, through increased access to at-risk families with the aim of identifying individual needs and providing targeted, multidisciplinary services (e.g., Howard & Brooks-Gunn, 2009).  Though there is clear potential for EHS to prevent and reduce maltreatment through enhancement of healthy family functioning, the role that home visitors play in this process has not been examined.  The current study uses qualitative methodology to identify how EHS home visitors understand and determine risk for maltreatment and work with families once risk has been identified.

Participants include EHS home visitors and supervisors (n = 17) employed by an EHS home-based program in southeastern Nebraska, ranging in age from 25 to 60 with three to five years of experience.  Semi-structured interviews focused on how home visitors understand and conceptualize maltreatment, factors that lead home visitors to have concern for the families with whom they work, and how they work with families they have identified as at-risk will be conducted.  Participants will be asked to read three vignettes and respond to open-ended questions.  Implications for how EHS can train home visitors, engage families, and deliver program and community-based services in a manner that reduces risk for and prevents maltreatment will be discussed.