Can Home Visits from Nurses Prevent Family Violence?

It’s been established in the literature that home visitation through Nurse Family Partnership (NFP) programs can result in improved health-related behaviors, maternal life course development, and prenatal care of children. But researchers believe that the potential exists for greater benefits from these programs; specifically, in helping to prevent intimate partner violence (IPV).

Speaking at the AACAP 57th Annual Meeting in New York, NY, Harriet McMillan, MD, of McMaster University in Ontario, Canada discussed efforts that are underway to develop a specific intervention aimed at reducing IPV using the nurse family partnership model. Aimed at first-time mothers who are socially disadvantaged, the NFP program consists of home visits by nurses that begin prenatally and extend until the child turns two years old, with visits starting on a weekly basis and gradually scaling down to monthly visits, based on the individual’s progress, according to data published in The Lancet.

“The idea is that the nurse helps the mother to more effectively care for herself and her own needs, which then translates to improved care of the child,” said McMillan, who, along with researchers from a handful of other institutions, is looking to improve existing methods—primarily by building trust between the nurse and mother.

Results from three major trials spanning nearly 20 years have shown that NFP programs can lead to improvements in women’s prenatal health, a reduction in child injuries, fewer pregnancies, greater intervals between births, increases in paternal involvement, increases in employment, reductions in welfare reliance, and improvements in school readiness, according to a study published in the Archives of Pediatrics & Adolescent Medicine. Of those trials, two found a benefit in child maltreatment and associated outcomes, including a 48% reduction in reports of abuse or neglect.

Where data is lacking, however, is on the effectiveness of interventions for IPV; specifically, interventions provided in the health care setting, said McMillan. Although some evidence exists suggesting that advocacy-based interventions and/or coordinated services can assist women already seeking help (such as those in shelters), success seems to vary according to the type and intensity of intervention.

Through a five-year study funded partially through a CDC grant, researchers McMaster University, along with several other organizations, are working to develop an NFP model to prevent IPV that can be incorporated on a larger scale by applying and testing several different strategies.

The first part of the mixed method study involves reviewing current literature and conducting qualitative interviews with nurses, clients, and other stakeholders to help design the intervention, while part 2 will consist of conducting randomized clinical trials in 10 NFP sites. The interviews, according to McMillan, were “very helpful” in terms of providing useful feedback. Researchers learned that most clients highly value their relationship with the nurse, but are still reluctant to disclose IPV to them for a number of reasons, including fear of losing custody of children. They also learned that nurses expressed feelings of inadequacy in responding to client concerns, and stakeholders reported potential barriers to IPV prevention, such as financial resources, cultural beliefs about marriage, and language barriers.

From these findings, researchers determined that nurses should be instructed on how to provide tailored interventions based on a patient’s specific needs; however, at the same time, universal assessment information should also be made available in the form of clinical documents.

Finally, the next stage of the project, according to McMillan, is to conduct clinical trials comparing the current NFP model with the proposed enhanced model to ensure optimal results.