L2b

ENHANCING THE IMPLEMENTATION SYSTEM TO STRENGTHEN THE IMPACT OF HOME VISITING IN PREVENTION OF HARSH PARENTING

Presenters: Anne Duggan

Abstract Category: Research 

Instruction Level: Beginner

Presentation: Click Here

Description:      

This presentation will describe how and why a cognitive retraining protocol is being implemented in Hawaii’s Healthy Start program.

Abstract:

Hawaii’s original Healthy Start Program (HSP) model has been disseminated in 39 states. It comprises: 1) population-based screening/assessment to identify at-risk families of newborns; and 2) home visiting by trained paraprofessionals and linkage with primary care and other services to reduce malleable risks for child maltreatment, prevent maltreatment, and promote child health and development.  Currently, home visitors receive training on how to work with families based on several core concepts (e.g., parenting education, role modeling and positive reinforcement to promote positive parenting).  Recent findings have called into question the HSP’s effectiveness in preventing child maltreatment and promoting positive parenting in at-risk families of newborns. 

Research has identified aspects of the program model and implementation system that compromise program effectiveness:  underspecification of the service model, and inadequacies in home visitor training and supervision. 

This protocol addresses the need to refine HSP in light of these findings. The refinement involves the addition of a cognitive reframing component to the HSP to prevent child abuse and emotional neglect by reducing acts of harsh parenting and increasing the quality of parent child interactions. The cognitive reframing component, developed by Bugenthal and colleagues aims to teach parents skills to read their children’s cues accurately and to decrease inappropriate cognitive attributions about their children’s actions (e.g., their child is doing “x” simply to challenge parental authority). The cognitive reframing component involves changes to the HSP model and changes to the HSP implementation system. 

For the model, the component includes an explicitly defined cognitive reframing protocol that specifies actions to be performed during home visits. 

For the implementation system, the component includes adding a criterion measure for staff acquisition of necessary skills to carry out the protocol and a fidelity monitoring mechanism to assure that the protocol is carried out faithfully in each home visit.