child maltreatment prevention and the power of the home visitor

Child Maltreatment Prevention and the Power of the Home VisitorMADELINE DUHAIME MCCLURE, LCSWEXECUTIVE DIRECTOR, TEXPROTECTS, THE TEXAS ASSOCIATION FOR THE PROTECTION OF CHILDREN | DALLAS, TXAPRIL 5, 2014

About TexProtectsMembership-based Statewide Advocacy Organization7,400 + members statewide

Advocate on behalf of abused and neglected children in 3 core areas:Investments in proven Child Abuse Prevention programs.Improvements to Child Protective Services and systems that impact abused children. Improvements to programs that heal victims.

Over the past 10 years, TexProtects has led and/or assisted the passage of 37 bills, including 2 omnibus bills, and has secured over $71 million in state funds for evidence-based home visiting services.

University of Phoenix Stadium: 63,400 Capacity

42,091 Unduplicated Reports of Abuse in 2012.

Child Maltreatment in Arizona

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5,00010,00015,00020,00025,00030,00035,00040,00045,000

0

6,999 5,863 4,326 3,895 3,439 3,7735,991

8,652 10,039

36,15039,176 37,546

34,537 34,690 35,121 33,228 34,17837,252

42,091

10-Year Trend

Confirmed Reports (Unduplicated)

KIDS COUNT Data Center. (2013). Arizona Indicators. Retrieved from http://datacenter.kidscount.org/data#AZ/2/0.

http://datacenter.kidscount.org/data#AZ/2/0

http://datacenter.kidscount.org/data#AZ/2/0

Child Victim Rate per 1,000 Children

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

2

4

6

8

10

12

14

3.3

4.83.9

2.7 2.4 2 2.2

3.7

5.46.2

12.2 12 12.1 12.1

10.69.5 9.3 9.3 9.2 9.2

Arizona Rate per 1,000 Linear (Arizona Rate per 1,000)National Rate per 1,000 Linear (National Rate per 1,000)

U.S. Department of Health and Human Services, Administration on Children, Youth and Families. (2013). Child maltreatment 2012. Washington, DC: US Government Printing Office. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2012.

Child Maltreatment Fatalities: 10-Year Trend

2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

10

20

30

40

50

60

70

80

37 40

50

6065

51

6470 71 70

Fatalities Linear (Fatalities)

In 2012, 70 children in Arizona died due to abuse and neglect.

The Arizona child population grew by 11.5% while child abuse fatalities increased an astounding 89.2% from 2003 to 2012.

KIDS COUNT Data Center. (2013). Arizona Indicators. Retrieved from http://datacenter.kidscount.org/data#AZ/2/0.

Victims by Age (2012)2094, 21%

2066, 21%

1744, 17%

1305, 13%

1052, 10%

1745, 17%

33, 0%

Under 1

1-3 years

4-6 years

7-9 years

10-12 years

13-17 years

age unknown

Children ages birth to 3 make up 42% of confirmed cases of abuse.

U.S. Department of Health and Human Services, Administration on Children, Youth and Families. (2013). Child maltreatment 2012. Washington, DC: US Government Printing Office. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2012.

Victims by Gender & Type (2012)

50.6%49.2%

0.2%

Male Female Unknown

87%

9%

0% 3%

Neglect Physical Emotional Sexual

Quick FactsAccording to the U.S. Department of Health and Human Services, over 80% of all child victims of maltreatment are victims of neglect1/3 if all child maltreatment victims are under the age of four It is often difficult to prevent abuse once it has already occurred, especially neglect, therefore the prevention of abuse and neglect is key.*

*MacMillan, H., Thomas, B., Jamieson, E., et al. (2005). Effectiveness f home visitation by public health nurses in prevention of the recurrence of child physical abuse and neglect: A randomized controlled trial. Lancet, 365 (9473), 1786-1793.

The Importance of the Early Years and Consequences for At-Risk Children

Why Are the Early Years Critical? 1. Our environment as young children influences genetics (Epigenetics)

2. The first five years are critical for brain development◦ The brain develops about 700 synapses per second (neural connections that transmit

information)◦ Brain circuits used are strengthened; those not utilized diminish (Developmental

Neuroscience)

Garner, A. (2013). Translating Developmental Science into Healthy Lives: Realizing the Potential of Pediatrics [PowerPoint Slides].

*Eco-Bio-Developmental Model of Health and Human Disease*“Ecology becomes biology and together they drive development across the lifespan”

-Andrew Garner, M.D., Ph.D., FAAP

Major Milestones in Brain Development

Pew Center on the States Home Visitation Campaign. (2000). [image adaptation] Nelson, C.A. (2000). In Jack P. Shonkoff and Deborah A. Phillips (Eds.), From Neurons to Neighborhoods: The Science of Early Childhood Development (p. 188). Washington, DC: National Research Council and Institute of Medicine, National Academy Press.

Brain Synapse Formation by Age(700 synapses per second during the early years)

What is Toxic Stress? “Strong, frequent, and/or prolonged activation of the body’s stress-response system in the absence of the buffering protection of a supportive, adult relationship.” Shonkoff & Garner (2012)

Shonkoff, J., & Garner, A. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1). 232-246.

Toxic Stress Root of adult physical and mental health issues Result of early exposure to risks:Child MaltreatmentParental DepressionParental Substance AbuseFamily ViolenceIncarcerated Parent

Slide from Brenda Jones Harden. (2014). Home Moments: Home Visiting to Address Toxic Stress [PowerPoint Slides]. Retrieved from https://s3.amazonaws.com/v3-app_crowdc/assets/events/LIcoEjkC8i/activities/Brenda_Jones_HardinPPT.original.1390919299.pdf.

Childhood Adversity has Lifelong Consequences.

Significant adversity in childhood is strongly associated with unhealthy lifestyles and

poor health decades later

Critical Concept:

ACE Categories Women Men Total

Abuse (n=9,367)(n=7,970)(17,337)◦ Emotional 13.1% 7.6% 10.6%◦ Physical 27.0% 29.9% 28.3%◦ Sexual 24.7% 16.0% 20.7%

Household Dysfunction◦ Mother Treated Violently 13.7% 11.5% 12.7%◦ Household Substance Abuse 29.5% 23.8% 26.9%◦ Household Mental Illness 23.3% 14.8% 19.4%◦ Parental Separation or Divorce 24.5% 21.8% 23.3%◦ Incarcerated Household Member 5.2% 4.1% 4.7%

Neglect*◦ Emotional 16.7% 12.4% 14.8%◦ Physical 9.2% 10.7% 9.9%* Wave 2 data only (n=8,667) Data from www.cdc.gov/nccdphp/ace/demographics

1:4!

1:4!


ACES in Arizona and Nationwide

0 ACE 1 ACE 2 ACE0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

42.50%

26.40%31.10%

52.10%

25.30% 22.60%

Percentage of Children 0-17 Years of Age in Arizona and Nation with ACE

Arizona Nation

Defining Adversity or StressPositive Stress

◦ Brief, infrequent, mild to moderate intensity◦ Most normative childhood stress

◦ Inability of the 15 month old to express their desires◦ The 2 year old who stumbles while running◦ Beginning school or daycare◦ The big project in middle school

◦ Social-emotional buffers allow a return to baseline(responding to non-verbal clues, consolation, reassurance, assistance in planning)

◦ Builds motivation and resiliency◦ Positive Stress is NOT the ABSENCE of stress


Defining Adversity or StressToxic Stress

◦ Long lasting, frequent, or strong intensity◦ More extreme precipitants of childhood stress (ACEs)

◦ Physical, sexual, emotional abuse◦ Physical, emotional neglect◦ Household dysfunction

◦ Insufficient social-emotional buffering(Deficient levels of emotion coaching, re-processing, reassurance and support)

◦ Potentially permanent changes and long-term effects◦ Epigenetics (there are life long / intergenerational changes in how the genetic

program is turned ON or OFF)◦ Brain architecture (the mediators of stress impact upon the mechanisms of brain

development / connectivity)


Impact of Early Stress

Chronic “fight or flight;” adrenaline / cortisol

Changes in Brain Architecture

Hyper-responsive stress response; calm/coping

CHILDHOOD STRESS


Outcomes of High-Risk Children: Impact of ACES

Be Arrested for a Violent Crime

Become a Juvenile Deliquent

Never Attend College

Drop Out of School

Become Pregnant as a Teenager

Have School Related Problems

Become Involved with Drugs

Face Learning Disorders Requiring Special Ed

70%

59%

60%

25%

40%

50%

50%

66%

Barnett, W.S., & Masse, L.N. (2002).; Swan, N. (1998).; Campbell, F. A., et al. (2002).; Widom, C., & Maxfield, M. (2001); Reynolds, A., et al. (2001)

Cost of Doing Nothing: CDC Lifetime Costs of CA/N

1%

99%

Average lifetime cost per fatal victim: $1,272,900

$60

$20,000,000,060

$40,000,000,060

$60,000,000,060

$80,000,000,060

$100,000,000,060

$120,000,000,060

$140,000,000,060 U.S. lifetime cost from one year of child

maltreatment

Fatal victims medical costsFatal victims productiv-ity lossesSurvivors special ed-ucation costsSurvivors criminal justice costsSurvivors child welfare costsSurvivors long-term healthcare costsSurvivors short-term healthcare costsSurvivors productivity losses

69%

16%

5%4% 3% 4%.

Average lifetime cost per survivor: $210,012

Nearly $124 billion

The Success of Family Support Home Visiting ProgramsREDUCING CHILD MALTREATMENT AND BUFFERING THE EFFECTS OF TOXIC STRESS CAUSED BY ADVERSE CHILDHOOD EXPERIENCES

Mothers can learn to better care for themselves and have healthier relationships with the father:

Outcomes of Home Visiting Programs

Months on Welfare and Using Food Stamps, Months on Medicaid, Arrests and Convictions, Days in Jail, Prenatal Smoking, Prenatal Hypertension, Depression, Domestic Violence

Months Mothers Employed, Education and Job Training, Rates of Living with Father, Spacing Between Child Births

Parents also can learn how to better care for their children:


Child Abuse and Neglect, Out of Home Placements, Child Injuries, Safety Hazards in Home, Parenting Harshness

Father Involvement, Parenting Sensitivity and Interaction with Child, Parenting Knowledge, Stimulating Home Environment

Which ultimately can lead to better outcomes for children:


Premature Deliveries, Neurodevelopmental Impairment, Language/Cognitive Delays, Psychological Maladjustment, Juvenile Arrests and Adjudication

Birth Weights, Child Health, Child Behavior, School Readiness, Academic and Cognitive Performance

NFP-Evidence of Child Abuse ReductionStudy Methodology

Design: Randomized Controlled Trial; Elmira, New York

Objective: To examine the long-term effects of NFP on women’s life course and child abuse and neglect.

Participants: 400 pregnant women with no previous live births. 324 participated in the follow-up 15 years later. There were 4 treatment conditions:

Treatment 1: Provided sensory and developmental screening at 12 and 24 months of age Treatment 2: Provided screening services offered in treatment 1, plus free transportation for prenatal and well-child care through the child’s 2nd

birthday Treatment 3: Provided screening and transportation services offered in treatment 2; in addition to being provided a nurse who visited them in

the home during pregnancy Treatment 4: Provided same services offered in treatment 3 but the nurses continued to visit through the child’s 2nd birthday

Follow-up: 15 Years after birth of first child

Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278(8), 637-643.

NFP-Child Abuse Prevention Outcomes

Dependent Variables Treatment 1 and 2

Treatment 3 Treatment 4 Treatment 1 &2 vs. 4 (95% CI)

Substantiated Reports of Child Abuse and Neglect

0.54 0.35 0.29 0.77* (0.34 to 1.19)

Incidence

Whole Sample

Dependent Variables Treatment 1 and 2

Treatment 3 Treatment 4 Treatment 1 &2 vs. 4 (95% CI)

Substantiated Reports of Child Abuse and Neglect

0.53 0.63 0.11 1.61* (0.87 to 2.35)

Incidence

Low-SES Unmarried Sample

* P=<0.01 (P=<0.05 equals statistical significance)

During the 15-year period after the birth of their first child, in contract to the comparison group, women who were visited by nurses during pregnancy AND infancy were identified as perpetrators of abuse significant less often (0.29 vs. 0.54 verified reports).

Results are even more significant for the low-SES unmarried sample (0.11 vs. 0.53).


Level 1: Universal Triple P/ Targets ALL parentsMedia-based Parent Information Campaign

Level 2: Selected Triple P / Targets 60% of parentsBrief Selective Intervention (e.g., Family practitioners provide information; Large group seminars)

Level 3: Primary Care Triple P /Targets 33% of parents Narrow Focus Parent Training (e.g., therapy sessions, telephone calls, group sessions)

Level 4: Standard & Group Triple P / Targets 9% of parentsBroad Focus Parent Training (similar to levels 2 & 3 - more intense interactions))

Level 5: Enhanced Triple P / Targets 2% of parentsBehavioral family intervention (intense, individually tailored, adds home visits)

POSITIVE PARENTING PROGRAM-TRIPLE P

Triple P-Study MethodologyDesign: Population Level Randomized Controlled Trial; 18 counties in South Carolina

Objective: To evaluate the impact of implementing Triple P with the existing workforce on population indicators related to child maltreatment (i.e., rates of substantiated child maltreatment, child out-of-home placements, and child hospitalizations and ER visits for maltreatment injuries).

Participants: 18 counties in South Carolina. 9 counties received System Triple P while the 9 received SAU.In addition, dissemination involved Triple P Professional training for the existing workforce (649

service providers). This training was 2-3 days.

Follow-up: 1 year

Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12.

Triple P Outcomes-Evidence of Child Abuse Reduction

Pre-Intervention

Post-Intervention

Pre-Intervention

Post-Intervention

Statistical Significance

Effect Size

Substantiated CM 10.86 11.74 11.12 15.06 P<0.03 1.09Out-of-home Placements

4.27 3.75 3.10 4.46 P<0.01 1.22

Child CM Injuries 1.73 1.41 1.41 1.69 P<0.02 1.14

Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12.

Triple P Counties Control Counties

35% reduction in hospitalizations and emergency room visits for child injuries 44% reduction in out-of-home placements 28% reduction in substantiated cases of abuse

SafeCare-Study MethodologyDesign: Randomized Controlled Trial; Scaled-up statewide trial in Oklahoma

Participants: Participants in 6 regions (2175). Randomized to receive SafeCare or Services as Usual (SAU)

Objective: The study was designed to compare maltreatment recidivism (recurrence) between participants who were referred by CPS to home-based SafeCare services or to comparable home-based services, but without SafeCare modules (SAU)

Follow-up: Approximately 6 years

Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012). A statewide trial of the SafeCare home-based services model with parents in child protective services. Pediatrics, 129(3), 509-515.

SafeCare-Outcomes

Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012). A statewide trial of the SafeCare home-based services model with parents in child protective services. Pediatrics, 129(3), 509-515. doi: 10.1542/peds.2011-1840

Recidivism of child abuse occurred less frequently (26%) for those who received SafeCare home visiting compared to SAU.

The SAU group received home-based services comparable to SafeCare but without the SafeCare modules. It is likely the effect size would have been even larger is the SAU would have been weaker or meant no services were provided.

According to the study findings, a home-based service system treating 1,000 cases could prevent 64-104 estimated first-year recurrences of abuse by adopting the SafeCare model.

Healthy Families-Study MethodologyDesign: Randomized Controlled Trial; New York

Objective: To evaluate the effects of Healthy Families on parenting behaviors in the first 2 years of life

Participants: 1173 families at-risk for child abuse and neglect; Participants were assigned to HFNY or control group (received information and referrals to other services).There was a subgroup, which included first-time mothers under the age of 19 who were enrolled in

HFNY at 30 weeks of pregnancy The remaining women were referred to as the “diverse subgroup”

Follow-up: 2 years

DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32(3), 295-315.

Healthy Families-Outcomes Prevalence

Year 2

P valueControl HFNY

% Confidence Interval % Confidence Interval

Minor Physical AggressionPrevention Group

70.02

57.80.3

51.04

38.6-63.4

0.02

Psychological AggressionPrevention Group

81.08

69.3-89.1

73.92

61.1-83.7

ns

Harsh Parenting (past week)Prevention Group

61.93

48.7-73.6

40.95

29.2-53.8

0.02

Substantiated Abuse or NeglectPrevention Group

7.42

3.3-15.9

3.36

1.1-10.2

ns

DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32(3), 295-315.

At the child’s second year of life, participants (mothers) in HFNY reported significantly fewer acts of physical aggression % harsh parenting

Lower levels of CA/N during first and second year of life but it was not statistically significant

Mother’s abusive and neglectful parenting behaviors toward children by treatment group: Prevention subgroup

Nurturing Parenting Program-Study Methodology

Design: Quasi-Experimental; Louisiana

Objective: To examine the relationship between NPP dosage and child maltreatment

Participants: 528 caregivers who attended the NPP in ten family resource centers across Louisiana's child welfare population between Oct. 2005 and April 2008. NPP was offered to all families with children under 6 with child abuse and/or neglect allegations

Follow-up: 6 months and 2 years

Maher, E. J., Marcynyszyn, L. A., Corwin, T. W. & Hodnett, R. (2011). Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment. Children and Youth Services Review, 33, 1426-1434.

Nurturing Parenting Program-Outcomes

Maltreatment report within 6 months after NPP Substantiated maltreatment report within 2 years after NPP

0%

5%

10%

15%

20%

25%

18%20%

11%13%

Likelihood of Child Maltreatment at Two Time Periods after NPP Partic-ipation

3 NPP Session 18 NPP Sessions

Maher, E. J., Marcynyszyn, L. A., Corwin, T. W. & Hodnett, R. (2011). Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment. Children and Youth Services Review, 33, 1426-1434.

Home Visiting to Prevent Child Maltreatment-Starts at PregnancyHome Visitors are in a unique position to prevent child abuse and neglect in the home, as they are in the home during critical developmental periods of the childHome-visitors need to assess for safety of the environment of the client

during pregnancy: Most dangerous time for IPV

When a young woman becomes pregnant before she’s ready to take care of a child, the risk factors for the entire family escalates. She may have a family background of low wages, welfare, or worse-an abusive pattern that , without intervention, she may be fated to repeat.

“Terrible things can be prevented and good things can be made to happen with the involvement of home visitors with these families early in their lives.” Quote from David Olds, PhD, Founder of Nurse-Family Partnership.

Home Visiting to Prevent Child Maltreatment: Home Safety HV can identify hazardous objects in the home and improve the

overall safety of the home environmentDemonstrate and teach safe behaviors including safe sleep, car seat

safetyPillows, blankets and stuffed animals should be removed from the

crib to prevent babies from suffocating. Covers, pillows, bumper pads, positioning devices, soft mattresses

and toys in the crib are associated with the risk of sudden infant death syndrome, a common concern among parents of infants.

Immediate feedback opportunity to provide families critical guidance

Home Visitor Breaking Cycle of MaltreatmentPhysical, emotional abuse and neglect are often a cycle: many children grow up with parents who were mistreated themselves and don’t know how to parent any differently.If parents don’t know what’s appropriate discipline and what’s inappropriate, they might not identify their own parent’s parenting practices as inappropriate-May think ignoring a crying child or spanking an infant is normal “discipline”.Neglect is the most common type of child maltreatment such as putting/leaving a child in a dangerous situation, or not meeting the basic physical and emotional needs of a child.

Reducing Physical AbuseOne of the most important tips Home Visitors pass on to young parents is that if a baby is crying inconsolably, it’s OK to take a time out and emotionally regroup.Mothers consider quieting and comforting the baby as her “job” —if they can’t, they feel there’s something wrong with them.Important to tell Mom’s and Dad’s it’s OK to put the baby down in a safe place and walk away.

Period of PURPLE Crying, and give them strategies for managing stressful periods when the baby just will not stop fussing.

Peak of CryingUnexpectedResists SoothingPain-like FaceLong LastingEvening

http://purplecrying.info/



Reducing Physical AbuseThe Period of PURPLE Crying is an acronym that explains that crying is a normal part of every infant’s development from about 2 weeks of age until about 3 to 4 months of age.

Teaching young moms and dads that babies are born to cry: That they may cry X many hours a day, it normalizes crying, so it can reduce stress.

Home Visitors can minimize shaken baby syndrome (form of abusive head trauma and inflicted traumatic brain injury often resulting from violently shaking an infant).

Peak of CryingUnexpectedResists SoothingPain-like FaceLong LastingEvening

Promoting Parent-Child Interaction to reduce child maltreatment riskPIVOT (Victor Bernstein)

Use family stressor to transition parent to focus on infant’s development

Focus on parental affect and infants’ response to affect

Use cognitive-behavioral strategies to address negative mood/behavior

Explore parents’ early childhood experience with parents

Address psychological significance of child to parent

Use moment-to-moment interactions to promote parental attunement

Help parents find joy in interaction with infant!

Slide from Brenda Jones Harden. (2014). Home Moments: Home Visiting to Address Toxic Stress [PowerPoint Slides]. Retrieved from https://s3.amazonaws.com/v3-app_crowdc/assets/events/LIcoEjkC8i/activities/Brenda_Jones_HardinPPT.original.1390919299.pdf.

Parent-Child Interaction: The Importance of PlayFollow child’s lead

Use interactive toys

Use toys/objects in the home

Engage in symbolic play

Narrate play

Introduce turn-taking

Express positive emotions

Identify teachable interactions

Address developmental benefits

Use self-expression/cultural activitiesSlide from Brenda Jones Harden. (2014). Home Moments: Home Visiting to Address Toxic Stress [PowerPoint Slides]. Retrieved from https://s3.amazonaws.com/v3-app_crowdc/assets/events/LIcoEjkC8i/activities/Brenda_Jones_HardinPPT.original.1390919299.pdf.

Home Visitors Power to Prevent Abuse/Neglect

Home visitors act as advocates by making the topic of abuse and neglect a common discussion in home visitation.

“If we’re not educating and advocating about the prevalence of child abuse for the 0-3 population, then we have no chance at preventing it. People don’t make perfect decisions in the heat of the moment, but if they can have some education and awareness of child abuse, I think they’re more sensitive in their response, or are more prone to ask for help.” Texas Home Visitor

The Power of the Home VisitorHelp teach parents appropriate developmental milestones of children, which in turn can limit unrealistic expectations of children that often can lead to child maltreatment (potty training, communication, etc.)Educate parents on proper feeding, mirroring, playtime to enhance healthy attachment reduce RADTeach parents stress management and emotional refueling, self care.Help teach parents the importance of a stimulating home environment and Instructing parents on the importance of speaking to the baby to reduce cognitive delays and deficits decreasing neglectThe home visitor cannot underestimate the power of role playing as a top teaching aid with the parent and the power of modeling behavior and interactions with the baby and family members, demonstrating self-care, organization, stress management and establish a trusting relationships.

Contact Information Madeline McClure, LCSW

Executive Director

TexProtects, The Texas Association for the Protections of Children

[email protected]

214-442-1672

2904 Floyd St., Suite C Dallas, TX 75204

mailto:[email protected]

References Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012). A statewide trial of the SafeCare home-based services model with parents in child protective services. Pediatrics, 129(3),

509-515. doi: 10.1542/peds.2011-1840

Child and Adolescent Health Measurement Initiative (2013). “Overview of Adverse Child and Family Experiences among US Children.” Data Resource Center, supported by Cooperative Agreement 1 U59 MC06980 01 from the U.S. Department of Health and Human Services, ‐ ‐ ‐Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Available at www.childhealthdata.org. Revised 5/10/2013.

DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32(3), 295-315. doi:10.1016/j.chiabu.2007.07.007


Harden, B. J. (2014). Home Moments: Home Visiting to Address Toxic Stress [PowerPoint Slides]. Retrieved from https://s3.amazonaws.com/v3-app_crowdc/assets/events/LIcoEjkC8i/activities/Brenda_Jones_HardinPPT.original.1390919299.pdf.

MacMillan, H., Thomas, B., Jamieson, E., et al. (2005). Effectiveness f home visitation by public health nurses in prevention of the recurrence of child physical abuse and neglect: A randomized controlled trial. Lancet, 365 (9473), 1786-1793.

Maher, E. J., Marcynyszyn, L. A., Corwin, T. W. & Hodnett, R. (2011). Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment. Children and Youth Services Review, 33, 1426-1434. doi: 10.1016/j.childyouth.2011.04.014


Prinz, R. J., Sanders, M. R., Shapiro, C. J., Whitaker, D. J., & Lutzker, J. R. (2009). Population-based prevention of child maltreatment: The U.S. Triple P system population trial. Prevention Science, 10(1), 1-12. doi:10.1007/s11121-009-0123-3

Shonkoff, J., & Garner, A. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1). 232-246.

U.S. Department of Health and Human Services, Administration on Children, Youth and Families. (2013). Child maltreatment 2003-2012. Washington, DC: US Government Printing Office. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment.

child maltreatment prevention and the power of the home visitor

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