• By Laura Whybra
  • Posted on Thursday 21st November, 2013

Volunteer home visitors: a cheaper option?

strong>Vulnerable new mothers can become better parents thanks to home visiting – at least when the visitors are specialist nurses. Could parents of young children also be helped by volunteers with only a few days of training? A new Dutch study suggests that volunteer visitors could be a useful addition to government arsenals.Family Nurse Partnership (FNP) is one of the most well-known programs for young, first-time mothers in the US and the UK. It’s also one of the programs most strongly supported by evidence from randomized control trials and by large amounts of program data from over 80 sites.And it’s an intensive program. Specialist nurses visit teenage mothers from pregnancy through their child’s second birthday. The program is carefully structured and closely monitored. While FNP (called NFP in the US) has been found to be cost-effective, the upfront costs are also relatively high. The yearly cost for delivering FNP in the UK is between £2500 and £3600, with a higher average in the first year attributed to set-up costs. So if commissioners want to add less expensive family visiting programs to the arsenal, what are good alternative options? According to a recent study from the Netherlands, Home-Start is worth a closer look. Volunteer visitorsHome-Start costs on average £1000 a year to deliver in the UK. The program keeps costs low by using volunteers for home visits. Parent volunteers with no professional parenting support experience are trained for three days, with periodic booster sessions and supervision by local coordinators. The goal is to improve the well-being, confidence, and social relations of at-risk mothers. By building parental competence and encouraging adaptive parenting styles, the program aims to have a positive influence on child behavior and development.The program is more flexible than programs that follow a manual (like Family Nurse Partnership). The length and content of the visits vary depending on the mother’s needs. It is also shorter than FNP, typically lasting less than a year. And the two programs target different groups. Where FNP is designed for mothers under age 20, Home-Start is also used with older parents. FNP starts with pregnancy, while Home-Start can begin when the children are anywhere from birth to six years old.New evidence from the NetherlandsPrevious research on Home-Start has found that the program improves mothers’ well-being and stress levels. However, there is less robust evidence for how long lasting the changes are, and how the program influences children’s behavior.The Dutch investigators, using a quasi-experimental design, evaluated the Home-Start program over four years. They aimed to answer, first, how changes in the mother endured over time, and second, how the program impacted child behavior. The study compared maternal characteristics, parenting style, and child behavior over time in three groups: mothers who received Home-Start (the Home-Start group), mothers who had similar levels of stress but received no support (the comparison group), and mothers who reported no need for intervention (the community group). Data were collected five times over four and a half years. The study found that at both follow-up points, mothers who received Home-Start reported improvements in their parenting style, confidence, well-being, and life satisfaction. The mothers in the comparison and community groups showed no significant change on these measures.On the measures of child behavior, both the mothers who received Home-Start and those in the comparison group reported significant positive change in their children’s externalizing behaviors. The Home-Start mothers reported slightly more improvement at the second follow-up. The Home-Start group also reported improvements in children’s emotional problems. Next steps for researchOverall, it’s a good result for the Home-Start program. But the study has its limitations. Because it was a quasi-experimental design, the Home-Start and comparison groups were different on a number of background characteristics. The rate of retention was also a concern. The study started with 59 families in the Home-Start group and 56 in the comparison group. It finished with only 33 in the Home-Start group, compared to 45 in the comparison group. The worry is that perhaps the most troubled families in the Home-Start program dropped out, making the average results of the Home-Start program look better than they would have been if more families had continued in the program.Finally, the lack of structure within Home-Start made it difficult to tease out the important components of the social support and therefore harder to explain and evaluate the change in the mother and the child. More structure and routine monitoring make it easier for data to be collected and analyzed – but a less structured approach may also be effective for the people who need support. In conclusion, the evidence for long-term change in child and maternal functioning following Home-Start makes a provisional case that less structured, less costly interventions may be a good complement to structured programs in supporting at-risk mothers and protecting children from poor behavioral outcomes. ************Reference: Hermanns, J. M. A., Asscher, J. J., Zijlstra, B. J. H., Hoffenaar, P. J., & Dekovic, M. (2013) Long-term changes in parenting and child behavior after the Home-Start family support program. Children and Youth Services Review. 35, 678-684.

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