Perceptions of child health nurses on the targeted Family C.A.R.E home visiting program for families with vulnerabilities

Nicole Latham

doi:10.25907/00462

Despite the wide use of home visiting programs used to support families with identified vulnerabilities, there is limited evidence to date of the effectiveness of the programs used within the participating hospital and health services in Queensland, Australia. One of these programs, the Family C.A.R.E program, was developed to target families with infants at risk of poor health outcomes and for mothers at high risk of domestic violence. Since this time, the Family C.A.R.E programs have been adapted by hospital and health services and there has been a paucity of research into the variation of home visiting models across Queensland health services. This research study was performed in two phases. In Phase One a comparative analysis was conducted of documents related to the adapted targeted home visiting programs against the original Family C.A.R.E program to evaluate the key elements of the programs, including program aims, target group and eligibility criteria, theoretical or conceptual frameworks, and outcome measures. Phase Two explored the Sunshine Coast Hospital and Health Service child health nurses’ perceptions on how the Family C.A.R.E program model within the Sunshine Coast Hospital and Health Service is being used. This exploration included the intentions and anticipated outcomes, and the strength and limitations of the program in meeting the needs of families with vulnerabilities. Phase One identified a considerable variation from the original program across the different hospital and health services involved in the introduction of the Family C.A.R.E. program across Queensland, Australia, with only one of the adapted home visiting models aligning closely to the original Family C.A.R.E program. This empirical evaluation demonstrated consistency with evidence from the scoping review and the documentation analysis that home visiting programs are poorly evaluated; only one of five health and hospital services had undertaken any evaluation of the adapted program. The adapted models used also had broad intentions or aims which made it difficult for any assessment on whether the models were achieving intended outcomes. Phase Two identified the child health nurses’ understanding of the Sunshine Coast’s adapted Family C.A.R.E. program intentions and outcomes, and the three key themes of its use in practice; the establishment of relationships, what works in practice, and we could do it better, of the Family C.A.R.E. program. Study results reaffirmed previous findings which have informed effective home visiting programs, as well as new evidence such as the difficulties of maintaining a sustained home visiting program within a universal child health framework. Other limitations that were identified within the adapted Family C.A.R.E. program include the narrow eligibility criteria, inadequate duration of the program to meet family needs, and the lack of program structure and flexibility with the schedule of visits. The large variation within adapted programs from the original Family C.A.R.E. program across Queensland, and the highlighted limitations of the Sunshine Coast’s adapted model, illustrate the lack of an evidence-base to inform best practice home visiting programs. Limited evaluation has contributed to model stagnation, which have often been adapted to meet service needs rather than outcomes for families, further contributing to a paucity of good quality evidence to support measurable outcomes for home visiting programs. This study highlights the need for further research in sustainable home visiting programs across Queensland to ensure that programs that are used to support families are evidenced-based and able to facilitate measurable outcomes to reduce the gap of disadvantage for families with vulnerability.

Perceptions of child health nurses on the targeted Family C.A.R.E home visiting program for families with vulnerabilities

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