Francine Jacobs

Limiting Home Visiting Effects: Maternal Depression as a Moderator of Child Maltreatment

OBJECTIVE: To test, with a sample of adolescent mothers (16–20 at childbirth) and their first-born infants/toddlers (average age 1 year), whether the impact of a home visiting (HV) child maltreatment prevention program was moderated by maternal depression. METHODS: The study design was a randomized controlled trial of Healthy Families Massachusetts, a statewide child maltreatment prevention program. A total of 707 first-time mothers were randomly assigned to the HV or control group. The HV group received visits from paraprofessional home visitors. Mothers in the control group were referred to other service providers. The outcome variable consisted of state Child Protective Services reports of child abuse and neglect (mother or other person as perpetrator). Maternal depression was assessed by maternal report (Center for Epidemiologic Studies-Depression questionnaire). RESULTS: A considerable proportion of families had child maltreatment reports (30% of sample) and maternal depression (38% had clinically significant symptoms). Most maltreatment was neglect. Among control group mothers, reports of maltreatment did not vary according to depressive symptoms. For HV mothers, probability of reports varied with levels of depressive symptoms. Nonsymptomatic HV mothers were less likely to have a child who was reported for maltreatment compared with HV mothers who endorsed clinical levels of depressive symptoms. CONCLUSIONS: The prevalence of maternal depressive symptoms in this sample, and the link between depression and child maltreatment prevention program effectiveness, suggest that home visitors be alert to maternal depression. Programs also should be aware of possible surveillance effects related to maternal depression.

Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families

OBJECTIVES Our aim was to estimate the effects of Healthy Families Massachusetts, a statewide home visiting program serving first-time adolescent parents, on parenting, child development, educational attainment, family planning, and maternal health and well-being. METHODS We used a randomized controlled trial design to randomly assign the 704 participants to a group receiving home visiting services or a control group. Between 2008 and 2012, telephone and in-person interviews were conducted and administrative data obtained at 12 and 24 months after enrollment. Intention-to-treat analyses compared group differences across 5 outcome domains: parenting, child health and development, educational and economic achievement, family planning, and parental health and well-being. RESULTS The home visiting program had a positive influence on parenting stress, college attendance, condom use, intimate partner violence, and engagement in risky behaviors. No negative findings were observed. CONCLUSIONS A paraprofessional home visiting program specifically targeting young mothers appears effective in domains of particular salience to young parents and their infants and toddlers. Expanding participation in the program appears a worthy goal for program administrators and policymakers.

Poor but Not Powerless: Women Workers in Production Chain Factories in China.

The present study demonstrates the processes by which 12 young women working in four production chain factories in China shape their own lives — their developmental trajectories — during the period following their entry into factory work. One-on-one, in-depth, semi-structured interviews were conducted in August, 2005, as part of an evaluation project that assessed the labor practices and interpersonal relationships in production chain factories. These interviews revealed considerable personal agency among the women, and prompted us to examine how this agency manifests itself, and what individual and contextual factors influence it. Operating from a developmental systems perspective, and using a “grounded approach” to identify active, personal agency as the organizing construct for this investigation, we adopted the selective optimization with compensation (SOC) model to guide data analysis and presentation, after initial data coding indicated its suitability. Findings suggest that activity within these three components (selection, optimization, and compensation) is oriented toward fulfilling both the women’s family goals and their career goals. These workers sought to improve the well-being of their families and themselves through selecting to work in these particular production chain factories, optimizing their factory experiences, and compensating for the attendant losses — personal and career-related. Individual characteristics, such as marital status, migrant status, and educational background, in combination with contextual factors, such as family socio-economic background and factory labor practices, influenced these women worker’s decisions, and thus, their developmental course.

Measuring program- and individual-level fidelity in a home visiting program for adolescent parents

•We used a novel approach to examine home visiting model fidelity.•We created two composite variables: program- and individual-level fidelity.•Program fidelity was consistently high, but individual fidelity was more variable.•Results suggest the importance of examining fidelity from multiple perspectives.

Rapid Repeat Birth: Intersections Between Meaning-Making and Situational Support Among Multiparous Adolescent Mothers

This study examined interpretations of motherhood among adolescents who have experienced rapid repeat births (second births within 24 months of the primiparous birth). Analyses of participants’ descriptions of their transitions to motherhood indicate four modal narratives that vary along two axes: the adoption of a motherhood identity, and the nature (or stability) of relational support available. By using subjective perceptions of motivation, stability, and feelings of competence, this study linked intrapersonal meaning-making with situational sources of support to describe various pathways through repeat adolescent childbearing in a way that both confirms and enriches extant literature. The implications of this study instruct home visiting programs and other interventions designed to forestall repeat pregnancies by elucidating pathways of reinforcement or increased risk inherent in some maternal trajectories. Following this logic, interventions directed at improving outcomes for young mothers and their children would do well to consider the interplay between internal meaning-making, relational support, and the transformative power of adopting the mother identity.

Patterns of goal attainment among young mothers in a home visiting program

ABSTRACT This paper examined heterogeneity in parents’ patterns of goal attainment following home visiting. Young mothers (n = 696) participating in a randomized controlled trial (RCT) evaluation of a statewide home visiting program were classified, using latent class analysis (LCA), according to their pattern of goal attainment (i.e., educational attainment, employment, parenting, personal functioning) two years postpartum. We explored direct and indirect (via social connectedness) associations between program participation and goal attainment. LCA revealed four classes: (a) High Education & Employment/High Parenting & Personal Functioning (n = 286, 41%); (b) High Education & Employment/Low Parenting & Personal Functioning (n = 212, 30%); (c) Low Education & Employment/Low Parenting & Personal Functioning (n = 71, 10%); and (d) Low Education & Employment/High Parenting & Personal Functioning (n = 127, 18%). Home visiting was not directly associated with class membership, but indirectly through social connectedness. This paper contributes to understanding home visiting impacts.