experiences by saying: “One <strong>of</strong> the clearest messages that has emerged fromthis program <strong>of</strong> research is that the functional and economic benefits <strong>of</strong> thenurse home-visitation program are greatest for families at greater risk.” (page21). Chaffin (2004) recommended that programmes may need to reconsider'universal' strategies or other strategies that target relatively low risk groups <strong>of</strong>parents.“The possibility needs to be considered that prevention programs mayexpend effort inefficiently by targeting far too many parents who willnever maltreat their children anyway, while failing to provide sufficientfocus and intensity for those who are truly at-risk.” (Chaffin; 2004; page593)In addition, a cost benefit analysis in the US (Aos et al., 2004) determined that“some forms <strong>of</strong> home visiting programs that target high-risk and/or low-incomemothers and children are also effective, returning from $6,000 to $17,200 peryouth” (page 4).There is a growing body <strong>of</strong> research and international thinking that suggeststhat those families with new infants that have serious risk features do better inhome visiting services than their less at-risk counterparts (Chaffin; 2004;Duggan, Fuddy, Burrel, Higman, McFarlane, Windham & Sia., 2004; Gomby,Culross, & Behrman; 1999). The recent Early Start <strong>Evaluation</strong> Report byFergusson and colleagues (Fergusson, Horwood et al., 2005) also suggeststhis may be a useful strategy. “…there was some suggestion the programme<strong>of</strong>fered greater benefits to Māori, older mothers, and families facing highlevels <strong>of</strong> disadvantage.” (page 77).However, apart from <strong>Family</strong> <strong>Help</strong> <strong>Trust</strong>, there do not appear to be homevisiting services, either in <strong>New</strong> <strong>Zealand</strong> or internationally, that have providedintensive home-visiting family support exclusively to this ultra high-risk group.Rather, there are sub-sets <strong>of</strong> such clients within larger cohorts that havereceived identical services. The literature (Duggan, Fuddy, Burrel, Higman,McFarlane, Windham & Sia., 2004; Gomby, Culross, & Behrman; 1999)18
suggests that such generic services are not focussed on changing parentalrisk behaviours; for example, substance abuse, criminal <strong>of</strong>fending, andabusive parenting. Many existing services use a strengths-based interventionthat fails to prioritise care and protection issues within this model (Centre forChild and <strong>Family</strong> Policy Research; 2005; Duggan, Fuddy, Burrel, Higman,McFarlane, Windham & Sia., 2004; Gomby, Culross, & Behrman; 1999)Criticism has also centred on the use <strong>of</strong> inexperienced staff, who were notwell trained or supported by their programmes (Centre for Child and <strong>Family</strong>Policy Research, 2005) 3 ; (Duggan et al., 2004); (Olds & Kitzman, 1993).Many services report not being able to cope with high-risk families withmultiple problems (Centre for Child and <strong>Family</strong> Policy Research, 2005);(Duggan et al., 2004). A review <strong>of</strong> recent research concluded that “…it seemslikely that extremely well-trained visitors are needed to serve families that facemultiple complex issues…” (Gomby et al., 1999; page 18).In a controversial commentary on the home visitation field, Chaffin (2005)states, in terms <strong>of</strong> home visiting services calling themselves child abuseprevention services:“Programs such as Healthy Families have self-identified and marketedthemselves to policy makers, legislators, communities, andpr<strong>of</strong>essionals primarily as child maltreatment prevention programs,even if they have not presented themselves that way to consumers. Ihave advocated for years that this is a mistake and that the programsare more accurately characterized as maternal and child healthenhancement programs, and should market and fund themselvesaccordingly” (page 244).3 In <strong>New</strong> <strong>Zealand</strong>, a common reason given by external agencies for not working more closelywith <strong>Family</strong> Start when assisting clients was a perceived lack <strong>of</strong> training among <strong>Family</strong> Startworkers (Centre for Child and <strong>Family</strong> Policy Research, 2005).19
- Page 1 and 2: "Programs may need to reconsider 'u
- Page 3 and 4: ForewordIt gives me pleasure to pro
- Page 5 and 6: Table of ContentsForeword..........
- Page 7 and 8: AcknowledgementsMany people and org
- Page 9 and 10: Executive SummaryFamily Help Trust
- Page 12: The wellbeing of children matters t
- Page 20 and 21: (Bilukha et al., 2005). “The Task
- Page 22 and 23: suggests that the most effective pa
- Page 24 and 25: eflected in fewer subsequent pregna
- Page 28 and 29: In summary, despite increased inter
- Page 30 and 31: enefits in the areas of maternal he
- Page 32 and 33: families that consented have been g
- Page 34 and 35: In 1995, Family Help Trust, as part
- Page 36 and 37: families have multiple risk factors
- Page 38 and 39: iii)Outcome evaluation, discussed b
- Page 40 and 41: their resources and exploit any eva
- Page 42 and 43: In summary, an evaluation of the ef
- Page 44 and 45: two data collection periods. In all
- Page 46 and 47: Type I errorWith such a large numbe
- Page 48 and 49: Along with the problem of low numbe
- Page 50 and 51: iii)‘social desirability’ and
- Page 52 and 53: to ensure the results of this evalu
- Page 54 and 55: history of offending. An outline of
- Page 56 and 57: Examination of Table 3.2 shows that
- Page 58 and 59: Table 3.4 shows that the majority o
- Page 60 and 61: From Table 3.6, it is apparent that
- Page 62 and 63: partners, should this variable be o
- Page 64 and 65: An examination of Table 3.10 indica
- Page 66 and 67: CHAPTER 4OUTCOMES AT TWELVE MONTHSW
- Page 68 and 69: • “do you have a washing machin
- Page 70 and 71: • In the past six months, has you
- Page 72 and 73: aseline had CYFS involvement at twe
- Page 74 and 75: at least to some extent, due to inp
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From Table 4.4 it can be seen that
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From Table 4.6 it can be seen that
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target families may be due to a rep
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4.3 SummaryChapter 4 has provided a
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CHAPTER 5DISCUSSIONThe purpose of t
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services, Table 5.1 shows a compari
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5.4 Comments on Selected Areas of P
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dental services are currently not a
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Case 2Referral from obstetric socia
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Perry (2004) emphasised that a key
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eported cigarette smoking by others
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ecause a) mothers would be busy wit
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ehaviours such as criminality and s
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Appendix I Risk Factors for Referra
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Chaffin, M. (2004). Is it time to r
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Evaluation Unit Ministry of Social
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Ministry of Health. (1994). Report
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Shirley, I., V., Adair, & Anderson,