Observing home-visit quality with the home visit rating scales: Introduction to the special section

Evidence-based home-visiting programs aim to address one of the most important challenges facing our species—setting the next generation on a healthy path of development that prepares them for a future that is simultaneously uncertain and promising. Diverse research literatures have pointed to practices to effectively meet this challenge and better achieve the unfulfilled promise of home visiting by more effectively engaging parents in supporting their children's early development and well-being. Measures of home-visit quality practices drawn from social work, pediatric nursing, early childhood, and early intervention research literatures have identified building relationships with families and focusing on their strengths as effective, practices that are particularly important for vulnerable families. The articles in this special section used the Home Visit Rating Scales to examine stability in home-visit quality over time, study specific home-visiting processes linked with quality, validate a supervisor checklist of home-visiting implementation, and consider the home visit in relation to an array of indicators reflecting overall home-visiting program strength and stability. These articles exemplify progress in home-visiting research over recent decades, including advances in direct observational methods and measurement as well as examinations of home visiting as an observable process across various home-visiting program models and populations.     

Observing home-visiting quality across time: A longitudinal reliability study of the Home Visit Rating Scales

Empirical examination of home-visiting quality over time is lacking in the research literature. To this end, this study examined the most recent edition of a widely used observational measure of home-visiting quality, the Home Visit Rating Scales (HOVRS), over four repeated assessments spanning an average of 6 months. Psychometric quality for the HOVRS Total and Home Visitor Practice Scales, including item ratings and calculated scores, across time was demonstrated. Stability indicators for the Family Engagement Scales varied, with superior reliability often indicated for individual ratings over the calculated score. The exploration of interrelationships among family demographics and change in HOVRS scores over time were largely insignificant. Interestingly, a decline in the Home Visitor Practice Scale significantly related to increased symptoms of maternal depression, possibly suggesting that home-visitors’ focus shifted from children's needs to those of parent s when mental health concerns were observed. Although this study is an examination of one program model and poses limited generalizability, it sets the stage for advancing the HOVRS and longitudinal measurement of home-visiting quality.     

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions

The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother–infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.     

Risk and protective factors for pre- and postnatal bonding

Since disturbances in the mother–child bond increase the risk of negative consequences for child development, it is important to identify risk and protective factors for bonding as well as longitudinal associations. Previous research has used different bonding instruments during pregnancy and the postnatal phase, leading to inconsistent results. In the current study, the same instrument was used during the various phases. In a large, community-based sample (N = 793), general information, feelings of pre- and postnatal bonding (Pre- and Postnatal Bonding Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and partner support (subscale Tilburg Pregnancy/Postnatal Distress Scale) were measured at both 32 weeks of pregnancy and 8 months postnatally. Partner support was found to be a protective factor for suboptimal pre- and postnatal bonding, as was the engagement with fetal movements for prenatal bonding. High maternal educational level was a risk factor for suboptimal prenatal bonding, as were depressive symptoms for suboptimal postnatal bonding. The associations between most prenatal determinants and postnatal bonding were mediated by prenatal bonding, which underlines the importance of promoting prenatal bonding. Professionals in clinical practice should be aware of partner support, engagement with fetal movements, and postnatal depressive symptoms: All these factors offer opportunities for improving the bonding processes.     

Early childhood predictors of boys’ antisocial and violent behavior in early adulthood

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.     

A developmental origins perspective on the emergence of violent behavior in males with prenatal substance exposure

Children with prenatal substance exposure are at increased risk for externalizing behavior problems and violence. However, the contribution of early life experiences for placing these individuals at risk is not well understood. Utilizing a sample of 1,388 children with prenatal substance exposure from the Maternal Lifestyle Study, we attempt to shed light on these contributing factors by examining the impact of infant temperament, maternal sensitivity, and early life stress on the expression of violent behavior at ages 12 through 14 years. Males may be more at risk for increases in violent behavior in early adolescence through a number of early life experiences, such as variability in responses to maternal flexibility and engagement related to individual differences in temperament, as well as exposure to early adversity. Comparing two prevailing developmental theoretical frameworks, deficit models and differential susceptibility, we aim to understand the developmental origins of violent behavior in males by identifying children who may be most susceptible to early caregiving experiences.     

Early-life risk for domestic violence perpetration: Implications for practice and policy

Research on risks and causes of domestic violence is hampered by a policy framework that not only does not fund but in some cases suppresses inquiry into those causes. This discussion, then, will be placed in the context of those policy frameworks that hamper and distort inquiry. This includes an overview of ideological, political, and historical issues that have shaped those frameworks. Related explanatory theories and theories of practice are summarized. The article will examine known early-life risk factors for those disorders and behaviors associated with domestic violence perpetration. Particular emphasis will be placed on maltreatment and attachment/bonding processes. Framed in broad perspectives of psychosocial theory, risk factors from related literature sources (e.g. general violence and criminality) will be included where risk profiles are substantially similar.     

Infant withdrawal and behavior problems in urban Chinese toddlers: Roles of maternal sensitivity to infant distress and emerging delay ability

Using a longitudinal design, this study examined the associations between infant temperamental withdrawal and behavior problems during toddlerhood and tested the moderating effects of maternal sensitivity to infant distress (MSID) and toddlers’ ability to delay gratification (ADG) in urban Chinese families. Participants were 84 Chinese children (37 boys, 47 girls) and their mothers. When the infants were 6 months old (T1: infancy), their mothers reported their temperamental withdrawal, and research assistants observed and coded MSID by using a subscale of the Maternal Behavior Q-Sort during free-play interaction. When the toddlers were 1 year old (T2: early toddlerhood), their mothers reported their internalizing and externalizing problems. When the toddlers were 2 years old (T3: late toddlerhood), their mothers again reported their internalizing and externalizing problems, and their abilities of delay gratification were assessed through a laboratory-based procedure. Infant temperamental withdrawal was associated with increased internalizing problems in early toddlerhood and increased externalizing problems during middle to late toddlerhood; infants whose mothers were extremely high sensitive or low sensitive to their distress or those with late poor ability of delay gratification were at particular risk. The findings highlight the importance of matching parenting and promotion of self-control for temperamental withdrawn children's optimal development.