Improving Intimate Partner Violence Services in Home Visiting: A Multisite Learning Collaborative Approach

Abstract

To improve intimate partner violence (IPV) service delivery, the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Initiative’s continuous quality improvement (CQI) team implemented a Breakthrough Series model Learning Collaborative with eight program sites. Using mixed-methods, we: examined post-Collaborative changes in Florida MIECHV home visitors’ knowledge, system awareness, and confidence; identified strategies to address challenges in supporting families with IPV; and assessed post-Collaborative program improvements. The Collaborative included three interactive 2-day sessions, six webinars, and testing strategies using the Model for Improvement (Plan-Do-Study-Act). Three online surveys assessed changes influencing IPV screening, referrals, and safety planning. Thematic content analysis of qualitative data revealed existing barriers and strategies to address challenges. Home visitors reported accurate knowledge (change: 2.3%-34.8%), confidence (change: 31.8%-37.9%), and system awareness (change: 22.7%-53.5%) for all items from baseline to final survey. There was also an increase in rates of IPV screening (change: 88.0%-91.0%) and referrals (change: 43.0%-100.0%). Strategies for addressing challenges in supporting families experiencing IPV were identified at the individual (self-care, continuous education); interpersonal (reflective supervision, trauma-informed approach); organizational (defining success, supportive agency/program, policies); and community (collaboration with IPV service providers) levels. Lessons learned from the MIECHV IPV Learning Collaborative informed future CQI projects.     

Families Across the Income Spectrum: A Decade in Review

During the past decade, scholars continued to focus on how larger economic trends impacted families across the income spectrum. From income and wealth inequality to economic insecurity, the gaps between the haves and the have nots remained, and some widened during this period. The authors' comprehensive review found the following three major takeaways: first, the biggest economic divides run through families with children; second, low-income families face concentrated disadvantage marked by insecurity and precarity; and third, inequality and insecurity shaped the “dynamism” of family life, including how families respond culturally and emotionally to economic changes, and how these responses unfold over time. They examine active areas of research, including parenting trends and the transition to adulthood. They also document a new scholarly emphasis on uncertainty and instability along with the forces that exacerbate or mitigate them, such as job quality, economic volatility, wealth, and incarceration. Research during the past decade focused on the experience and consequences of dynamism, reflecting not only the reality that families evolve but also that they face continual change in their economic, social, and political contexts. The authors highlight research investigating how families “do dynamism,” work that looks over time or offers in-depth examinations of how families adapt to and cope with dynamism every day. This research reveals that inequality and insecurity are not only matters of levels and gaps but also ongoing matters of meaning-making, identity, and feeling. The authors conclude by highlighting some strengths and weaknesses of these research streams and pointing out new avenues for future scholarship.     

Children's understanding of emotional facial expressions and verbal labels

Preschool, kindergarten, first and second-grade children were told twelve stories describing emotion-inducing events. After each story the subjects were presented either with three emotion labels (e.g., happy, sad, surprised) or with facial expressions of three emotions. Subjects were asked to choose the label or expression appropriate for the story's main character. Data analysis showed that children's accuracy increased with age. Performance was high on both response measures but recognition of labels exceeded that of facial expressions. Some of the six emotions studied (e.g., happiness and sadness) were recognized more easily than others (surprise, fear, and anger), with disgust being correctly identified least often.The authors wish to thank the children, staff, and parents of St. Chrysostom's Day School and St. Clement's School for their generous cooperation in this study.     

Misdirection on the road to Shangri-La

Will life expectancy in the United States rise or fall in this century? The implications of either scenario are far reaching. We contend that the rise of childhood obesity in the United States in the past three decades has been so dramatic that it will soon lead to higher than expected death rates at middle ages and a possible decline in life expectancy by midcentury. The most detrimental health and longevity effects will not be seen for decades--a phenomenon that cannot be detected by current methods used to forecast life expectancy or estimate the number of deaths currently attributable to obesity. This scenario contrasts sharply with the views of mathematical demographers who generate forecasts by relying on the assumption that the U.S. pattern of longevity will follow that of other longer lived nations and on the extrapolation of historical trends in life expectancy into the future.     

Male Pregnancy Intendedness and Children's Mental Proficiency and Attachment Security During Toddlerhood

Using a sample of biological resident fathers and their children from the Early Childhood Longitudinal Study Birth Cohort (ECLS‐B) 9‐ and 24‐month surveys (N = 5,300), this study examines associations and the direct and indirect pathways through which men's pregnancy intentions influence toddlers' mental proficiency and attachment security. Findings indicate that unwanted and mistimed pregnancies for fathers had negative consequences for toddlers' mental proficiency and attachment security. Additionally, men's pregnancy intentions were found to work indirectly through lower prenatal behaviors and father engagement and greater mother‐father relationship conflict to negatively influence toddlers' mental proficiency. Men's pregnancy intentions also worked indirectly through greater relationship conflict and higher father involvement to influence attachment security.     

A qualitative look at child care selection among rural welfare-to-work participants

The welfare reforms of 1996 changed the administration of public assistance to children and families. One of the key provisions, requiring parents to join the workforce, resulted in an expanded need for child care. Prior research demonstrates that welfare recipients, particularly in rural areas, utilize informal child care arrangements. Further, recipients in rural communities face greater challenges due to a lack of transportation, geographic spread, and less access to services. This qualitative study examined the child care selection experiences of 33 welfare recipients in six rural Northern California counties. More families selected home-based than center-based child care. During their search processes, welfare recipients utilized both formal and informal routes to locate child care providers. Parents took advantage of their connections with the social service system, but also accessed their social networks for recommendations. Rural families also reported that their choices were constrained by the available programs, transportation, and by the quality of the programs they were able to access. Given the high rate of utilization of home-based arrangements among families in welfare-to-work programs, quality of care in such programs should be improved. Recommendations for increasing quality and access, as well as supports for welfare to work participants, are discussed.     

A Mixed Method Approach to Quality of Life Research: A Case Study Approach

Increased use of qualitative and quantitative methods in quality of life projects necessitates an examination of how to effectively work within a mixed method framework. The research objectives of this paper are to (1) operationalize the two goals of mixed method research (confirmation and comprehension) and (2) develop a strategy for using mixed methods in quality of life research. Face-to-face interview (qualitative) and telephone survey (quantitative) data from the Community–University Institute for Social Research Quality of Life (CUISR QoL) project in Saskatoon, Saskatchewan were used for operationalization. Overall, confirmation and comprehension were challenging concepts to operationalize. Seven benefits and four guidelines were developed and are presented as dynamic, rather than definitive, structures.     

Self‐policing and reinforcement as alternatives to government regulation for quality assurance in research

The issue of government regulation of scientific research exists in the context of an increasingly litigious society and a growing reliance on legal contracts in lieu of informal agreements. These trends suggest regulation of research may intensify in the absence of countermeasures by the researchers themselves. This paper explores the possibility that increased or altered discipline within the research community itself could result in sufficient quality control to obviate the need for increased government regulation. Possible actions are suggested for program managers, for universities, and for researchers.     

A THEORETICAL INVESTIGATION OF PUBLIC ATTITUDES TOWARD SEX EDUCATION

Rates of teen pregnancy in the United States are significantly higher than those in most other industrialized nations. This is troubling in light of the consequences to teen mothers, their children, and society. Some suggest that teen pregnancies can be decreased by providing sex education in the public school system, while others believe that sex education is inappropriate for public school. Little research exists, however, on predictors of attitudes toward sex education, and most existing research is dated and lacks a theoretical framework. Guided by the seminal work of Ira L. Reiss, we examine the impact of labor shortages, religiosity, militarism, gender egalitarianism, regulation of sexuality, and a naturalistic view of sexuality on attitudes toward sex education. Results suggest that Hispanics, those with high levels of religiosity, and those who supported regulation of sexuality were significantly less likely to support sex education in public schools. Implications of the findings and directions for future research are discussed.