The goal of this R21 proposal is to develop and pilot a standardized behavioral health screening and linkage to treatment protocol designed to increase access to behavioral health services among at-risk parents participating in evidence-based home visiting programs. Home visiting is the most widely used child maltreatment prevention strategy across the country, but does not adequately address parental substance abuse and mental health problems, key risk factors for child maltreatment. Substance abuse and mental health problems are prevalent among home visiting clients, and their presence diminishes positive program impacts. The proposed R21 will develop and test a protocol for a Behavioral Health Enhancement (BHE) to the home visiting model that will be adapted from an evidence-based intensive case management approach and will include expanded home visitor training in parental behavioral health risks, use of well-validated screening tools for substance abuse and mental health problems, and standardized case management procedures for linking clients with needed services following positive screens. The BHE will be designed and piloted within the context of Healthy Families America (HFA), one of the most widely implemented home visiting models, with high adaptability potential to other models. Participants will be drawn from among HFA clients in four New Jersey counties, with two counties receiving the BHE and two counties serving as matched controls.
Specific aims are (1) to develop a protocol for a BHE to evidence-based home visiting models that includes procedures for training providers, screening families, and linking families to behavioral health services using evidence- based case management and motivational interviewing interventions;(2) to test the feasibility, acceptability, and fidelity of BHE within HFA;and (3) to pilot test the impact of the BHE on increasing identification of behavioral health problems and engagement in services compared to matched controls from a demographically similar county. Study findings will yield important data on whether incorporating standardized screening and linkage procedures into home visiting increases identification of parental behavioral health risks and engagement into needed services, and on whether such procedures are feasible to implement with fidelity by paraprofessional home visitors. Additionally, the proposed study will aid in determining key barriers that prevent successful linkages to treatment for home visiting clients. New study products will include a standardized and piloted BHE toolkit, home visitor training and fidelity monitoring procedures, and a fidelity monitoring tool. If validated, the resulting BHE protocol has the potential for widespread deployment within HFA and eventual adaptation for use with other home visiting models.
Child maltreatment is a public health problem with great individual and economic costs. Parental substance abuse and mental health problems are salient risk factors for child maltreatment that are not currently adequately addressed by home visiting programs aimed at preventing child maltreatment. The success of home visiting programs at improving parenting and preventing child maltreatment would likely be significantly enhanced by the inclusion of standardized procedures for substance abuse and mental health screening and linkage to treatment. This R21 study will lead to the development of a Behavioral Health Enhancement (BHE) to home visiting services that will include enhanced training for home visitors in parental behavioral health risks, standardized screening for substance abuse and mental health, and standardized case management procedures for linking clients to community-based treatment services.