Home visitation to prevent family violence: The potential and the challenges

What is home visitation?

According to the Alberta Home Visitation Network Association (AHVNA), ‘Home visitation is a voluntary free-of-charge program for Alberta families with children from newborn to six years of age. Priority is given to children in the 0-3 years age range.’ (Link)

Through weekly visits, home visitors can confer with parents to strengthen parenting skills, as well as to share valuable information on topics such as child development, healthcare and ways to promote healthy relationships within the family.

Home visitation is a strength-based approach. The aim of creating connections with families is to help them recognize their own strengths and capacities with relevance to improved child care and parent-child relationships. The information shared with parents is also intended to connect the families with community agencies who could conceivably meet diverse additional needs.

The duration of a family’s engagement with a home visitation program can vary over time and depends on the needs of the family.  According to the AHVNA: ‘Weekly visits may gradually be reduced to monthly. Families may take part in the program for up to 6 years, depending on individual needs.’ (Link)

How do families access home visitation programs?

According to the AHVNA site: ‘Families are referred to the program by a public health nurse, social worker or through self-referral. The screening and assessment process is completed by public health nurses, family assessment workers or family support workers.’ (Link)

Can home visitation help in the prevention of family violence?

Home visitation is an evidence based form of primary prevention of violence.  According to Rutherford et al (2007):

Sustained nurse homevisiting of mothers with young children is an evidencebased primary prevention strategy that does link with service provision and is widely acknowledged to improve outcomes for children and reduce their risk of becoming victims or perpetrators of abuse.’ (Link).

Home visitation programs can be useful to reach out to women who are isolated at home and who may be unable to access transport. Sufferers of abuse might be afraid or unable to leave the home and might be monitored and surveyed by abusers. These are factors that prevent women from accessing services and resources at agency locations. When an empathetic relationship has been created between mothers and home visitors, unthreatening conversations about healthy families can open the door to conversations about help and supports against family violence. Indeed there is policy recognition of the potential value of home visitation in violence screening and prevention:

Home visitation was identified in the framework in family violence (Family Violence Hurts Everyone: A Framework To End Family Violence In Alberta; parentheses inserted). They (home visitors; parentheses inserted) were identified as being in the unique position to be able to screen for family violence because they developed long-term relationships with their clients. Many home visitors of course they’re in the home for years. That said, home visitors should be able to screen.’

(Interview excerpt from 2015-2016 ICWA needs assessment report. Link.).

What are the challenges of implementing home visitation programs?

Despite the acknowledgement of the violence-preventive value of home visitation and outreach, it is not the norm for Edmonton’s mainstream service agencies to go into the community to meet and support clients of so-called ethnocultural groups. Also, even where such outreach efforts are found (usually the domain of grassroots ethnocultural agencies), workers need to be highly cautious so as not to expose victims to further escalated violence and, just as important, to ensure their own safety. These videos illustrate some of the practical considerations involved in doing offsite work, including home visits.

Home visitation to immigrant homes is hampered by the lack of formal ties and lack of informal trust and rapport between mainstream agencies, ethnocultural grassroots service agencies, and members of ethnocultural communities. Whereas grassroots agencies may have developed relationships of trust with members of relevant communities, mainstream providers may experience non-receptivity if not outright distrust. These challenges are magnified in situations where a service provider, such as a home visitor, seeks to meet a legal and institutional obligation by reporting observed domestic violence to the provincial government department Child and Family Services (CFS). For example, the home visitor observes violence between the parents (known to have adverse impacts on children witnessing it) and is obligated to report it as a risk to the child in a violent environment.

‘Even with the family violence protocol we’re implementing home visitation programs. It is written in the protocol that in all positive family violence screens the home visitors are required to consult with and/or report to child and family services and we get so much push back from that and that’s working with mainstream for the majority. People still believe that if children don’t witness that they’re not impacted. I think that it stems back from to really getting a better understanding and awareness of the impact on children and that exposure to family violence it’s about exposure and that’s not about witnessing and that’s not about them whether they were home or not and all of those things… I don’t think people necessarily make all those connections either to understand that that falls under our requirements of duty to report.’

(Interview excerpt from 2015-2016 ICWA needs assessment report. Link.)

When a grassroots outreach worker knows or sees that there is violence in a home that is witnessed and experienced by children, the worker faces hesitations and dilemmas about contacting CFS. There is a worry that reporting to CFS or even informing clients of the obligation to report may damage relationships of trust with the client and perhaps even the community.

There are also tensions and dilemmas for a grassroots ethnic agency that brokers the mainstream provider’s (e.g. home visitor) access to a home where there is violence. If the home visitor reports violence, the rejection of the home visitor can lead to the rejection of the broker as well, not only by the family but perhaps also the community in the area.

From the standpoint of families, allowing brokered or direct access to a home visitor is a challenging decision. A persistent fear is that the home visitor is a potentially hostile presence with a covert purpose of governmental surveillance of the home that may translate to punitive action e.g., that CFS may apprehend their children.  Such fears can be acute for families that may feel threatened that their parenting practices may be seen as abusive (e.g., where corporeal punishment such as spanking is seen as an acceptable disciplinary method; see p16 of this 2017 ethnographic report by Salami et al) and that they may face severe (and from their viewpoint unwarranted) institutional action.

The situations described above reflect the mutual tension of organizational interests, legal duty, and organization-community-family relationships: e.g., an agency’s obligation to report violence versus the need to maintain a relationship of parochial familiarity with client and community. Overall, when it comes to implementing home visitation for newcomer families, there are real barriers owing to these conflicts and tensions around reporting duties vs organizational interest vs relationship management.

Communities are small, if we’re talking about an ethnic minority community I think there is more often relationships that are developed and I think they’re very much just okayed, it’s just accepted if you will. I think that makes it challenging to really build a rapport of even just then if you go back to the other issue as I’m talking about as far as reporting or really being able to support the individual around even suggestions versus advice, the relationship is different, it’s different. If I’m looking to another way to be able to support or if I need to encourage that we need to consult with child and family services but our relationship has crossed boundaries that are no longer around service provider and client then it makes it even more challenging. I think that that’s one piece around boundaries and then — is around the relationships and then — that’s probably really the big one around boundaries as well relationships and I think that part of that just is about the communities being small … There is the expectation that there’s going to be a report and yet I see and I know the reluctance of my staff to do because they’re going, yeah it’s going to ruin my relationship with the client but beyond that it’s going to impact their reputation within the community.’

(Interview excerpt from 2015-2016 ICWA needs assessment report. Link.)

What are the sustainability challenges of home visitation programs?

As with nearly all community services, funding impacts sustainability and continuity. In the case of home visitation programs, short-term project-based funding means staff loss and turnover, which also means conjoint losses of knowhow, organizational memory and hard-won relationships established between home visitors and clients.

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