Decreasing Child Abuse with Nurse Partnership Essay

Child abuse in America is not a new epidemic; our country’s history has been tainted with it since its inception. Children are abused at all ages, indiscriminate of gender, race, or culture. While the abuse of any child is appalling, the abuse of an infant is especially heinous. Dr. John Leventhal, a professor of pediatrics at Yale School of Medicine completed a recent study which highlighted the fact that â€Å"serious abuse-related hospitalizations are more common in infants under the age of one year old and tend to disproportionately affect families on Medicaid,† (Mann, 2012). These incidents occur because parents are ill-prepared for parenthood and lack the resources necessary to appropriately manage the stress of a new infant. A Nurse Partnership Program (NPP) is the answer to our nation’s call to significantly decrease the amount of child abuse cases for infants under the age of 1 year. If appropriately executed and managed, this program could also improve the quality of life for participating families as well as potentially decrease the number of families who receive aid from public welfare and assistance programs. Needs Assessment Child Abuse Statistics According the United States Department of Health & Human Services (USDHSS) (2011), Nevada is tied with Tennessee as the state with the third highest rate of child abuse per capita for children under the age of one year; 16. 9% of Nevada’s infants were abused in 2010, 47. 7% of those cases resulted in fatalities, and 81. 3% of the perpetrators were parents of the victim. The USDHSS (2011) also reports that the federal government’s Fourth National Incident Study of Child Abuse found that abuse is three times more common in poor families and neglect is seven times more common in poor families as well (poor as defined by national poverty line). Poverty Statistics The U. S. Census Bureau reports that 16. 4% of Nevada residents live in poverty, which places Nevada as 38th in the nation (2010). In terms of pure numbers, 306K people receive Medicaid in the state of Nevada (Haynes, Vogel, and Tetreault, 2012). Nevada has a large target population for this program and as the third worst state in the union for child abuse of infants, Nevada has demonstrated a dire need for action. Specific Target Population The target population for the Nurse Partnership Program would be expectant mothers who are Medicaid recipients. The Nevada State Department of Human and Health Services and the Prevent Child Abuse Nevada organization would serve as supporting agencies since both organizations already work to prevent and control child abuse in Nevada. The NPP would also benefit from the participation of dedicated social workers. Community Level Nursing Diagnosis Nursing Diagnosis One The target population is at risk for impaired parenting related to situational characteristics that precipitate child abuse. Previously mentioned statistics prove that a disproportional amount of child abuse cases for children under one year of age occur in families who receive Medicaid. Child abuse, neglect, and maltreatment are classified as impaired parenting. According to the USDHHS (2012), research has uncovered a number of risk factors or situational characteristics that create a higher probability of child abuse within families. These situational characteristics of parents or caretakers include previous trauma history, altered mental health, and an unhealthy or negative response to stress. Research also indicates a link between substance abuse and child maltreatment. There is also an increased risk when children are raised by a single parent, when one parent is already to victim of domestic violence, and when parents are socially isolated. Nursing Diagnosis Two Many young or teenage parents receive public aid and Medicaid, which places them in the target population. These young and teenage parents are at risk for ineffective coping related to lack of social and emotional support, lower economic status, high stress levels, and inadequate education. Brownridge and Douglas found that lack of or inadequate employment, education, social and emotional support, and self-esteem are associated with child abuse among children of adolescent mothers (2008, pp. 9-42). Without a sufficient support system or education to prepare young parents for the monumental task of caring for infants, they are rendered inadequately prepared to cope with the stresses of early parenthood. Cancain, Slack, and Yang (2012) state that researchers and policy makers have long recognized that children living in families with limited economic resources are at a higher risk for maltreatment than children from higher socioeconomic strata. Nursing Diagnosis T hree The children of the target population are risk for trauma related to their dependent role in the parent child relationship. Infants are especially susceptible to maltreatment due to their early developmental status and need for constant care. As Dr. Leventhal (2012) stated, when abuse occurs in children under the age of one year abused, they are more likely to incur serious injuries that require hospitalization than abused children over the age of one year. Project Goals, Objectives, and Interventions  A Nurse Partnership Program would match a registered nurse with an expectant mother, who would in turn provide education and mentorship throughout the pregnancy and first year of the child’s life. The nurse would perform home visits and help the mother prepare the home as well as herself for the safe arrival of the infant. The nurse would advocate for a healthy pregnancy and assist the mother in finding the resources she would need to facilitate that healthy pregnancy. While evaluation of the goals would include comparing the rate of child abuse cases among those enrolled in the NPP with those in the ontrol group, the overall evaluation of the program would include the rate of families who set and meet educational and professional goals as well as achieve and maintain economic independence of government aid programs. Project Goal One The first goal of this program is to improve pregnancy outcomes of the targeted population. This would start with matching an expectant mother with a registered nurse early in the pregnancy. This initial relationship builds the foundation for a successful therapeutic relationship and the overall success of this program. The nurse would educate the woman on preventative practices during pregnancy to include prenatal care, appropriate diets, and any behavior modifications that may need to occur such as the use of cigarettes, alcohol, or drugs. The success of interventions and determination of meeting this goal would be evaluated by comparing the rate of healthy births by mothers enrolled in the program with the rate of healthy births by mothers in a control group not participating in the NPP. Project Goal Two The second goal of this program would be to create a safe home environment for children to reduce the likelihood of accidental injuries. This process would also create confidence in young parents as they take control and responsibility for the safety of their child. Duva & Metzger (2010) found that a lack of confidence and self-esteem increase the risk of children suffering from abuse. Ongoing evaluation of this goal would occur during the home visits and overall evaluation of this goal would include the comparison of accidental injuries to children whose family is enrolled in the NPP to the control group. Project Goal Three Project goal three would include teaching the young parents how to build an appropriate support system. Young parents need to be able to communicate to others what their needs are. Something as simple as asking someone to watch their child so they can have a break could benefit the parents and child, providing a stress management tool which can decrease the likelihood of child abuse. Support systems include families, friends, and community networks (such as other parents, churches, etc. ). Evaluation consists of comparing the rate of child abuse cases among those enrolled in the NPP with those in the control group. Child abuse cases among the participants would be screened to determine if they were successful at building that special support system. Nurses can evaluate the progress of this goal during their home visits throughout the first year of the child’s life. Project Goal Four Project goal four includes improving child health and development. Nurses would work hand in hand with a licensed social worker to help parents provide responsible and competent care. This goal revolves around the main intervention of education. Their education would include stress management techniques, effective parenting skills, early childhood development, and the development of realistic expectations for themselves as parents and their children. This goal would include home visits by both the social worker and nurse throughout the first year of the infant’s life. Participants in this program are both students and parents. This unique compilation creates a situation ideal for the involvement of social workers. According to the Illinois Association of School Social Workers (2012), social workers help people understand themselves and others, cope with stress, develop decision making skills, help parents to meet and understand the needs of their children’s social and emotional needs, how to identify and utilize resources effectively, provide counseling services, and advocate for patients. They are a valued partner in the proposed program as the collaboration between the social worker, nurse, and parents are fundamental to the success of the NPP. Evaluation of this goal outcome includes comparing the rate of child abuse cases among those enrolled in the NPP with those in the control group. Project Goal Five Project goal five is the lynchpin for the overall success of the program. The final goal is to improve the economic self-sufficiency of parents. This would include the nurse and the social worker collaborating with the participants to develop goals for their own futures by completing their education, developing employable skills, finding employment, and planning future pregnancies. The success of this goal would be determined by the umber of cases who achieve economic independence, no longer utilize government aid programs, and have no unplanned pregnancies within two years of the child’s birth. That number would then be compared to the control group. Estimated Cost Discussing the cost of the program would by an injustice without discussing the possible savings the program could also produce. Child abuse and neglect costs the U. S. $124 billion from just one year of confirmed cases of child maltreatment and the lifetime cost for each victim of child maltreatment who lived was $210,012 (Fang, X. , Brown, D. , Florence, C. , & Mercy, J. 2012). The Nurse-Family Partnership organization reports that a recent cost-benefit update by Washington State Institute for Public Policy (2012) determined that long term benefits could equal as much as $23,000 per participant of a NPP. As families gain economic independence of government aid programs, the government saves money. This program would also decrease the amount of Medicaid dollars spent as children are expected to be born within a healthy birth weight and generally healthy overall when compared to the control group. In comparison, the cost of the program would be significantly less per family. The supporting agencies are already in place in the targeted community. The Nevada State Department of Human and Health Services and the Prevent Child Abuse Nevada organization both work to prevent and control child abuse in Nevada; the infrastructure is already established. The cost would be allocated to initiate a new program within the Prevent Child Abuse Nevada organization with the oversight of the Nevada State Department of Human and Health Services. The Nurse-Family Partnership organization has estimated the cost of such a program to be approximately $5,000 per family per year. Ideally, in order to establish and maintain continuity and oversight throughout the program, it would be managed by a single entity such as the Prevent Child Abuse Nevada organization. This is different than other programs which are managed individually by hospitals and smaller organizations. Some may balk at utilizing government funds, but funding this program is more economical than paying the price of child abuse. Fang et al. (2012) determined the lifetime cost for each victim of child maltreatment who lived was $210,012, which includes medical and legal costs, as well as other costs associated with child abuse (social services, etc. . It is definitely cheaper to teach them than it is to treat them. Collaboration With a Licensed Social Worker This program proposal was discussed with a licensed social worker, Mandy S. , in the state of Nevada. This licensed social worker stated individual programs exist through hospitals and smaller organizations, but agreed that a larger program w ith a single point of managerial oversight in the county would be the most beneficial. I proposed the ideal situation would include State Legislature mandating Medicaid recipients to participate in such a program in order to receive benefits of Medicaid and other public assistance programs such as welfare, food stamps, and Women, Infants, and Children (WIC). WIC â€Å"provides Federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk† (Food & Nutrition Service, 2012). Mandy S. stated that this legislative push would be a goal to pursue after the success rate of the NPP could be established. Implementation The program would be administered and managed by the Prevent Child Abuse Nevada organization. The Nevada State Department of Human and Health Services would maintain oversight and monitor outcomes of the program. It also requires the cooperation of hospitals and physician offices as they will be the initial referral source for patients to the program. Ideally, if successful, patients would refer their friends and family to the program as well. There are only two qualification standards for participation in the program. First, the woman must be less than 24 weeks pregnant to ensure adequate time for prenatal care to maximize the success rate of project goal one. Second, the family must be at or below the government established poverty line. A registered nurse and licensed social worker would be assigned to the woman to complete the project goals and planning with the patient in her home. The same registered nurse and licensed social worker would complete home visits ever one or two weeks throughout the pregnancy and first year of the infant’s life. The frequency of visits would be determined during the initial assessment and re-evaluated as required to ensure participants are receiving the interventions they need to ensure success in the program. Each goal is monitored by the nurse and social worker throughout the family’s participation in the program and changes or new interventions are developed as required. The participation would continue during the pregnancy thru the child’s first birthday. During that year participants are armed with the knowledge and resources to ensure safe and healthy environments for their children, healthy support networks, reduce or eliminate negative behaviors, provide responsible and competent care to their children, and to be economically independent of government aid programs. If patients are determined to not be safely discharged from the program, they may be determined eligible for additional assistance. Evaluation of Project Overall evaluation of the program is difficult to ascertain as this program would take over a year to achieve results. However, nurse partnership programs have begun to gain popularity throughout our country and have achieved wonderful results. So much so, that the Centers for Disease Control have named these programs as effective with a great potential to reduce economic burden of child maltreatment. Further collaboration with the licensed social worker, Mandy S. , determined a weakness in this program. While the original goal was to decrease the number of child abuse cases in children under the age of one year, it was determined by the social worker that many of her clients had children under the age of two and required much assistance from her. My initial plan to provide services thought the first year of the child’s life was inadequate. Together, we determined participation through the second year of the child’s life would be most beneficial to participants. Mandy S. was a great resource as she stated that the majority of child abuse cases she personally supervises are due to a lack of support, resources, and most importantly, education. This program provides those things to participants, thus decreasing the risk of child abuse and trauma, increasing positive parenting skills, and developing positive coping skills. Interviews with young mothers proved positive. When asked if they would be interested in participating in a NPP program or would have liked to have a program available when they were expecting, 22 of the 25 polled stated yes, they would have been excited to participate. Those 22 mothers unanimously stated they felt they would benefit from such a program. Although the original program did not include support groups of participants, the polled mothers stated they would enjoy the social benefits of participating in support group comprised of participants. This would be a great resource for those participants who do not have a family or other social circle to rely on for support. The community overall benefits from a program that decreases the rate of child abuse. It breaks a cycle that research has proven exists. Many times people who have been abused continue the cycle of abuse; Clark County has the opportunity to stop that cycle. Children who are subject to abuse are at a higher risk of developing mental health issues, substance abuse problems, and overall negative health behaviors (Herrenkohl, R. Harrenkohl, T. , Moylan, C. , & Sousa, C. , Tajima, E. 2008). The community not only saves money with this program, but it builds a strong community where healthy families thrive and prosper. Summary Parenting can be a challenging and lonely experience. The course of this project has taught me that preparation is the key to success. The more we can prepare young mothers for the challenges of parenthood, the more we are likely to decrease the rate of child abuse among children under the age of one year. Young parents are often faced with the stress of financial dependence on others and government programs; the NPP provides resources to set and meet goals to complete education and achieve employment to maximize financial independence. This is not a lifelong program. The intention of the program is to provide parents the mental tool box and resources they need in order to provide a healthy life and economical independent life for their children. The concept is relatively new, and I am excited to see the proven long term effects in the years to come.