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Item A comparison of three evidence based home visiting programs aimed at the prevention of childhood maltreatment(Montana State University - Bozeman, College of Nursing, 2014) Michalsky, Messina Michelle; Chairperson, Graduate Committee: Sandra KuntzChildhood maltreatment has lifetime consequences to a child's mental and physical health. For decades childhood maltreatment has been recognized as a public health crisis. In 2010, The Patient Protection and Affordable Care Act (ACA) of 2010 created the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) to promote and improve the health, development and well-being of at risk children and families through evidence based home visiting programs. This initiative has recognized home visiting programs as an early intervention preventative step in reducing incidence of childhood maltreatment. Urie Bronfenbrenner's Ecological Systems Theory of Development was used as the theoretical framework. This paper outlines and compares the effectiveness of the Nurse-Family Partnership, Parents as Teachers, and Early Head Start Home Visiting programs. The objectives of the paper are to provide a literature review exploring the ecological effects of childhood maltreatment, compare three home visiting programs delivery, efficacy, staffing, and costs. The Nurse Family Partnership is implemented in two cities in Montana. The fidelity of the program requires baccalaureate nurses. Appropriately trained personnel and funds must be available to implement. Parents as Teachers is the most widely used program in Montana accounting for sixteen programs. It costs the least of the three programs and is implemented by paraprofessionals. Early Headstart Home Visiting is offered in ten Head Start facilities throughout Montana. This is an option offered to families, but not utilized by all. Nurse Family Partnership showed favorable results in both reduction of childhood maltreatment and positive parenting practices. Parents as Teachers and Early Headstart Home Visiting findings enhanced positive parenting practices, but had mixed results in the prevention of childhood maltreatment. Much of the research of home visiting programs did not identify childhood maltreatment as a main intervention, which was evidenced by mixed results of effectiveness among the programs. Evidenced based home visiting programs are new to Montana. It may take years of implementation before effectiveness is assured. Home visiting programs need further study and a clear focus of program goals and measurements in order to correlate interventions with the reduction of childhood maltreatment.Item Exploring trust in the provider - patient DYAD : capturing the mother's voice in her own words(Montana State University - Bozeman, College of Nursing, 2014) Cline, Elize Marie; Chairperson, Graduate Committee: Sandra KuntzIn 2013, Montana was ranked 50th, or the lowest ranking state, for child health status according to the Annie E. Casey Foundation. The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was created when the Patient Protection and Affordable Care Act was signed into law. Several counties within Montana adopted the evidence-based Nurse-Family Partnership (NFP) home visiting program under the direction of MIECHV. The NFP program delivers care to at-risk pregnant mothers and their children. The purpose of this paper was to conduct a review of the literature to investigate communication approaches that the NFP nurse uses or could use during a home visit with the mother, that strengthens the ability of the nurse to capture and empower the mother's voice as customer. Three databases were utilized with a total of ten search terms. A total of five qualitative articles were found that directly examined the voice of the mother receiving home visiting services. Trust was the key term used to examine components of the dyad relationship. Trust within the provider-patient relationship is important as it is tied directly to program engagement and positive outcomes. After analysis of the articles, six themes surfaced that the mothers expressed and included personality, friendship, availability, empowerment, reducing vulnerability, and testing. Additional sub themes included emotional support, knowing, control, verbal praise, advocacy, and respect. Little research exists that directly examines and seeks to garner the experiences of at-risk mothers participating in home visiting programs. Complicating the literature search was the finding that trust is poorly defined in nursing literature and the health science literature as a whole. Further research and inquiry is needed to understand, according to the patient perspective, how trust is built, maintained, broken, and repaired. Understanding the concept of trust according to the patient perspective is imperative as home visiting programs are implemented within the state of Montana. Capturing the voice of the customer is not only a mandate but is imperative to improve the health status of our State.