Encountering Child Abuse and Neglect in Home Visiting: a Qualitative Study of Visitor and Supervisor Experiences.

Prevention of child maltreatment is a goal of home visiting (HV) for new mothers. How home visitors and their clinical supervisors manage concerns about child maltreatment may impact both the families' and the home visitors' engagement with the program. We sought to understand how HV personnel encounter and respond to concerns of child maltreatment and how these concerns are related to their work with families. We conducted an interpretive descriptive qualitative study of home visitors and supervisors in a statewide HV program, using the Parents as Teachers curriculum, to describe the experience of HV personnel. Two researchers conducted semi-structured interviews March 2016 to October 2017. Interviews were concurrently transcribed, coded, and analyzed, using thematic analysis. After 13 interviews with home visitors and 13 interviews with supervisors, codes and themes were saturated. We identified three themes: Decision to Call Child Protective Services (CPS), Relationships, and Collaborating with CPS. The decision to call CPS was described as difficult, and there was substantial variation in the details of this decision. The relationship between home visitor and family was consistently the most important. Variations were seen in how home visitors and supervisors collaborated with CPS, ranging from strong connections through liaisons to frustrations due to poor communication and perceived variation in how cases were handled. The decision to report a family to CPS is a challenging clinical issue; additional training and connections with CPS may improve consistency across sites for home visitors.