Abstract:
The early years of life are critical, however it is widely acknowledged that our existing support efforts for these years don’t work well for young families/whānau experiencing multiple stressors. An early intervention approach which has gained considerable empirical support is that of ‘nurse-family partnership/home visitation.’ One application of this approach in Aotearoa New Zealand is a prototype initiative called ‘Start Well’ in South Auckland. The current study aimed to explore the level of family harm and psychological distress for whānau engaged with Start Well, and how Start Well has engaged/supported with this. A case note review was followed by descriptive analysis of the data. Findings indicate that although family harm is commonly assumed to be dyadic in nature, there were usually more than two people involved in family harm incidents for the Start Well population. Grandmothers took protective action during a significant minority of family harm incidents. The topic of family harm was raised (without the use of a formal screening tool) on average 73 days into service engagement, resulting in an unusually high positive disclosure rate. Families remained engaged despite mandatory reporting, and data indicates that as whānau increasingly disclosed family harm to Start Well over time, clinicians were able to provide assistance that was effective in reducing further incidence. Conversations about psychological distress were recorded as occurring frequently and conversationally. This resulted in a high rate of disclosure and an unusually high rate of access to further mental health support where needed - including to a limited-access maternal mental health respite facility. However, findings suggest that further support may have been differentially available. Overall, findings suggest that Start Well, working from an effective commissioning/contracting environment, is able to invest heavily in relationship and to use clinical skills effectively, enabling successful partnership with whānau to address family harm and psychological distress. Recommendations for policy and clinical practice are made.
