142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Referrals for reproductive care in home visitation: Administrator perspectives on staff responsiveness

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 12:30 PM - 12:50 PM

Stephen Edward McMillin, PhD , School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO
Background: Home visiting programs build supportive, non-judgmental relationships between trained home visitors and at-risk parents of young children which are theorized to improve parental self-efficacy and confidence. These program models also offer linkage and referrals to services including family planning.  Little is known about how programs handle parental requests for referrals for reproductive services that are controversial to staff and may impact the helping relationship.

Method: Interviews approximately 90-120 minutes in length were conducted with 34 home visiting program administrators in a large Midwestern state.

Analysis: Interviews were audio-recorded, transcribed, coded thematically, and subjected to content analysis.   

Results: Abortion and contraception emerged as referral requests or topics that were sometimes challenging to program staff.  Mothers who were receiving home visiting and who experienced a subsequent pregnancy they sought program help to terminate tended to receive staff responses that framed abortion as implicitly or explicitly negative.  Implicitly negative responses framed abortion as a "bad" choice comparable to other "bad" choices participants made, such as to use drugs or have multiple sexual partners.  Explicitly negative responses framed abortion as incompatible with or oppositional to home visitation.  Responses to contraception were wide-ranging, with some staff opposing contraceptive referrals, some advocating program neutrality on contraception, and some welcoming contraceptive referrals.   

Conclusion: Responses seem in accord with political scientist Charles Lindblom’s concept of circularity or controlled volition, which suggests that programs may deflect requests for things they would prefer not to grant.  This may constrain choices on some reproductive issues for program participants.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Social and behavioral sciences

Learning Objectives:
Identify contexts in which women receiving home visitation services may seek program assistance to obtain an abortion. Compare home visiting program responses to requests for contraception referrals or assistance. Assess how home visitation program models describe formal and informal policies on providing referrals for reproductive care.

Keyword(s): Abortion, Contraception

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Home visitation program administration is my principal area of research and I have completed extensive qualitative interviews with home visiting program trainers and administrators. I hold a master's degree in health policy and administration from Northwestern University and a master's degree and PhD in social service administration from the University of Chicago.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.