Protective factors against child maltreatment among postpartum mothers and engagement in home visiting

Home visiting (HV) seeks to prevent maltreatment by promoting protective factors (PFs). Little is known, however, about PFs' associations with maternal characteristics and HV engagement.

To (1) determine associations between maternal characteristics with PFs and (2) determine associations between maternal characteristics and PFs with maternal agreement to HV referral. We hypothesized that maternal need for HV (i.e., higher risk and lower PFs) would be associated with lower (i.e., misaligned) maternal agreement to HV referral.

English and Spanish-speaking mothers (n = 480) enrolled during birth hospitalizations at an urban US hospital.

Protective Factors Survey, 2nd Edition measured PFs against child maltreatment: (1) family functioning/resilience, (2) nurturing/attachment, (3) social supports, and (4) concrete supports. Multivariable ordinal and logistic regressions estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for PFs scores and maternal agreement to HV referral, respectively.

Lower education and income were independently associated with lower social supports and concrete supports, Hispanic ethnicity with lower family functioning/resilience and social supports, CPS involvement with lower family functioning/resilience, and intimate partner violence and positive depression screening with lower concrete supports. No risk factors were positively associated with HV referral. Social supports were misaligned with HV referral with mothers reporting higher social supports more likely to agree to HV referral (aOR 1.54 [95% CI: 1.06, 2.23]). Only concrete supports were ideally aligned with HV referral (aOR 0.52 [95% CI: 0.39, 0.71]).

Maternal agreement to HV referral was generally misaligned with risk for and PFs against child maltreatment.