Mobiele menu

Inzet van passende zorg bij zeer kwetsbaar (jong) ouderschap na 28 weken zwangerschap: VoorZorg Late Start.Suitable care in case of very vulnerable (young) parenthood after 28 weeks of pregnancy: VoorZorg Late Start.

Projectomschrijving

VoorZorg Late Start: Inzet van passende zorg bij zeer kwetsbaar (jong) ouderschap na 28 weken zwangerschap

Vraagstuk

3-5% van de Nederlandse kinderen wordt geboren in gezinnen met een cumulatie van risico’s. Hier komen zorgwekkende opvoedingssituaties en kindermishandeling vaker voor. VoorZorg is een effectief preventief verpleegkundig huisbezoeken programma. VoorZorg is ontwikkeld voor, en onderzocht bij de doelgroep met een zwangerschapsduur < 28 weken. De vraag is of VoorZorg ook effectief is als de zwangerschap verder gevorderd is.

Onderzoek

Prenatale ondersteuning èn het vroeg opbouwen van een vertrouwensrelatie zijn werkzame elementen in VoorZorg. Later starten vraagt aanpassingen van het programma en de werkwijze en onderzoek naar de werkzaamheid van de aangepaste versie.

Verwachte uitkomst

De ontwikkelaars van VoorZorg LS hopen dat het lukt om ook voor kwetsbare gezinnen die tussen 28 weken zwangerschap en 6 weken postpartum in zorg komen een werkzaam programma te ontwikkelen, op basis van de werkzame elementen van VoorZorg. Hiermee krijgen meer kwetsbare gezinnen betere kansen.

Contact

Mocht u in contact willen komen met dit project, dan kunt u mailen naar: FSondeijker@verwey-jonker.nl.

Verslagen


Samenvatting van de aanvraag

Exposure to stress, smoke, poor nutrition, abuse or other risk factors in the formative first 1000 days of life may be the root of developmental and health problems ( Detmar et al., 2016). Parental stress - caused by, for example, domestic violence, relationship problems, lifestyle, debt problems - is an important risk factor. Out of all new born children, 3-5% are born in very vulnerable families with a cumulation of risks. Vulnerable parents should be given appropriate support aimed at relieving stress, improving health skills and sensitive parenthood to decrease the risk of parenting problems and child development problems. According to obstetric care providers and municipalities there is a need for effective, integral care around pregnancy and vulnerable parenthood for high-risk groups. VoorZorg (VZ), a (cost)effective home-visiting program, is in line with this demand, but has been developed and researched with strict inclusion criteria, including a start before the 28th week of pregnancy. In case of an unintended, unwelcome or unrecognized (teen)pregnancy, high risk pregnant women and their families are reached after the 28th week of pregnancy. Parental problems are often present in these families, resulting in child behaviour problems and even placement under supervision or out of home care. This could be prevented with adequate support. Available programs that can start after 28 weeks of pregnancy, like ‘Stevig Ouderschap’, are far less intense and thus not adequate for the target group. Therefore we want to develop VZ Late Start (VZ LS), in which VZ is adapted for the high-risk group of women who sign up late in their first pregnancy: between 28 weeks pregnant and 6 weeks postpartum. The core elements will be the same as in VZ: a long lasting relation between the nurse and the family, following the family until the child is 2 years old, supporting the clients goals, and training skills in communication, attachment, playing and talking with the child. Specific adjustments to the program are necessary to account for important differences between the late start and the regular VZ target group. First, normally about 20 out of 60 home visits occur during pregnancy within VoorZorg. Due to a late start clients miss a part of the support and trained skills that are usually given before the 28th week of pregnancy, which must be compensated for in VZ LS. Second, preventing prenatal damage is difficult or not possible with a late start; prenatal damage is associated with health-related, developmental, and behavioural problems, which may make the situation more complex. Third, there is less time to build up a relationship of trust with parents. Despite of the differences, municipalities, birth care organizations and VZ-nurses believe that late starting clients can benefit from VZ, if the content and intensity of the program are adapted to the late start situation. We intend to include from 28 weeks pregnancy until 6 weeks postpartum. The phase shortly before a child is born or after birth means that a lot of energy is required to support the attachment bond between client and child. On the other hand, this phase may make VZ Late start clients more accepting of advice from VZ-nurses. We expect that patterns of parenting and attachment will have developed after 6 weeks and will not be easily influenced. The question is what adjustments to the existing program are needed and whether the adjusted program is effective for the target group. To answer these questions, we start with analysing the experiences of families and nurses who participated under pretesting conditions since January 2019. We will use these to adapt and develop a concept program for VZ LS (including manual, training and materials), following a theory of change approach, also known as a participative process. VZ-nurses will be trained to carry out the adapted program. We intend to follow twenty VZ LS clients, assessing outcome measures through questionnaires and file analyses. Ten of these clients will also be studied in a case study design (interviews), following the clients, their VZ LS nurse and other important people in their lives. Participation starts simultaneously with participation in the program and follows the client system for the full duration of the program, which is until the child reaches the age of 2 years. We expect that VZ LS impacts the mother's parenting skills, lifestyle skills, and attitude towards support, thereby leading to less parenting problems and improved child development. Ahead of a positive result, we start a national implementation and bring VZ LS to the national databases for effective programs (NJi; RIVM). It is an enormous opportunity to develop a proven (cost) effective intervention for this new target group. It is a chance for society to breach the negative spiral for a very vulnerable group, and offer these parents and their children the chance to grow up healthier, safer and to a more promising life.

Kenmerken

Projectnummer:
554002002
Looptijd: 79%
Looptijd: 79 %
2021
2025
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. F.E.P.L. Sondeijker
Verantwoordelijke organisatie:
Verwey-Jonker Instituut