Voorzorg

Target group:

The target group for VoorZorg is (eldest) children (aged 9 months to 2 years), born to mothers dealing with a range of risk factors to do with abuse and neglect, such as low levels of education, domestic violence, substance abuse in pregnancy, limited efficacy and pedagogical skills. VoorZorg is primarily focused on the children, but the support is directed at supporting the mothers themselves.

Objectives:

The main objective is to reduce (the risk of) child abuse in children within a specific target group of young, high-risk pregnancies in order to increase the developmental and health-related opportunities of the children. 

Sub-targets:

  • The pregnancy and birth outcomes for mother and child are improved.
  • The health and developmental opportunities of the child are improved.
  • The personal development of the mother is strengthened so that she can have a more meaningful relationship with her child.

Intervention structure:          

VoorZorg is comprised of home visits by a VoorZorg nurse during pregnancy and the first two years of life. VoorZorg works at health and safety, personal development, the mother as a parent, relationships with partner and family, use of community services.

Methodology:

Access to VoorZorg is via a two-step selection process.

The initial selection is made by professionals working with a pregnant woman. They assess whether or not the following criteria are met:

  • no previous live-born child;
  • maximum of 28 weeks pregnant;
  • maximum age of 25 years old;
  • maximum education level of VMBO (preparatory mid-level applied education) or education not completed;
  • some command of the Dutch language.

The professional will check how interested the woman is in taking part and then pass her information to the VoorZorg nurse.

The VoorZorg nurse makes the second selection. During a home visit, this nurse will discuss with the woman whether there are any additional risk factors that may make support from VoorZorg particularly desirable.

Additional risk factors are:

  • no partner;
  • no (support from) social network;
  • alcohol and/or drug use;
  • current domestic or partner violence;
  • a woman has been abused in the past and/or experienced domestic violence;
  • psychological problems: anxiety, depression;
  • unrealistic ideas about motherhood;
  • the nurse has concerns;
  • financial and/or housing problems.

Based on the input from the home visit and the balance model by Bakker http://www.nji.nl/nl/Download-NJi/BalansmodelBakker.pdf, an assessment will be made as to whether or not the mother is eligible. There will also be a clear discussion about whether or not the mother really does want the support. If so, the ‘VoorZorg participation form’ will be signed by the expectant mother and the VoorZorg nurse.

A good relationship between the nurse and the mother is an important basis for the success of the programme and for the mother’s learning experience. During implementation of VoorZorg, the nurse will work with the mother on structured behavioural changes (healthy lifestyle, stress reduction, healthy diet, exemplary behaviour, etc.), realistic and achievable targets (in respect of attachment, play, safety, etc.) and on strengthening her skills as a mother (education and work, developing a supportive network, self-reflection, etc.)

After the intake meeting/introduction, VoorZorg will begin as early as possible in the pregnancy; theoretically, this will be between the 13th and 16th week and at the very latest before the 28th week. VoorZorg will continue until the child is two years old. The frequency is, on average, two visits per month, with more frequent visits (weekly) in the first month of the programme and during the first six weeks following the birth. During the final four months, the frequency of home visits will decrease to being once per month. Home visits are set out according to fixed structure, and last around 60 to 90 minutes.

The three handbooks describe 64 home visits: 14 in the pregnancy phase, 28 in the baby phase (0-1 years) and 22 in the toddler phase (1-2 years).  The handbooks also contain information materials for the mother (and father) about all kinds of subjects.

The content of home visits is based on (sub) objectives, in which each home visit addresses the following areas:

  1. Healthy mother (healthy lifestyle, good diet, stress reduction)
  2. Healthy environment (home situation, safety)
  3. Mother’s life course (self-reflection, education and work)
  4. Motherhood (care, attachment, play and exemplary behaviour)
  5. Family and friends (informal support network)
  6. Using community services (formal support network)

Improvements in and strengthening of the six stated areas must result in the main objective as well as the sub-objectives being achieved.

Premature termination of the programme

If a mother does not wish to continue to take part in VoorZorg and the safety of the child is not at risk, then VoorZorg will be put on hold for six months. The child remains part of VoorZorg, as experience shows that there is a great deal of unpredictability within these families, which means that VoorZorg is often required again at a later date. After six months, the VoorZorg nurse will re-establish contact with the mother and during a home visit will discuss whether it is desirable and possible to stop, given the development and safety of the child. If VoorZorg does stop, they will say their goodbyes and following consultation, care will be transferred to the child healthcare team, and other involved parties will be alerted.

If more support agencies are involved than just VoorZorg, then a 1Family1Plan meeting will be organised if necessary. The various objectives, tasks and roles of the involved parties will be discussed and synchronized as much as possible, making it possible to create a joint approach plan.

Costs related:

A full VoorZorg trajectory lasting two and half years costs around €13,000 per mother (at the 2013 rate). The following costs are taken into account in this sum:

  • time spent on preparation, implementation and review (reporting, etc.) of home visits by the nurse;
  • time spent on teaching and supervision by the implementing organisation;
  • time spent on introductory conversations/ intake (including intakes that do not lead to participation in the programme);
  • the cost of basic training and national meetings;
  • the cost of network contacts and multidisciplinary consultations;
  • licensing costs per organisation.

Costs may vary in practice depending on the rates applicable to the organisation, the formative scope of the VoorZorg nurses and the turnover of staff.

Further information:

The intervention is carried out by experienced HBO (vocational university) trained child care experts with additional training as VoorZorg nurses. Training to become a VoorZorg nurse includes modules on Pregnancy, Babies, Toddlers and VHT (video home training, specially developed for VoorZorg).

Resources available:

An extensive description and contact details are included in the database of the Nederlands Jeugdinstituut (Dutch Youth Institute).  

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