Psychology, Department of


First Advisor

David J. Hansen

Date of this Version


Document Type



Schreier, A. (2017). Early Head Start home visitor's identification of risk for maltreatment (Unpublished doctoral dissertation). University of Nebraska-Lincoln, Nebraska.


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor David J. Hansen, Lincoln, Nebraska: April, 2017


Infants and toddlers enrolled in Early Head Start are at increased risk for child maltreatment due to the presence of numerous factors across a developmental-ecological framework, such as poverty, parental mental health problems, and developmental disability (e.g., Belsky, 1993; Bronfenbrenner, 1979). Within Early Head Start, home visitors are in a unique position to identify the families most likely to experience maltreatment. However, research has demonstrated that home visitors are often ill-equipped to identify and address risk factors such as parental mental health concerns, substance abuse, and domestic violence (Azzi-Lessing, 2011; Tandon, Mercer, Saylor, & Duggan, 2008). Further, little is known about how home visitors understand risk for maltreatment.

The current mixed methods study sought to: (a) identify how Early Head Start home visitors understand maltreatment, determine risk for maltreatment, and refer families identified as at-risk to relevant Early Head Start program and community-based services; and (b) identify the association between presence of risk factors and court-substantiated child maltreatment to develop the model of factors that best predicts maltreatment occurrence. To answer these questions, archival program and clinical service data and juvenile court records on 743 Early Head Start families were extracted and analyzed. Qualitative interviews exploring identification of risk for maltreatment were also conducted with Early Head Start home visitors and supervisors.

Results demonstrate high risk for maltreatment, with 14.9% of enrolled families having a court-substantiated case of maltreatment. Home visitors identified numerous risk factors for maltreatment across child, caregiver, interactional, and social/environmental risk levels. Of the risk factors identified, being a single parent, presence of intimate partner violence, and prior CPS involvement were predictive of court-substantiated maltreatment. There was no significant difference in maltreatment prediction between evidence-based risk factors and home visitor risk factors. Families with actual and predicted maltreatment were significantly more likely to receive program services than families without maltreatment. Findings provide rich information about the role that home visitors play in maltreatment prevention within Early Head Start. Directions for effectively training home visitors to engage families and deliver program and community-based services in a manner that reduces risk for and prevents maltreatment are discussed.

Advisor: David J. Hansen

Included in

Psychology Commons