Purpose: Many newly arrived immigrant and refugee families live in extreme economic conditions, have minimal social support, and have lost their cultural framework for parenting. These stressors present as risk factors for depression and poor parenting and may lead to maltreatment of infants. In the past, home-visiting interventions, staffed by professionals, have been used to prevent child maltreatment for high-risk families (Olds, et al., 1999). However, paraprofessional home-visitors often share a language and life experience with clients. Thus, with reduced social distance they are able to influence a mother's motivation to use resources and help her feel self-efficacious (Hiatt, et al., 1997). A community-based program proposed employing paraprofessional bicultural home-visitors to intervene with at-risk, low income, limited English speaking immigrant/refugee mothers and infants to reduce risk of child abuse/neglect. The purpose of this study is to assess the techniques utilized and to evaluate the impact on the mothers' level of stress and depression.

Methods: Agency generated data were obtained for mothers of infants who participated in this 8 month-long strengths-based program during 2004. The sample is comprised of 32 mothers, 72% of whom were married or living with partners (average age 28 years). Eighty-four percent of them were on public assistance, were immigrants or refugees from Latin America (66%), Africa (16%), or Asia (12%), and monolingual in their native language (94%). Incomes were overwhelmingly low, with 62% earning less than $20,000. Data were available from intake evaluations, which contain information about: history of immigration, familial and social supports, and current life difficulties; staff contact logs detailing interventions, as well as pre and post-intervention measures of depression (BDI II, Beck, 1996) and parenting stress (PSI, Abidin, 1990).

Results: Results indicate that interventions were employed to address the broad array of family problems and were not solely focused on mother and infant needs. The five most prevalent stressors addressed by the home-visitors and experienced by more than 70% of families were: lack of finances, unemployment, language barriers, access to benefits, and maternal depression. For example, the mothers were offered general emotional support, assistance with translation, and referral to domestic violence programs, as well as help with concrete baby needs (e.g. clothes, baby formula, cribs, and car seats) and parenting education. Often the home-visitors served as cultural brokers for their clients. In bivariate analyses, we found that mothers were considerably less depressed and less stressed in their parenting roles after completing the intervention.

Implications: Although this is a small uncontrolled study, it reflects the reality of real world social work practice in poor immigrant communities. Results demonstrate that in working with high-risk populations, paraprofessional home-visitors face overwhelming challenges in offering home-visiting services to prevent child maltreatment. However, the ability of bicultural home-visitors to expand their interventions to include the larger context of family life enabled them to meet many of the mothers' needs, and support optimal parenting practices. Further research should examine the efficacy of this type of program as compared to others, and study the in-depth processes of the intervention.