Child health

Due to the significant influence of child health on other developmental outcomes, some of the early childhood home visiting models in the HomVEE review address the promotion of child health in some way. Models that begin during a mother’s pregnancy aim to improve birth outcomes by linking mothers to prenatal health care and providing them with information about fetal development. Following the birth of the child, programs ensure that children have access to health care, receive appropriate well-child care and immunizations, and receive appropriate medical care for illnesses and injuries. Some programs also provide information to parents about ways to support physical health, such as the importance of nutritious meals and physical activity.

Measures of a child’s growth, physical health, and use of health services (such as immunizations) are all included in this domain. Outcome measures in this domain are birth outcomes and counts of health care service use, which are extracted from medical records. Other outcome measures in this domain are based on parent reports about children’s health and use of health care services. For some outcomes the direction of the effect is not clearly favorable or unfavorable and instead it is ambiguous. For example, the direction of the effect on the number of days hospitalized is ambiguous because it is not necessarily due to poorer health: more time in the hospital may be due to increased access to health care. In other words, families’ participation in the home visiting program may have increased the likelihood that they would receive needed health care services, and therefore more days hospitalized may not be an unfavorable outcome.

Most diet and feeding measures belong in this domain. Measures of how often the child eats certain foods and whether the type of food and/or frequency of intake are appropriate belong is this domain. HomVEE’s domain categorization of other food intake measures depends on the types of foods included, how they are measured, and the age of the child. For example, HomVEE categorizes higher frequency intake of foods such as sugars, fats, and sweets as unfavorable. For other types of foods, HomVEE generally categorizes higher frequency intake as ambiguous, unless measures are designed to align with published food and nutrition guidelines. Outcomes related to the parent’s responsive feeding practices do not belong in this domain but instead belong in the positive parenting practices domain because they measure a parent’s attitudes and interactions with their child. Another diet-related outcome, the Breastfeeding Self-Efficacy Scale, belongs in the positive parenting practices domain instead because it measures the parent’s attitudes.

Child mental and behavioral health do not belong in this domain. HomVEE categorizes measures of children’s mental and behavioral health in the child development and school readiness domain, in contrast to the measures of physical health that are reported in the child health domain.

Medical attention outcomes generally fall into this domain. HomVEE categorizes measures of how often the child has been taken to the doctor or a hospital/clinic for a medical issue, and measures of whether the child received medical attention due to specific health issues (such as an infection or asthma), in this domain, and categorizes the direction of statistically significant impacts on such measures as ambiguous. That is because seeking more medical attention could be reflecting poorer health outcomes (unfavorable) but at the same time it could reflect increased access to health care and attention to medical health conditions (favorable). However, health care encounters due to injuries and ingestions do not belong in this domain. Most health care encounters for children belong in the child health domain. However, health care encounters that may occur specifically as a result of child maltreatment, such as treatment for injuries or ingestions, are placed in the reductions in child maltreatment domain.

Health insurance coverage does not belong in this domain. HomVEE places access to health insurance, for both the child and mother, in the family economic self-sufficiency domain.

The effects shown in the research are grouped into four categories: (1) favorable, (2) no effect, (3) unfavorable or ambiguous, and (4) not measured. Results for models that only have low-rated research are listed as “not applicable.” For more information on these categories please read the procedures and standards handbook. Only results from manuscripts that receive a moderate or high rating are considered below. This table includes manuscripts links to more information on the model’s effectiveness, implementation, and details on findings in this domain.

Effects shown in research — Child health domain