Reductions in child maltreatment

Because young children are more likely than older children to be maltreated, the goal of some of the early childhood home visiting models in the HomVEE review is to prevent or reduce the incidence of child abuse and neglect. To achieve this goal, home visitors typically work with parents to improve knowledge, skills, and behaviors that are associated with maltreatment. For example, they may educate parents on how to interact with their children in a more responsive manner, teach them alternative ways to discipline their children, or provide strategies for meeting their children’s developmental needs. They may also attempt to decrease the numbers of stressors that may make families vulnerable to inappropriate parenting. For example, home visitors may work to enhance children’s functioning by improving child health and development or connect families with community resources (such as mental health and substance abuse services).

Outcomes in this domain include measures and assessments related to child maltreatment. Outcome measures include evidence of substantiated child maltreatment from administrative records and counts taken from medical records of encounters with health care providers for injuries or ingestions. Encounters with health care providers may include physician visits, emergency room visits, or hospitalizations. Parents in home visiting programs may be encouraged to use health care services more often, such as for well child care visits. In addition, families’ patterns of health care use may change after enrollment in a home visiting program. For example, if a program connects families with primary care physicians, they may reduce their use of the emergency room for health care. Therefore, in the HomVEE review, only health care encounters that may occur as a result of child maltreatment, such as treatment for injuries or ingestions, are included in the reductions in child maltreatment domain.

There is some concern that counts of child maltreatment reports may not be accurate indications of the incidence of maltreatment. For example, participation in early childhood home visiting programs increases surveillance of families and may result in increased reports of child maltreatment. Therefore, this review includes only substantiated reports of child maltreatment as an outcome measure; outcome measures based on unsubstantiated reports are excluded. HomVEE also includes child welfare outcomes such as placement outside the home.

HomVEE has classified the Conflicts Tactics Scale-Parent Child (CTS-PC), a measure that assesses neglectful, psychologically aggressive, and abusive parenting behavior, as a measure of child maltreatment.

HomVEE includes only substantiated reports of child maltreatment and child welfare measures such as custody loss and placement outside the home; outcome measures based on unsubstantiated reports are ineligible for review. There is some concern that counts of child maltreatment reports may not be accurate indications of the incidence of maltreatment. For example, participation in home visiting programs increases surveillance of families and may result in increased reports of child maltreatment.

Only health care encounters that may occur specifically as a result of child maltreatment, such as treatment for injuries or ingestions, are included in the reductions in child maltreatment domain. Encounters with health care providers may include physician visits, emergency room visits, or hospitalizations. Parents in home visiting programs may be encouraged to use health care services more often, such as for well child care visits. In addition, families’ patterns of health care use may change after enrollment in a home visiting program. For example, if a program connects families with primary care physicians, families may reduce their use of the emergency room for health care. Therefore, HomVEE places other health care encounter measures in the child health domain.

Categorizing runaway information. If a child running away is measured in child welfare records, that measure would be listed here. In contrast, if a parent or child reports that the child ran away from home, that measure would be reported in the child development and school readiness 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 — Reductions in child maltreatment domain