Manuscript Detail | Home Visiting Evidence of Effectiveness

Source

Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829–852. doi:10.1016/j.chiabu.2007.02.008

Rating

High

Model(s) Reviewed

Healthy Families America (HFA)®

Author Affiliation

None of the study authors are developers of this model.

Funding Sources

Alaska Mental Health Trust Authority and the Alaska State Department of Health and Social Services.

Study Design

Design	Attrition	Baseline equivalence	Confounding factors	Valid, reliable measures?
Randomized controlled trial	Low	Established on race and SES. Baseline equivalence on outcomes not feasible.	None

Notes

In 2020, HomVEE updated this review in three ways. First, HomVEE moved two findings on CTS-PC discipline from the Positive Parenting Practices to the Reductions in Child Maltreatment because ACF determined that nonviolent discipline and corporal punishment outcomes belong in the Positive Parenting Practices domain, unless those outcome are assessed using the Conflict Tactics Scale-Parent/Child. Second, HomVEE moved "Child has health care coverage" from the Child Health domain to the Family Economic Self-Sufficiency domain because ACF determined that health insurance coverage belongs in that domain. Finally, HomVEE moved the NCAST Child Response Score from the Child Development and School Readiness to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain.

Johns Hopkins University (2005) reports on the same outcomes based on maternal report and finds no statistically significant outcomes. These results are based on medical records.

High rating applies to hospitalization and emergency room visit outcomes. Analyses of other outcomes receive a moderate rating because of high attrition.

Study Participants

Between January 2000 and July 2001, 388 families who screened positive on a Healthy Families Alaska (HFAK) protocol for risk factors associated with poor health and social outcomes and received scores of 25 or higher on the Kempe Family Stress Checklist were recruited during pregnancy or at the time of birth (Duggan et al., 2007). Of these families, 364 consented to participate and were randomly assigned to the program group (n = 179) or the comparison group (n = 185). 325 families completed a baseline interview. The sample was 22% Alaska native, 55% Caucasian, 8% multiracial, and 15% other race. 58% of families were below poverty level, 58% of mothers had graduated from high school, and 73% had worked in the year prior to enrollment (Johns Hopkins University, 2005). The average age of mothers at baseline was 23.5 years. This study reports the second-year follow-up results of the HFA K evaluation, with a sample size of 138 program group primary caregivers and 140 comparison group primary caregivers. Most of the analyses are limited to families in which the biological mothers had custody of the index child at follow-up (249 families), with additional outcomes obtained from medical records (268 families). The outcomes included in this study were also described in an earlier report (Johns Hopkins University, 2005).

Setting

This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai.

Home Visiting Services

Families in the program group were assigned to receive visits monthly until their child’s birth and weekly thereafter. By design, families receive gradually less frequent visits as they reach critical milestones; ranging to quarterly visits at the highest level of functioning. Families were enrolled in the program until they functioned sufficiently to “graduate” or until their child turned 2. In practice, home visits were less frequent than intended, with only 4% of families receiving 75% or more of their designated frequency of visits and completing the full two years. Home visits were intended to emphasize preparing for child growth, development, and critical milestones; screening and referral for developmental delays; promoting a safe environment; positive parent-child interactions; establishing a “medical home” for the child; and supporting the family during crises. The program also emphasized the development of an Individual Family Support Plan (IFSP) or setting and monitoring progress toward individual family goals.

Comparison Conditions

Families assigned to the comparison condition received referrals to other community services.

Subgroups examined

• Risk of child maltreatment (mother screens positive for risk of child abuse) • Intimate partner violence (reported history of IPV or no history of IPV)