American Indian or Alaska Native
22%
Source
Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8), 801–827.
Model(s) Reviewed
Funding Sources
Alaska Mental Health Trust Authority and 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
High rating applies to the following outcomes: child maltreatment, mother relinquished role, child hospitalized for ACSC, and child seen in the emergency room. A moderate rating applies to all other outcomes in the study’s Table 3, as well as the partner violence and substance use outcomes in the study’s Table 4, because of high attrition and equivalence on race and SES. Mental health outcomes in Table 4 receive a low rating because of high attrition and statistically significant baseline differences by race or SES.
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’s 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.
Were any subgroups examined?
No
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’s 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.
Were any subgroups examined?
No
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Substantiated CPS reports, all types | Child age 1 | High | 0.12 | Not statistically significant, p ≥ 0.05 | 309 families | Full sample, Alaska trial | ||
| Substantiated CPS reports, neglect | Child age 1 | High | 0.34 | Not statistically significant, p ≥ 0.05 | 309 families | Full sample, Alaska trial | ||
| Substantiated CPS reports, all types | Child age 2 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 297 families | Full sample, Alaska trial | ||
| Substantiated CPS reports, neglect | Child age 2 | High | 0.10 | Not statistically significant, p ≥ 0.05 | 297 families | Full sample, Alaska trial | ||
| Psychological aggression (CTS-PC) | Year 2 | High | 0.04 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Mild physical assault (CTS-PC) | Year 2 | High | 0.21 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Severe assault (CTS-PC) | Year 2 | High | 0.17 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Neglectful behavior (CTS-PC) | Year 2 | High | 0.11 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Common corporal punishment (CTS-PC) | Year 2 | High | 0.08 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Threat to esteem (CTS-PC) | Year 2 | High | 0.07 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Hit with object (CTS-PC) | Year 2 | High | 0.45 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Extreme physical punishment (CTS-PC) | Year 2 | High | 0.25 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Neglectful behavior revised (CTS-PC) | Year 2 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Corporal/verbal punishment (CTS-PC) | Year 2 | High | 0.05 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Psychological aggression Frequency (CTS-PC) | Year 2 | High | Statistically significant, p < 0.05 |
246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Mild physical assault Frequency (CTS-PC) | Year 2 | High | Statistically significant, p < 0.05 |
246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Severe assault Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Neglectful behavior Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Common corporal punishment (CTS-PC) | Year 2 | High | Statistically significant, p < 0.05 |
246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Threat to esteem Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Hit with object Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Extreme physical punishment Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Neglectful behavior revised Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Corporal/verbal punishment Frequency (CTS-PC) | Year 2 | High | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Mother relinquished role (child lived separately from mother for one month or more) | Years 1 and 2 | High | 0.09 | Not statistically significant, p ≥ 0.05 | 322 families | Full sample, Alaska trial | ||
| Poor caregiver interaction, (NCAST score = 35) | Year 2 | Moderate | 0.16 | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Poor quality home environment (HOME score = 33) | Year 2 | Moderate | 0.36 | Statistically significant, p < 0.05 |
246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | ||
| Attitudes toward corporal punishment (AAPI) | Year 2 | Moderate | Not statistically significant, p ≥ 0.05 | 246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial | |||
| Total AAPI score | Year 2 | Moderate | Not Statistically significant, p >: 0.05 |
246 mothers | Biological mothers with custody of index child at follow-up, Alaska trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Problem alcohol use | Year 2 | High | 0.39 | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | ||
| Any illicit drug use | Year 2 | High | 0.12 | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial | ||
| Alcohol or drug use | Year 2 | High | 0.14 | Not statistically significant, p ≥ 0.05 | 249 mothers | Biological mothers with custody of index child at interview, Alaska trial |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Child hospitalized for ambulatory care sensitive conditions ( |
Years 1 and 2 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 268 families | Families with complete medical record data, Alaska trial | ||
| Child seen in emergency department for ACSC | Years 1 and 2 | High | 0.11 | Not statistically significant, p ≥ 0.05 | 268 families | Families with complete medical record data, Alaska trial | ||
| Number of times hospitalized for ACSC | Years 1 and 2 | High | Not statistically significant, p ≥ 0.05 | 268 families | Families with complete medical record data, Alaska trial | |||
| Number of times seen in emergency department for ACSC | Years 1 and 2 | High | Not statistically significant, p ≥ 0.05 | 268 families | Families with complete medical record data, Alaska trial |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Alaska