Asian
28%
Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28(6), 597–622.
Model(s) Reviewed
Navigate to model page for more information about the home visiting model.
Funding Sources
Maternal and Child Health Bureau (R40MC00029 (formerly MCJ 240637) and R40 MC 00123 (formerly MCJ 240838); The Robert Wood Johnson Foundation (18303); The Annie E. Casey Foundation (94-4041); The David and Lucile Packard Foundation (93-6051, 94-7957, 97-8058, and 98-3448); National Institute of Mental Health, Epidemiological Center for Early Risk Behaviors, P30MH38725; the Hawaii State Department of Health (99-29-J); and the National Institute of Mental Health, Epidemiological Center for Early Risk Behaviors, P30MH38725.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race but not SES (e.g., maternal employment). Maternal employment is included as a control. Baseline equivalence on outcomes not feasible. |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
In 2020, HomVEE updated this review to move measures of Nonviolent discipline and Time outs (CTS-PC) from the Positive Parenting Practices domain 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.
Findings that rate moderate or high in this manuscript
Reductions in child maltreatment
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Psychological aggression (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Minor physical assault (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Severe physical abuse (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Common corporal/verbal punishment (past year) (CTS-PC) | Years 1-3 | High | Statistically significant,p < 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Assault on child’s self-esteem (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Hitting with an object (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Extreme physical abuse (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Shook child (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Common corporal/verbal punishment (past week) (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Neglect (Traditional CTS measure) (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Neglect (Revised CTS measure) (CTS-PC) | Years 1-3 | High | Statistically significant,p < 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Hospitalizations for trauma | Years 1-3 | High | 0.08 | Statistical significance not reported | 573 children | Full sample, Hawaii trial | ||
| Psychological aggression (CTS-PC) | Year 1 | High | 0.15 | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | ||
| Minor physical assault (CTS-PC) | Year 1 | High | 0.06 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Severe physical abuse (CTS-PC) | Year 1 | High | 0.26 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Very severe physical abuse (CTS-PC) | Year 1 | High | 0.12 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past year) (CTS-PC) | Year 1 | High | 0.26 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Assault on child’s self-esteem (CTS-PC) | Year 1 | High | 0.07 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Hitting with an object (CTS-PC) | Year 1 | High | 0.08 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Extreme physical abuse (CTS-PC) | Year 1 | High | 0.00 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Shook child (CTS-PC) | Year 1 | High | 0.00 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past week) (CTS-PC) | Year 1 | High | 0.02 | Not available | 558 mothers | Full sample, Hawaii trial | ||
| Neglect (Traditional CTS measure) (CTS-PC) | Year 1 | High | 0.24 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Neglect (Revised CTS measure) (CTS-PC) | Year 1 | High | 0.25 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports all types | Year 1 | High | 0.19 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports abuse or neglect | Year 1 | High | 0.00 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports threatened abuse neglect or harm | Year 1 | High | 0.19 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Psychological aggression (CTS-PC) | Year 2 | High | 0.11 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Minor physical assault (CTS-PC) | Year 2 | High | 0.05 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Severe physical abuse (CTS-PC) | Year 2 | High | 0.05 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Very severe physical abuse (CTS-PC) | Year 2 | High | 0.00 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past year) (CTS-PC) | Year 2 | High | 0.34 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Assault on child’s self-esteem (CTS-PC) | Year 2 | High | 0.00 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Hitting with an object (CTS-PC) | Year 2 | High | 0.07 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Extreme physical abuse (CTS-PC) | Year 2 | High | 0.00 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Shook child (CTS-PC) | Year 2 | High | 0.00 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past week) (CTS-PC) | Year 2 | High | 0.03 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Neglect (Traditional CTS measure) (CTS-PC) | Year 2 | High | 0.03 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Neglect (Revised CTS measure) (CTS-PC) | Year 2 | High | 0.16 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports all types | Year 2 | High | 0.32 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports abuse or neglect | Year 2 | High | 0.19 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports threatened abuse neglect or harm | Year 2 | High | 0.09 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Psychological aggression (CTS-PC) | Year 3 | High | 0.06 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Minor physical assault (CTS-PC) | Year 3 | High | 0.00 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Severe physical abuse (CTS-PC) | Year 3 | High | 0.28 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Very severe physical abuse (CTS-PC) | Year 3 | High | 0.10 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past year) (CTS-PC) | Year 3 | High | 0.30 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Assault on child’s self-esteem (CTS-PC) | Year 3 | High | 0.05 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Hitting with an object (CTS-PC) | Year 3 | High | 0.19 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Extreme physical abuse (CTS-PC) | Year 3 | High | 0.43 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Shook child (CTS-PC) | Year 3 | High | 0.10 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Common corporal/verbal punishment (past week) (CTS-PC) | Year 3 | High | 0.07 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Neglect (Traditional CTS measure) (CTS-PC) | Year 3 | High | 0.09 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Neglect (Revised CTS measure) (CTS-PC) | Year 3 | High | 0.16 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports all types | Year 3 | High | 0.28 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports abuse or neglect | Year 3 | High | 0.00 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Substantiated CPS reports threatened abuse neglect or harm | Year 3 | High | 0.28 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Timeouts, ever used in past week (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Nonviolent discipline, times used in past year (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Timeouts, times used in past year (CTS-PC) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Nonviolent discipline, ever used in past year (CTS-PC) | Year 1 | High | 0.43 | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | ||
| Timeouts, ever used in past week (CTS-PC) | Year 1 | High | 0.03 | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | ||
| Nonviolent discipline, times used in past year (CTS-PC) | Year 1 | High | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | |||
| Timeouts, times used in past year (CTS-PC) | Year 1 | High | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | |||
| Nonviolent discipline, ever used in past year (CTS-PC) | Year 2 | High | 0.00 | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | ||
| Timeouts, ever used in past week (CTS-PC) | Year 2 | High | 0.00 | Not statistically significant, p ≥ 0.05 | 549 mothers | Full sample, Hawaii trial | ||
| Nonviolent discipline, times used in past year (CTS-PC) | Year 2 | High | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | |||
| Timeouts, times used in past year (CTS-PC) | Year 2 | High | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | |||
| Nonviolent discipline, ever used in past year (CTS-PC) | Year 3 | High | 0.00 | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | ||
| Timeouts, ever used in past week (CTS-PC) | Year 3 | High | 0.11 | Not statistically significant, p ≥ 0.05 | 541 mothers | Full sample, Hawaii trial | ||
| Nonviolent discipline, times used in past year (CTS-PC) | Year 3 | High | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | |||
| Timeouts, times used in past year (CTS-PC) | Year 3 | High | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial |
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Hospitalizations for ambulatory care | Years 1-3 | High | 0.12 | Not statistically significant, p ≥ 0.05 | 573 children | Full sample, Hawaii trial |
Positive parenting practices
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Maternal responsivity to child (HOME) | Years 1-3 | High | Not statistically significant, p ≥ 0.05 | 558 mothers | Full sample, Hawaii trial | |||
| Maternal acceptance of child’s behavior (HOME) | Year 1 | High | Statistical significance not reported | 558 mothers | Full sample, Hawaii trial | |||
| Maternal acceptance of child’s behavior (HOME) | Year 2 | High | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | |||
| Maternal responsivity to child (HOME) | Year 2 | High | Statistical significance not reported | 549 mothers | Full sample, Hawaii trial | |||
| Maternal acceptance of child’s behavior (HOME) | Year 3 | High | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | |||
| Maternal responsivity to child (HOME) | Year 3 | High | Statistical significance not reported | 541 mothers | Full sample, Hawaii trial | |||
| Maternal responsivity to child (HOME) | Year 1 | High | Statistical signifivance not reported | 558 mothers | Full sample, Hawaii trial |
Study Participants
Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the three follow-ups of the Hawaii Healthy Start randomized controlled trial. In each follow-up year, interviews were completed for 88% of families. 81% of participating families completed all three follow-up interviews. Data were also collected from home observations, administrative records from child protective services, and pediatric medical records.
Setting
Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Home Visiting Services
Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected them to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months old. Families still active at the end of year 1 received an average of 22 visits in the first year. (Duggan, et al., 1999)
Model(s) Reviewed
Navigate to model page for more information about the home visiting model.
Comparison Conditions
The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004).
Subgroups examined
• Maternal age (less than 20 years) • Intimate partner violence (three or more incidents or injury resulting from partner violence in prior year) • Parity (primiparous or multiparous) • Household poverty status (above poverty threshold or below poverty threshold) • Risk of child maltreatment (mother screens positive for risk of child abuse)
This study included participants from the following locations:
- Hawaii