Manuscript Details

Source

Duggan, A., Fuddy, L., Burrell, L., Higman, S. M., McFarlane, E., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse & Neglect, 28(6), 623–643.

High rating
Author Affiliation

None of the study authors are developers of this model.

Funding Sources

Maternal and Child Health Bureau (R40 MC 00029 (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); 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
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 first two follow-ups of the Hawaii Healthy Start randomized controlled trial. Follow-up interviews were completed for 88% of families in years 1 and 2, and 83% of participating families were included in both follow-ups.

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.

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 depression (present based on screening) • Intimate partner violence (three or more incidents or injury resulting from partner violence in prior year)

Findings that rate moderate or high in this manuscript

Reductions in juvenile delinquency, family violence, and crime
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Partner psychological abuse (CTS) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner physical abuse (CTS) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner incident resulting in injury (CTS) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner psychological abuse (CTS) Year 1 High
0.00 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner physical abuse (CTS) Year 1 High
0.13 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner incident resulting in injury (CTS) Year 1 High
0.06 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Partner psychological abuse (CTS) Year 2 High
0.00 Not statistically significant, p ≥ 0.05 556 mothers Full sample, Hawaii trial
Partner physical abuse (CTS) Year 2 High
0.18 Statistically significant, p < 0.05 556 mothers Full sample, Hawaii trial
Partner incident resulting in injury (CTS) Year 2 High
0.26 Statistically significant, p < 0.05 556 mothers Full sample, Hawaii trial
Partner psychological abuse (CTS) Year 3 High
0.10 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Partner physical abuse (CTS) Year 3 High
0.03 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Partner incident resulting in injury (CTS) Year 3 High
0.04 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Mothers with depressive symptoms (CES-D) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Severe parenting stress (PSI) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Illicit drug use Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Problem alcohol use (CAGE) Years 1-3 High
Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Mothers with depressive symptoms (CES-D) Year 1 High
0.00 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Severe parenting stress (PSI) Year 1 High
0.06 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Poor general mental health (MHI < 67) Year 1 High
0.25 Statistically significant, p < 0.05 564 mothers Full sample, Hawaii trial
Illicit drug use Year 1 High
0.00 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Problem alcohol use (CAGE) Year 1 High
0.15 Not statistically significant, p ≥ 0.05 564 mothers Full sample, Hawaii trial
Mothers with depressive symptoms (CES-D) Year 2 High
0.09 Not statistically significant, p ≥ 0.05 556 mothers Full sample, Hawaii trial
Severe parenting stress (PSI) Year 2 High
0.08 Not statistically significant, p ≥ 0.05 556 mothers Full sample, Hawaii trial
Poor general mental health (MHI < 67) Year 2 High
0.20 Statistically significant, p < 0.05 556 mothers Full sample, Hawaii trial
Illicit drug use Year 2 High
0.06 Not statistically significant, p ≥ 0.05 556 mothers Full sample, Hawaii trial
Problem alcohol use (CAGE) Year 2 High
0.08 Not statistically significant, p ≥ 0.05 556 mothers Full sample, Hawaii trial
Mothers with depressive symptoms (CES-D) Year 3 High
0.00 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Severe parenting stress (PSI) Year 3 High
0.00 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Poor general mental health (MHI < 67) Year 3 High
0.09 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Illicit drug use Year 3 High
0.14 Not statistically significant, p ≥ 0.05 548 mothers Full sample, Hawaii trial
Problem alcohol use (CAGE) Year 3 High
0.24 Statistically significant, p < 0.05 548 mothers Full sample, Hawaii trial
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Asian
28%
Native Hawaiian or Pacific Islander
34%
White
12%
Unknown
27%

Maternal Education

Data not available

Other Characteristics

Indigenous population
34%