Manuscript Detail | Home Visiting Evidence of Effectiveness

Source

Anisfeld, E., Sandy, J., & Guterman, N. B. (2004). Best Beginnings: A randomized controlled trial of a paraprofessional home visiting program: Technical report. Report to the Smith Richardson Foundation and New York State Office of Children and Family Services. New York: Columbia University School of Social Work.

Rating

Moderate

Model(s) Reviewed

Healthy Families America (HFA)®

Author Affiliation

None of the study authors are developers of this model.

Funding Sources

New York State Office of Children and Family Services; the U.S. Department of Health and Human Services Children’s Bureau Abandoned Infants Assistance Program; and the Smith Richardson Foundation.

Study Design

Design	Attrition	Baseline equivalence	Confounding factors	Valid, reliable measures?
Randomized controlled trial	High	Established on race/ethnicity, SES, and feasible outcomes. Statistical controls for feasible baseline outcomes included.	None

Notes

Moderate rating applies to outcomes where the analytic sample size is at least 90 percent as large as the sample used to demonstrate baseline equivalence. Other outcomes receive a low rating. The moderate rating applies to the following outcomes: Increase in mother’s highest grade completed (baseline to 24 months); receipt of public assistance (up to 24 months postpartum); number of pediatric emergency room visits (up to 36 months of age); ASQ communication, gross motor, fine motor, social, and composite score (6 months); perceived social support (6, 12, and 24 months); service referrals (up to 24 months postpartum) for daycare/babysitting, English as a second language, job skills/search, pediatric primary care, AFDC or food stamps, housing assistance, Medicaid, immigration services, GED prep, early intervention program, family planning, food pantry, counseling, adult primary care, child health plus, WIC, parenting education or training, and domestic violence services.

Study Participants

Women who were pregnant or had an infant under 2 months old and who lived in two eligible census tracts were screened using a checklist for risk factors for child abuse and neglect. Women who were deemed at risk were further screened using the Kempe Family Screening Inventory (FSI). Consenting women (n = 672) who received a score of 25 or higher on the FSI were assigned to the program group (n = 329) or the comparison group (n = 343). From November 1994 to November 1995, all women in one tract were assigned to the program group and participants from the other tract were enrolled in the comparison group. If Family Assessment Workers determined during the course of screening that a member of the family was affected by substance use, the family was provided additional Best Beginnings services (regardless of program or comparison group membership). Starting in November 1995, women were randomly assigned to the program group or comparison group within their census tract. Of the women who were randomly assigned, 535 were enrolled in Best Beginnings (273 in the program group, and 262 in the comparison group). Among participating women, 89.9% were born outside the United States and 88.3% were of Dominican ethnicity. On average at baseline, mothers were 26.3 years of age, 19.1% were employed, and 61.4% were receiving public assistance.

Setting

Eligible women were recruited from one of two contiguous census tracts in Washington Heights, New York. Most women were receiving health care from the New York Presbyterian Hospital (NYPH) Ambulatory Care Network Corporation (ACNC).

Home Visiting Services

Families in the program group received home visits modeled after Healthy Families New York, but modified to meet specific goals. Goals for the visits included (1) assessing family strengths and needs and connecting the families with needed services, (2) improving maternal psychosocial functioning and life course, (3) improving parent-child interactions, and (4) promoting child growth and development.

Comparison Conditions

Participants in the comparison group received 1-2 home visits every six months until the child was age 5, and were provided with educational materials and information about community services. Assessment, screening and referrals for needed services were provided.

Were any subgroups examined?

Subgroups examined

• Child gender (boy or girl)

Findings that rate moderate or high in this manuscript

Child development and school readiness
Outcome measure	Timing of follow-up	Rating	Effect size	Stastical significance	Sample size	Sample description
ASQ Communication score	6 months	Moderate	0.07	Statistical significance not reported	359 children	Program group children not affected by substance abuse, NY Best Beginnings trial
ASQ Gross Motor score	6 months	Moderate	0.12	Statistical significance not reported	359 children	Program group children not affected by substance abuse, NY Best Beginnings trial
ASQ Fine Motor score	6 months	Moderate	0.12	Statistical significance not reported	359 children	Program group children not affected by substance abuse, NY Best Beginnings trial
ASQ Social score	6 months	Moderate	-0.06	Statistical significance not reported	359 children	Program group children not affected by substance abuse, NY Best Beginnings trial
ASQ Composite score	6 months	Moderate	0.15	Statistical significance not reported	359 children	Program group children not affected by substance abuse, NY Best Beginnings trial

Effect rating key

Favorable finding / Statistically significant

UnFavorable finding / Statistically significant

Ambiguous finding / Statistically significant