American Indian or Alaska Native
1.30%
Source
Green, B. L., Sanders, M. B., & Tarte, J. (2017). Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2–year impacts on child maltreatment & service utilization. Children and Youth Services Review, 75, 77–86.
Model(s) Reviewed
Funding Sources
The research was funded by the U.S. Department of Health and Human Services, Children’s Bureau (grant number 90CA1782).
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race and ethnicity; established on SES; outcomes not feasible to assess at baseline | None |
Notes
This study reported outcomes based on analyses of unadjusted means and proportions, as well as outcomes calculated based on regression analyses. Among the outcomes reported based on analyses of unadjusted means and proportions, all outcomes that are not assessable at baseline rate high. Three outcomes from the analyses of unadjusted means and proportions are assessable at baseline. Two of those outcomes, the percentage of mothers who ever received employment services and the number of days mother received employment services, rate moderate because the study does not establish baseline equivalence or control for differences in the baseline outcome. The third outcome, the percentage of mothers receiving substance abuse treatment services, rates low because we could not calculate attrition, and the study does not demonstrate equivalence or control for differences in the baseline outcome. All outcomes from the regression analyses rate low because we could not calculate attrition and the study does not establish baseline equivalence.
Study Participants
Healthy Families Oregon staff who visited hospitals and clinics serving pregnant women screened families for eligibility. Eligible families were English-speaking, first-time parents with a child under 90 days old and identified as high-risk on a standardized screening tool (the New Baby Questionnaire [NBQ]). Parents who scored positive for substance abuse or depression, or a combination of two other parent and child risks (such as lack of comprehensive prenatal care or single-parent status) were determined to be high risk. The NBQ was used to screen 8,520 first-time parents, and 2,727 of these parents were found eligible and randomized to either the home visiting program or a control group (1,438 and 1,289, respectively). Enrollment took place between February 2010 and February 2012. Families were randomized in seven home visiting program sites in Oregon. At randomization, between 57 and 60 percent of families were white, non-Hispanic; 24 to 27 percent were Hispanic/Latino; and 15 to 16 percent were another race. Parents were, on average, 22 years old, and between 31 and 33 percent lacked a high school diploma or equivalent. Both parents were unemployed in between 35 and 37 percent of families. Outcomes were assessed using state administrative data matched to mother and child at two years following study enrollment for an analytic sample of 1,427 families in the intervention group and 1,280 families in the comparison group.
Setting
This study took place in seven Healthy Families Oregon sites that were oversubscribed, three of which served primarily rural communities and four of which served mixed urban and rural communities.
Home Visiting Services
Healthy Families Oregon is an accredited state home visiting program based on the HFA model. Families enroll prenatally or up to 90 days after birth and receive home visiting services through the child’s third birthday. Families receive weekly individualized home visits for at least six months that typically focus on child development and positive parent-child interactions. Families also receive case management services that identify their needs and link them to relevant services. Intervention uptake was low; of those assigned to the home-visiting group, only 44 percent received at least one home visit.In addition, all families in the study received brochures on parenting and child development, information about community resources, books, videos, and other small gifts.
Comparison Conditions
Families assigned to the comparison condition were not eligible to receive home visiting services through the Healthy Families Oregon program. However, they did receive brochures on parenting and child development, information about community resources, books, videos, and other small gifts.
Subgroups examined
• Public benefit receipt (mother received Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, child care subsidy, or employment services)
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Number of substantiated maltreatment reports, intent-to-treat analysis, unadjusted | 2 years | High | Not reported | 2707 children | Oregon, 2010-2012 | |||
| Number of substantiated neglect allegations, intent-to-treat analysis, unadjusted | 2 years | High | Not reported | 2707 children | Oregon, 2010-2012 | |||
| Number of substantiated abuse allegations, intent-to-treat analysis, unadjusted | 2 years | High | Not reported | 2707 children | Oregon, 2010-2012 | |||
| Percentage with at least one substantiated maltreatment report, intent-to-treat analysis, unadjusted | 2 years | High | 0.03 | Not statistically significant, p = 0.41 | 2707 children | Oregon, 2010-2012 | ||
| Percentage with at least one substantiated neglect report, intent-to-treat analysis, unadjusted | 2 years | High | 0.03 | Not statistically significant, p = 0.40 | 2707 children | Oregon, 2010-2012 | ||
| Percentage with at least one substantiated physical or sexual abuse report, intent-to-treat analysis, unadjusted | 2 years | High | -0.29 | Statistically significant, p = 0.00 | 2707 children | Oregon, 2010-2012 | ||
| Percentage with at least one out-of-home placement, intent-to-treat analysis, unadjusted | 2 years | High | 0.10 | Statistically significant, p = 0.01 | 2707 children | Oregon, 2010-2012 | ||
| Number of days in out-of-home care, intent-to-treat analysis, unadjusted | 2 years | High | Not reported | 2707 children | Oregon, 2010-2012 |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Percentage ever received TANF, intent-to-treat analysis, unadjusted | 2 years | High | 0.02 | Not statistically significant, p = 0.56 | 2707 mothers | Oregon, 2010-2012 | ||
| Number of days on TANF, intent-to-treat analysis, unadjusted | 2 years | High | 0.03 | Not statistically significant, p = 0.51 | 2707 mothers | Oregon, 2010-2012 | ||
| Percentage ever received SNAP, intent-to-treat analysis, unadjusted | 2 years | High | 0.10 | Statistically significant, p = 0.01 | 2707 mothers | Oregon, 2010-2012 | ||
| Number of days on SNAP, intent-to-treat analysis, unadjusted | 2 years | High | 0.05 | Not statistically significant, p = 0.20 | 2707 mothers | Oregon, 2010-2012 | ||
| Percentage ever received child care subsidy, intent-to-treat analysis, unadjusted | 2 years | High | -0.04 | Not statistically significant, p = 0.33 | 2707 mothers | Oregon, 2010-2012 | ||
| Number of days with child care subsidy, intent-to-treat analysis, unadjusted | 2 years | High | 0.00 | Not statistically significant, p = 0.92 | 2707 mothers | Oregon, 2010-2012 | ||
| Percentage ever received employment services, intent-to-treat analysis, unadjusted | 2 years | Moderate | 0.01 | Not statistically significant, p = 0.77 | 2707 mothers | Oregon, 2010-2012 | ||
| Number of days with employment services, intent-to-treat analysis, unadjusted | 2 years | Moderate | 0.02 | Not statistically significant, p = 0.53 | 2707 mothers | Oregon, 2010-2012 |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Oregon