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Reductions in Child Maltreatment

In Brief

Overview

Because young children are more likely than older children to be maltreated, the goal of some of the home visiting models in the HomVEE review is to prevent or reduce the incidence of child abuse and neglect. To achieve this goal, home visitors typically work with parents to improve knowledge, skills, and behaviors that are associated with maltreatment. For example, they may educate parents on how to interact with their children in a more responsive manner, teach them alternative ways to discipline their children, or provide strategies for meeting their children’s developmental needs. They may also attempt to decrease the numbers of stressors that may make families vulnerable to inappropriate parenting. For example, home visitors may work to enhance children’s functioning by improving child health and development or connect families with community resources (such as mental health and substance abuse services).

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Measurement Considerations

In this domain, primary outcome measures include evidence of substantiated child maltreatment from administrative records and counts taken from medical records of encounters with health care providers for injuries or ingestions. There is some concern that counts of child maltreatment reports may not be accurate indications of the incidence of maltreatment. For example, participation in home visiting programs increases surveillance of families and may result in increased reports of child maltreatment. Therefore, this review includes only substantiated reports of child maltreatment as an outcome measure; outcome measures based on unsubstantiated reports are excluded. Encounters with health care providers may include physician visits, emergency room visits, or hospitalizations. Parents in home visiting programs may be encouraged to use health care services more often, such as for well child care visits. In addition, families’ patterns of health care use may change after enrollment in a home visiting program. For example, if a program connects families with primary care physicians, they may reduce their use of the emergency room for health care. Therefore, in the HomVEE review, only health care encounters that may occur as a result of child maltreatment, such as treatment for injuries or ingestions, are included in the child maltreatment domain. Counts of health care system encounters garnered from medical records are considered primary outcome measures; parent reports of health care system encounters are considered secondary outcome measures. Several studies of home visiting program models also use the Conflicts Tactics Scale-Parent Child (CTS-PC), a measure that assesses neglectful, psychologically aggressive, and abusive parenting behavior, as a measure of child maltreatment. Because the CTS-PC is a parent self-report measure and not standardized (normed), it is classified as a secondary outcome measure in the HomVEE review.

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Review of Studies

The HomVEE review examined the research on 45 home visiting program models with studies published between 1979 and 2015. (More information is available on literature search and prioritizing program models for review.) Of the 11 home visiting program models with high- or moderate-quality studies that measured reductions in child maltreatment, 7 had favorable effects on primary outcome measures and 3 had favorable effects on secondary outcome measures.

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Summary of Findings

The effects shown in the research are grouped into four categories: (1) favorable, (2) no effect, (3) unfavorable or ambiguous, and (4) not measured. Results for program models that do not have studies with a high or moderate rating are listed as “not applicable.” For more information on these categories please read Describing Effects. Only results from studies that meet the standards for the high or moderate ratings are considered below. This table includes links to more information on the program model’s effectiveness, implementation, and details on outcomes in this domain.

Effects Shown in Research — Child Maltreatment Domain


Program Model Name Meets DHHS-Criteria Primary Outcome Measures Secondary Outcome Measures For More Information
Attachment and Biobehavioral Catch-Up (ABC) Intervention
ABC
No Not measured Not measured
Child First Yes

Favorable:  1
No effect: 2
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

Child Parent Enrichment Project (CPEP) No

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 1
Unfavorable or ambiguous: 0

Childhood Asthma Prevention Study (CAPS) No Not measured Not measured
Computer-Assisted Motivational Intervention (CAMI)
Computer-Assisted Motivational Intervention (CAMI)
No Not measured Not measured
Early Head Start-Home Visiting (EHS-HV) Yes

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

Favorable:  1
No effect: 4
Unfavorable or ambiguous: 0

Early Intervention Program for Adolescent Mothers Yes Not measured Not measured
Early Start (New Zealand)
Early Start (New Zealand) - Full Sample
Yes

Favorable:  1
No effect: 0
Unfavorable or ambiguous: 0

Favorable:  1
No effect: 1
Unfavorable or ambiguous: 0

Early Start (New Zealand) – Māori subgroup
Yes

Favorable:  0
No effect: 1
Unfavorable or ambiguous: 0

Favorable:  1
No effect: 0
Unfavorable or ambiguous: 0

Even Start-Home Visiting (Birth to Age 5) No Not applicable Not applicable
Family Check-Up® For Children Yes Not measured Not measured
Family Connections (Birth to Age 5) No Not applicable Not applicable
Family Connects Yes Not measured Not measured
Family Spirit® Yes Not measured Not measured
Health Access Nurturing Development Services (HANDS) Program Yes

Favorable:  1
No effect: 0
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

HealthConnect One's® Community-Based Doula Program No Not applicable Not applicable
Healthy Beginnings Yes Not measured Not measured
Healthy Families America (HFA)® Yes

Favorable:  1
No effect: 33
Unfavorable or ambiguous: 0

Favorable:  14
No effect: 109
Unfavorable or ambiguous: 0

Healthy Start-Home Visiting No Not measured Not measured
Healthy Steps (National Evaluation 1996 Protocol) Yes

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 1
Unfavorable or ambiguous: 0

Home Instruction for Parents of Preschool Youngsters (HIPPY)® Yes Not measured Not measured
Home-Start No Not measured Not measured
HOMEBUILDERS (Birth to Age 5)® No Not applicable Not applicable
Maternal Early Childhood Sustained Home-Visiting Program (MECSH) Yes Not measured Not measured
Maternal Infant Health Outreach Worker (MIHOW)® No Not applicable Not applicable
Minding the Baby® Yes

Favorable:  0
No effect: 1
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

MOM Program No Not measured Not measured
Mothers’ Advocates in the Community (MOSAIC) No Not applicable Not applicable
North Carolina Baby Love Maternal Outreach Workers Program No Not applicable Not applicable
Nurse Family Partnership (NFP)® Yes

Favorable:  7
No effect: 18
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 1
Unfavorable or ambiguous: 0

Nurses for Newborns® No Not applicable Not applicable
Nurturing Parenting Programs (Birth to Age 5) No Not applicable Not applicable
Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program Yes Not measured Not measured
Parent-Child Assistance Program (PCAP)
Parent-Child Assistance Program (P-CAP)
No Not applicable Not applicable
Parent-Child Home Program No Not measured Not measured
Parents as Teachers (PAT)®
Parents as Teachers
Yes

Favorable:  1
No effect: 2
Unfavorable or ambiguous: 0

Favorable:  0
No effect: 0
Unfavorable or ambiguous: 0

Philani Outreach Programme No Not applicable Not applicable
Play and Learning Strategies (PALS)
Play and Learning Strategies (PALS) Infant
Yes Not measured Not measured
Pride in Parenting (PIP) No Not applicable Not applicable
Promoting First Relationships® No Not applicable Not applicable
Resource Mothers Program No Not applicable Not applicable
Resources, Education, and Care in the Home (REACH) No Not measured Not measured
REST Routine No Not measured Not measured
SafeCare®
SafeCare Augmented
Yes

Favorable:  1
No effect: 5
Unfavorable or ambiguous: 0

Favorable:  1
No effect: 5
Unfavorable or ambiguous: 0

Seattle-King County Healthy Homes Project No Not applicable Not applicable
Triple P-Positive Parenting Program®-Home Visiting (Triple P-Home Visiting)
Triple P-Home Visiting
No Not measured Not measured
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