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Study Detail

Kirkland, K., & Mitchell-Herzfeld, S. (2012). Evaluating the effectiveness of home visiting services in promoting children’s adjustment in school: Final report to the Pew Center on the States. Rensselaer, NY: New York State Office of Children and Family Services, Bureau of Evaluation and Research.

Program(s) Reviewed: Healthy Families America (HFA)®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
ModerateRandomized controlled trialNew York SampleHighEstablished on race and SES. Baseline equivalence on outcomes not feasible.NoneNone

Study Characteristics

Study Participants

Community agencies, including prenatal care providers and hospitals, screened expectant parents and parents with an infant younger than 3 months of age who lived in high-risk target areas and who were considered to be at risk for child abuse or neglect. Women were selected for the study following the same screening and assessment procedures used to determine eligibility for Healthy Families New York (HFNY). Family assessment workers (FAWs) obtained informed consent from women before the administration of a well-established risk assessment tool. In total 1,254 mothers were randomly assigned (intervention, n = 621; control, n = 633), and 1,173 mothers (intervention, n = 579; control, n = 594) completed baseline interviews. This study reported on the Year 7 follow-up for this study sample, with the authors matching Grade 1 school records when possible for study children whose mothers provided consent for the record collection. This results in an analysis sample size of 577 children (intervention, n = 288; control, n = 289). In this analysis sample, 36 percent of the mothers were white, non-Latina; 46 percent were African American, non-Latina; and 16 percent were Latina. Fifty-six percent of the study children were the first child for mothers in the study; 47 percent of mothers had a high school diploma or equivalent, and 28 percent were receiving cash assistance at random assignment. The authors’ estimation of annual earnings for mothers in the analysis sample was $5,173.

Setting

This study took place in three sites within the HFNY home visiting program.

Home Visiting Services

HFNY, which is based on the Healthy Families America (HFA) model, was established as a strengths-based, intensive home visitation program with the explicit goals of (1) promoting positive parenting skills and parent-child interaction; (2) preventing child abuse and neglect; (3) supporting optimal prenatal care, and child health and development; and (4) improving parents’ self-sufficiency.

Families are provided intensive home visitation services bi-weekly during the prenatal period, weekly until the child is at least 6 months old, and periodically thereafter based on the needs of the family until the child begins school or Head Start. Home visits typically emphasize content that is appropriate to the particular service level on which the family is currently assigned. For example, visits on the prenatal level focus on promoting adequate prenatal care and providing information regarding fetal development, as well as preparing the family for childbirth and providing instruction on the care and safety of a newborn. Postnatal visits focus primarily on promoting positive parent-child interactions, educating parents about child growth and development, and enhancing family functioning and self-sufficiency.

HFNY programs determine the most appropriate curricula to use during home visits based on the specific needs and characteristics of individual families. At all stages, home visitors provide support, education, information, and activities designed to promote healthy parenting behaviors and child growth, including proper nutrition, age-appropriate behaviors, and positive discipline strategies. Home visitors also help mothers access health care and other services as needed; identify and address issues regarding positive family functioning; and discuss child care, education, training, and employment options.

Comparison Condition

The control group was given information on and received referrals to appropriate services other than home visiting.

Staff Characteristics and Training

The program is primarily delivered by trained paraprofessionals who typically come from the communities that the program targets for service.

Funding Source

The Pew Charitable Trusts, The Pew Center on the States, Grant #2010-0588.

Author Affiliation

None of the study authors are developers of this program model.


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