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).

Measurement Considerations

Outcomes in this domain include measures and assessments related to child maltreatment. 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 self-reported measures related to child maltreatment that are not standardized, which HomVEE classifies as secondary outcomes, were included in studies of home visiting models reviewed by HomVEE. For example, HomVEE has classified the Conflicts Tactics Scale-Parent Child (CTS-PC), a measure that assesses neglectful, psychologically aggressive, and abusive parenting behavior, as a secondary measure of child maltreatment. Similarly, the Child Abuse Potential Inventory (CAPI) is a self-reported questionnaire, so HomVEE classifies its measures as secondary.

Review of Studies

The HomVEE review examined the research on 50 home visiting models with studies published between 1979 and 2018. (More information is available on literature search and prioritizing models for review.) Of the 11 home visiting models with high- or moderate-quality studies that measured reductions in child maltreatment, 6 had favorable effects on primary outcome measures and 4 had favorable effects on secondary outcome measures.

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 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 model’s effectiveness, implementation, and details on outcomes in this domain.

Effects Shown in Research — Child Maltreatment Domain

Summary of findings across models for the reductions in child maltreatment outcome domain
Model Meets HHS Criteria Outcome measures For more information

Attachment and Biobehavioral Catch-Up (ABC) Intervention

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Child First

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 1
No effect: 2
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
For more information

Child Parent Enrichment Project (CPEP)

Meets HHS criteria?
No
Outcome measures
Primary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0
For more information

Childhood Asthma Prevention Study (CAPS)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Computer-Assisted Motivational Intervention (CAMI)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Early Head Start–Home-Based Option (EHS-HBO)

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
Secondary:
Favorable: 1
No effect: 4
Unfavorable or ambiguous: 0
For more information

Early Intervention Program for Adolescent Mothers

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Early Start (New Zealand)

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 1
No effect: 1
Unfavorable or ambiguous: 0
Secondary:
Favorable: 2
No effect: 1
Unfavorable or ambiguous: 0
For more information

Early Steps to School Success™—Home Visiting

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Even Start-Home Visiting (Birth to Age 5)

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not applicable
For more information

Family Check-Up® For Children

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Family Connections (Birth to Age 5)

Meets HHS criteria?
No
Outcome measures
Not applicable
For more information

Family Connects

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Family Spirit®

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Following Baby Back Home (FBBH)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Health Access Nurturing Development Services (HANDS) Program

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 1
No effect: 0
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
For more information

HealthConnect One's® Community-Based Doula Program

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Healthy Beginnings

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Healthy Families America (HFA)®

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 2
No effect: 48
Unfavorable or ambiguous: 1
Secondary:
Favorable: 14
No effect: 109
Unfavorable or ambiguous: 0
For more information

Healthy Start-Home Visiting

HHS has determined that Healthy Start is not eligible for review by HomVEE because it is a federal grant program and not a home visiting model. Information on Healthy Start has been removed from the website.

Outcome measures
Not measured
For more information

Healthy Steps (National Evaluation 1996 Protocol)

This report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation.

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0
For more information

Home Instruction for Parents of Preschool Youngsters (HIPPY)®

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Home-Start

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

HOMEBUILDERS (Birth to Age 5)®

Meets HHS criteria?
No
Outcome measures
Not applicable
For more information

Maternal Early Childhood Sustained Home-Visiting Program (MECSH)

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Maternal Infant Health Outreach Worker (MIHOW)®

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Maternal Infant Health Program (MIHP)

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Minding the Baby®

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
For more information

MOM Program

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Mothers’ Advocates in the Community (MOSAIC)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

North Carolina Baby Love Maternal Outreach Workers Program

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Nurse-Family Partnership (NFP)®

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 7
No effect: 18
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0
For more information

Nurses for Newborns®

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Nurturing Parenting Programs (Birth to Age 5)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Parent-Child Assistance Program (PCAP)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

ParentChild+® Core Model

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Parents as Teachers (PAT)®

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 1
No effect: 2
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
For more information

Philani Outreach Programme

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Play and Learning Strategies (PALS)

Entries in this row combine information across all versions of PALS except for PALS Infant. The main version of PALS has no high- or moderate-quality impact studies. Some other versions of PALS have at least one such study, but no version of the model other than PALS Infant meets HHS criteria for an evidence-based home visiting model.

Meets HHS criteria?
No
Outcome measures
Not applicable
For more information

Play and Learning Strategies (PALS) Infant

Meets HHS criteria?
Yes
Outcome measures
Not measured
For more information

Pride in Parenting (PIP)

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Promoting First Relationships®—Home Visiting Option

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Promoting Parental Skills and Enhancing Attachment in Early Childhood (CAPEDP) Trial

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Resource Mothers Program

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Resources, Education, and Care in the Home (REACH)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

REST Routine

Implementation support is not currently available for the model as reviewed.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

SafeCare®

Entries in this row combine information across all versions of SafeCare except for SafeCare Augmented. The main version of SafeCare has no high- or moderate-quality impact studies. Some other versions of SafeCare have at least one such study, but no version of the model other than SafeCare Augmented meets HHS criteria for an evidence-based home visiting model. Planned Activities Training (a SafeCare module) and Cellular Phone Enhanced Planned Activities Training (a SafeCare module with an add-on) show evidence of effectiveness.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

SafeCare Augmented

Meets HHS criteria?
Yes
Outcome measures
Primary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
Secondary:
Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0
For more information

Seattle-King County Healthy Homes Project

Meets HHS criteria?
No
Outcome measures
Not applicable
For more information

Triple P - Positive Parenting Program®—Variants suitable for home visiting

No Triple P intervention is exclusively delivered in the home with families with children from birth through age 5. This profile is based on (1) studies of programs that provided Triple P services in the home to families with children from birth through age 5, and (2) developer input on the Triple P interventions suitable for delivery in the home with families with children from birth through age 5.

Meets HHS criteria?
No
Outcome measures
Not measured
For more information

Video-Feedback Intervention to Promote Positive Parenting-Sensitive Discipline® (VIPP-SD)

Meets HHS criteria?
No
Outcome measures
Not measured
For more information