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Jacobs, F., Easterbrooks, M. A., Goldberg, J., Mistry, J., Bumgarner, E., Raskin, M., Fosse, N., & Fauth, R. (2015). Improving adolescent parenting: Results from a randomized controlled trial of a home visiting program for young families. American Journal of Public Health, published online ahead of print, e1-e7.

Model(s) Reviewed: Healthy Families America (HFA)®
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial Low Baseline equivalence is not established on race/ethnicity, SES, or baseline measures of the outcomes; some outcomes were not feasible to assess at baseline. None None
Notes:

footnote243

Submitted by user on Fri, 03/15/2019 - 14:29

In addition to the outcomes that rated moderate, several outcomes in this study rated low: corporal punishment at 1 and 2 years, parenting stress measures at 1 and 2 years, healthy baby, child behavior problems, high school diploma or equivalent at 1 year, completed at least 1 year of college at 1 year, employment at 1 and 2 years, use of hormonal birth control at 1 and 2 years, use of condoms at 1 and 2 years, engagement in risky behavior, marijuana use, intimate partner violence (self-perpetrated) at 1 and 2 years, and intimate partner violence (perpetrated by partner) at 1 and 2 years. These outcomes rated low because they had high attrition and baseline equivalence was not established on race/ethnicity or <abbr title="socioeconomic status">SES</abbr>. Information on attrition and baseline equivalence was based on correspondence with the author.

Study characteristics
Study participants This is a randomized controlled trial that randomly assigned 837 women to the Healthy Families Massachusetts (HFM) program or to a control group. From the 837 randomized women, 704 mothers (517 treatment, 320 control) were recruited and completed the initial (baseline) interview and/or allowed access to administrative data. Participants were from 18 HFM sites, female, at least 16 years old, conversant in English or Spanish, new to HFM, and able to provide informed consent. Based on HFM enrollment criteria, mothers also had to be first-time parents under age 21 who enrolled while they were pregnant or during the child's first year. The full baseline sample of 704 mothers was 37 percent white non-Hispanic, 19 percent black non-Hispanic, 36 percent Hispanic, and 8 percent other; 74 percent preferred speaking in English only, 20 percent preferred English and another language, and 6 percent preferred Spanish only. Before enrollment, mothers were 19 years old, on average, and 19 percent received cash assistance, 17 percent received food assistance, 35 percent were parenting, and 4 percent had been previously reported for child maltreatment.
Setting 18 sites in Massachusetts.
Intervention services Home visiting services were offered from pregnancy through the child's third birthday. Visits were offered biweekly during pregnancy, weekly for at least six months following the baby's birth, and then less frequently. Home visiting services included setting goals, curriculum-based activities, family support, routine developmental and health screenings, and linkages to medical and other needed services.On average, mothers received 24 home visits (SD = 26.4, median = 14) over an average of 14.7 months (SD = 12.8, median = 9.8).
Comparison conditions The control group received information about child development and referrals to other services.
Staff characteristics and training Staff characteristics and training were not described in the current study; however, they were described in the Initial Findings Report (Easterbrooks et al., 2012). Home visitors were paraprofessionals with experience working with families, knowledge of child development and family relationships, and other characteristics (such as the ability to establish trusting relationships and a willingness to work with culturally diverse populations). Home visiting staff completed an initial six-day core training and, within their first year of employment, 10 additional topical trainings. Home visitors, supervisors, and program coordinators received weekly supervision (1 – 1.5 hours) from professionally trained staff.
Funding sources The Massachusetts Children’s Trust and the Pew Center for States funded this research.
Author affiliation All authors are affiliated with the Tufts University Eliot-Pearson Department of Child Study and Human Development, with the exception of Dr. Bumgarner, who is affiliated with Abt Associates.
Study Registration:
Clinicaltrials.gov Identifier: NCT01926223. Study registration was assessed by HomVEE beginning with the 2014 review.

Findings details

Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Completed at least 1 year of college - 2 years
FavorableUnfavorable or ambiguousNo Effect
MA sample 2 years post enrollment 604 mothers Not reported Not reported OR = 1.92 HomeVEE calculated = 0.39 Statistically significant, p < 0.01
Moderate High school diploma or equivalent - 2 years
FavorableUnfavorable or ambiguousNo Effect
MA sample 2 years post enrollment 604 mothers Not reported Not reported OR = 0.87 HomeVEE calculated = -0.08 Not statistically significant, p = 0.52
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Repeated birth
FavorableUnfavorable or ambiguousNo Effect
MA sample 2 years post enrollment 612 mothers Not reported Not reported OR = 0.73 HomeVEE calculated = -0.19 Not statistically significant, p = 0.161

footnote244

Submitted by user on Fri, 03/15/2019 - 14:29

The <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated p-value of the effect size is statistically significant (p=0.02)

Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Substantiated maltreatment (administrative data)
FavorableUnfavorable or ambiguousNo Effect
MA sample within 27 months post-enrollment 690 children Not reported Not reported OR = 0.88 HomeVEE calculated = -0.08 Not statistically significant, p = 0.59

Outcome measure summary

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Completed at least 1 year of college - 2 years

Percentage of mothers whose highest level of education at the 2-year follow-up was completion of at least 1 year of college Mother self-report

Not reported

High school diploma or equivalent - 2 years

Percentage of mothers whose highest level of education at the 2-year follow-up was completion of high school or equivalent Mother self-report

Not reported

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Repeated birth

Percentage of mothers who gave birth subsequent to the target child Mother self-report

Not reported

Reductions in child maltreatment
Outcome measure Description of measure Data collection method Properties of measure

Substantiated maltreatment (administrative data)

Percentage of target children who had a substantiated report of maltreatment Administrative records from child protective services

Not applicable