HomVEE calculated significance
Statistical significance is based on HomVEE calculations.
Manuscript Detail
Model(s) Reviewed: Healthy Families America (HFA)®
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race but not SES (e.g., maternal employment). Maternal employment is included as a control. Baseline equivalence on outcomes not feasible. | None | None |
| Study participants | Families were recruited to the study between November 1994 and December 1995. Hawaii Healthy Start Program staff screened the medical records of mothers from one of four Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Mothers found to be at risk, or those whose records did not contain sufficient information to screen out, were screened further using the Kempe Family Stress Checklist; eligible families were those in which either parent scored 25 or greater (Duggan, 2004a). Of the 897 families who were eligible to participate in the study, 730 (81%) agreed to participate and were randomly assigned to the program group (n = 395), the main comparison group (n = 290), or a testing comparison group (n = 45). 684 families completed a baseline interview (373 families in the program group, 270 families in the main comparison group, and 41 in the testing group comparison). On average, at baseline, mothers were 23.7 years of age (program group) and 23.3 years of age (comparison group). 63% (program group) and 67% (comparison group) of participating families lived below the poverty line. The racial composition of the program group was 34% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 10% Caucasian, and 27% of unknown primary ethnicity. The main comparison group consisted of 33% native Hawaiian or Pacific Islander, 28% Asian or Filipino, 14% Caucasian, and 26% of unknown primary ethnicity. This study reports results from the first two follow-ups of the Hawaii Healthy Start randomized controlled trial. Follow-up interviews were completed for 88% of families in years 1 and 2, and 83% of participating families were included in both follow-ups. |
|---|---|
| Setting | Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii. |
| Intervention services | Home visiting services were designed to provide three to five years of home visiting, with weekly visits for most or all of the child’s first year of life, and visits of gradually decreasing frequency thereafter depending on family need. Home visitors endeavored to establish trusting relationships with families, help them resolve immediate crises, and help them build on existing strengths to improve their ability to function independently. Visitors helped families develop problem-solving skills, connected them to needed services, and aimed to develop an individual service plan with each family every six months and help the family reach six-month goals. The actual frequency of visits, however, was lower than that specified by the model, with families receiving an average of 13 visits in the child’s first year of life, and 51% of families not actively participating in the program by the time the child was 12 months old. Families still active at the end of year 1 received an average of 22 visits in the first year. |
| Comparison conditions | The main comparison group was tested annually to measure outcomes. A second “testing” comparison group was evaluated only at year 3 to ascertain the effect of repeated testing on observed outcomes (Duggan, McFarlane, Fuddy, Burrell, Higman, Windham, et al., 2004). |
| Staff characteristics and training | Trained paraprofessionals were recruited from the community to conduct the home visits (Duggan et al., 1999). The authors report that training for home visitors and supervisors may not have been sufficient, particularly in the areas of parent mental health, substance abuse, and domestic violence and their relationship to child abuse. |
| Funding sources | Maternal and Child Health Bureau (R40 MC 00029 (formerly MCJ 240637) and R40 MC 00123 (formerly MCJ 240838)); The Robert Wood Johnson Foundation (18303); The Annie E. Casey Foundation (94-4041); The David and Lucile Packard Foundation (93-6051, 94-7957, 97-8058, and 98-3448); the Hawaii State Department of Health (99-29-J); and the National Institute of Mental Health, Epidemiological Center for Early Risk Behaviors, P30MH38725. |
| Author affiliation | None of the study authors are developers of this model. |
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Illicit drug use | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 10.00 | % = 11.00 | = -1.00 | HomeVEE calculated = -0.06 | Not statistically significant, p ≥ 0.05 | |
| High | Illicit drug use | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 9.00 | % = 9.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Illicit drug use | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 11.00 | % = 9.00 | = 2.00 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Illicit drug use | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | Not available | Not available | OR = 1.06 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Mothers with depressive symptoms (CES-D) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 23.00 | % = 23.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Mothers with depressive symptoms (CES-D) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 16.00 | % = 16.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Mothers with depressive symptoms (CES-D) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | Not available | Not available | OR = 0.97 | Not available | Not statistically significant, p ≥ 0.05 | footnote51Adjusted odds ratios are based on the average effect across all follow-up years. |
| High | Mothers with depressive symptoms (CES-D) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 16.00 | % = 18.00 | = -2.00 | HomeVEE calculated = -0.09 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Poor general mental health (MHI < 67) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 35.00 | % = 38.00 | = -3.00 | HomeVEE calculated = -0.20 | Statistically significant, p < 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Poor general mental health (MHI < 67) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 36.00 | % = 46.00 | = -10.00 | HomeVEE calculated = -0.25 | Statistically significant, p < 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Poor general mental health (MHI < 67) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 29.00 | % = 32.00 | = -3.00 | HomeVEE calculated = -0.09 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Problem alcohol use (CAGE) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | Not available | Not available | OR = 0.76 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Problem alcohol use (CAGE) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 8.00 | % = 9.00 | = -1.00 | HomeVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Problem alcohol use (CAGE) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 8.00 | % = 10.00 | = -2.00 | HomeVEE calculated = -0.15 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Problem alcohol use (CAGE) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 7.00 | % = 10.00 | = -3.00 | HomeVEE calculated = -0.24 | Statistically significant, p < 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Severe parenting stress (PSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 11.00 | % = 10.00 | = 1.00 | HomeVEE calculated = 0.06 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Severe parenting stress (PSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 8.00 | % = 8.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Severe parenting stress (PSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | Not available | Not available | OR = 1.04 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Severe parenting stress (PSI) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 8.00 | % = 9.00 | = -1.00 | HomeVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Partner incident resulting in injury (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 14.00 | % = 20.00 | = -6.00 | HomeVEE calculated = -0.26 | Statistically significant, p < 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner incident resulting in injury (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | % = 24.00 | % = 26.00 | OR = 0.81 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Partner incident resulting in injury (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 17.00 | % = 18.00 | = -1.00 | HomeVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner incident resulting in injury (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 24.00 | % = 26.00 | = -2.00 | HomeVEE calculated = -0.06 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner physical abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 26.00 | % = 32.00 | = -6.00 | HomeVEE calculated = -0.18 | Statistically significant, p < 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner physical abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | % = 37.00 | % = 42.00 | OR = 0.83 | Not available | Not statistically significant, p ≥ 0.05 | |
| High | Partner physical abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 29.00 | % = 30.00 | = -1.00 | HomeVEE calculated = -0.03 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner physical abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 37.00 | % = 42.00 | = -5.00 | HomeVEE calculated = -0.13 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner psychological abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Years 1-3 | 564 mothers | % = 49.00 | % = 49.00 | OR = 1.05 | Not available | Not statistically significant, p ≥ 0.05 | footnote51Adjusted odds ratios are based on the average effect across all follow-up years. |
| High | Partner psychological abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 3 | 548 mothers | % = 42.00 | % = 38.00 | = -4.00 | HomeVEE calculated = 0.10 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner psychological abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 1 | 564 mothers | % = 49.00 | % = 49.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
| High | Partner psychological abuse (CTS) | FavorableUnfavorable or ambiguousNo Effect |
Full sample, Hawaii trial | Year 2 | 556 mothers | % = 42.00 | % = 42.00 | = 0.00 | HomeVEE calculated = 0.00 | Not statistically significant, p ≥ 0.05 | HomVEE calculated significanceStatistical significance is based on HomVEE calculations. |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
CES-D: Depressive symptoms |
The CES-D is a 20-item assessment of depressive symptoms. A binary variable was formed from the total score where parents with scores greater than or equal to 24 were said to have probable cases of depression. | Parent/caregiver report | Not reported by author |
MHI: Poor general mental health |
The MHI assesses levels of anxiety and depressive symptoms. The researchers created a binary variable where those with MHI scores less than 67 were considered to have poor mental health. | Parent/caregiver report | Not reported by author |
PSI: Severe parenting stress |
The PSI assesses stress in the parent-child relationship arising from child temperament, parental depression, and negatively reinforcing parent-child interactions. A mother was considered positive for severe parenting stress if she scored positive for personal adjustment problems, child abuse potential, or high child abuse potential as defined by Abidin. | Parent/caregiver report | Not reported by author |
Illicit drug use |
Percentage of parents who engaged in illicit drug use, defined as a report of any illegal drug use in the past year | Parent/caregiver report | Not reported by author |
Problem alcohol use (CAGE) |
Percentage of parents with problem alcohol use, defined as a report of alcohol use in the year prior to pregnancy and a CAGE score greater than or equal to 2 | Parent/caregiver report | Not reported by author |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
CTS:
|
The CTS assesses victimization and perpetration related to intimate partner violence and maltreatment. The researchers examined the prevalence of psychological abuse, physical abuse, and an incident of injury. The father was considered to be physically violent if he had committed three or more incidents of physical violence toward the mother in the year prior to the baseline interview and was psychologically aggressive if he had committed acts of psychological aggression more than 35 times in the year prior to the interview. | Parent/caregiver report | Not reported by author |