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Caldera, D., Burrell, L., Rodriguez, K., Crowne, S. S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829–852. doi:10.1016/j.chiabu.2007.02.008

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Cluxton-Keller, F., Burrell, L., Crowne, S., McFarlane, E., Tandon, S., Leaf, P., & Duggan, A. (2014). Maternal relationship insecurity and depressive symptoms as moderators of home visiting impacts on child outcomes. Journal of Child & Family Studies, 23(8), 1430-1443.
Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Established on race and SES. Baseline equivalence on outcomes not feasible. None None Not assessed in manuscripts reviewed before 2021
Notes:

In 2020, HomVEE updated this review in three ways. First, HomVEE moved two findings on CTS-PC discipline from the Positive Parenting Practices to the Reductions in Child Maltreatment because ACF determined that nonviolent discipline and corporal punishment outcomes belong in the Positive Parenting Practices domain, unless those outcome are assessed using the Conflict Tactics Scale-Parent/Child. Second, HomVEE moved "Child has health care coverage" from the Child Health domain to the Family Economic Self-Sufficiency domain because ACF determined that health insurance coverage belongs in that domain. Finally, HomVEE moved the NCAST Child Response Score from the Child Development and School Readiness to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain. 

footnote57

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

Johns Hopkins University (2005) reports on the same outcomes based on maternal report and finds no statistically significant outcomes. These results are based on medical records.

footnote75

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

High rating applies to hospitalization and emergency room visit outcomes. Analyses of other outcomes receive a moderate rating because of high attrition.

Study characteristics
Study participants Between January 2000 and July 2001, 388 families who screened positive on a Healthy Families Alaska (HFAK) protocol for risk factors associated with poor health and social outcomes and received scores of 25 or higher on the Kempe Family Stress Checklist were recruited during pregnancy or at the time of birth (Duggan et al., 2007). Of these families, 364 consented to participate and were randomly assigned to the program group (n = 179) or the comparison group (n = 185). 325 families completed a baseline interview. The sample was 22% Alaska native, 55% Caucasian, 8% multiracial, and 15% other race. 58% of families were below poverty level, 58% of mothers had graduated from high school, and 73% had worked in the year prior to enrollment (Johns Hopkins University, 2005). The average age of mothers at baseline was 23.5 years. This study reports the second-year follow-up results of the HFA K evaluation, with a sample size of 138 program group primary caregivers and 140 comparison group primary caregivers. Most of the analyses are limited to families in which the biological mothers had custody of the index child at follow-up (249 families), with additional outcomes obtained from medical records (268 families). The outcomes included in this study were also described in an earlier report (Johns Hopkins University, 2005).
Setting This study included six Healthy Families Alaska sites, two in Anchorage and one each in Wasilla, Fairbanks, Juneau, and Kenai.
Intervention services Families in the program group were assigned to receive visits monthly until their child’s birth and weekly thereafter. By design, families receive gradually less frequent visits as they reach critical milestones; ranging to quarterly visits at the highest level of functioning. Families were enrolled in the program until they functioned sufficiently to “graduate” or until their child turned 2. In practice, home visits were less frequent than intended, with only 4% of families receiving 75% or more of their designated frequency of visits and completing the full two years. Home visits were intended to emphasize preparing for child growth, development, and critical milestones; screening and referral for developmental delays; promoting a safe environment; positive parent-child interactions; establishing a “medical home” for the child; and supporting the family during crises. The program also emphasized the development of an Individual Family Support Plan (IFSP) or setting and monitoring progress toward individual family goals.
Comparison conditions Families assigned to the comparison condition received referrals to other community services.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).
Subgroups are not listed for manuscripts reviewed before 2021.
Staff characteristics and training Guidelines suggest paraprofessional staff have a high school diploma at a minimum and that program managers have a master’s degree in a relevant field. In five of the six sites included in the evaluation, home visits were conducted by paraprofessionals. The remaining site combined nurse-visiting and paraprofessional-visiting models. Staff members were required to complete a one-week training geared directly to their role and a community-based training. Training for staff who conducted home visits or administered the Kempe Family Stress Checklist was conducted by certified instructors. All staff also had to complete 100 hours of training covering “child development, parent-child interaction, family dynamics, child safety, the dynamics of child abuse and neglect, crisis intervention and problem solving, communication skills, domestic violence, substance abuse, infant mental health and other related topics.” Continuous training varied by program. Training was initially administered by the Hawaii Family Stress Center and later by Great Kid’s Inc.
Funding sources Alaska Mental Health Trust Authority and the Alaska State Department of Health and Social Services.
Author affiliation None of the study authors are developers of this model.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High CBCL percentage with externalizing scores in normal range
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children % (adjusted) = 82.00 Adjusted mean % = 77.00 OR = 1.48 HomeVEE calculated = 0.19 Statistically significant,
p < 0.05
High CBCL percentage with internalizing scores in normal range
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children % (adjusted) = 87.00 Adjusted mean % = 79.00 OR = 2.06 HomeVEE calculated = 0.35 Statistically significant,
p < 0.05
High CBCL total externalizing score
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 50.80 Adjusted mean = 53.00 Mean difference = -2.20 Not available Not statistically significant, p ≥ 0.05
High CBCL total internalizing score
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 48.20 Adjusted mean = 51.00 Mean difference = -2.80 Not available Statistically significant,
p < 0.05
High BSID Cognitive score
FavorableUnfavorable or ambiguousNo Effect
Children with complete medical record data, Alaska trial Age 2 249 children Adjusted mean = 88.00 Adjusted mean = 84.80 Mean difference = 3.20 Not available Statistically significant,
p < 0.05
High BSID percentage within normal limits on cognitive
FavorableUnfavorable or ambiguousNo Effect
Children with complete medical record data, Alaska trial Age 2 249 children % (adjusted) = 58.00 Adjusted mean % = 48.00 OR = 1.55 HomeVEE calculated = 0.24 Statistically significant,
p < 0.05
High BSID percentage within normal limits on psychomotor
FavorableUnfavorable or ambiguousNo Effect
Children with complete medical record data, Alaska trial Age 2 249 children % (adjusted) = 85.00 Adjusted mean % = 80.00 OR = 1.36 HomeVEE calculated = 0.21 Not statistically significant, p ≥ 0.05
High BSID Psychomotor score
FavorableUnfavorable or ambiguousNo Effect
Children with complete medical record data, Alaska trial Age 2 249 children Adjusted mean = 98.10 Adjusted mean = 96.00 Mean difference = 2.10 Not available Not statistically significant, p ≥ 0.05
Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Adequate well-child visits
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at interview, Alaska trial Year 2 249 children % (adjusted) = 4.00 Adjusted mean % = 8.00 OR = 0.96 HomeVEE calculated = -0.45 Not statistically significant, p ≥ 0.05
High Has primary care provider
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at interview, Alaska trial Year 2 249 children % (adjusted) = 74.00 Adjusted mean % = 78.00 OR = 0.76 HomeVEE calculated = -0.13 Not statistically significant, p ≥ 0.05
High Immunizations up-to-date
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at interview, Alaska trial Year 2 249 children % (adjusted) = 27.00 Adjusted mean % = 27.00 OR = 1.01 HomeVEE calculated = 0.00 Not statistically significant, p ≥ 0.05
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
High Has health care coverage
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at interview, Alaska trial Year 2 249 children % (adjusted) = 95.00 Adjusted mean % = 90.00 OR = 2.05 HomeVEE calculated = 0.45 Statistically significant,
p < 0.05
Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Child Response Score NCAST
FavorableUnfavorable or ambiguousNo Effect
Children in custody of biological mother at year 2 follow-up interview, Alaska trial Age 2 249 children Adjusted mean = 18.40 Adjusted mean = 18.50 Mean difference = -0.90 Not available Not statistically significant, p ≥ 0.05

footnote56

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

Child’s response to a caregiver who is teaching him/her a new skill.

Moderate Caregiver contingency score (NCAST)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 15.40 Adjusted mean = 15.00 Mean difference = 0.40 Not available Not statistically significant, p ≥ 0.05
Moderate Cognitive growth fostering (NCAST)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 11.80 Adjusted mean = 11.90 Mean difference = -0.10 Not available Not statistically significant, p ≥ 0.05
Moderate Infant caregiving (AAPI)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 112.10 Adjusted mean = 109.50 Mean difference = 2.60 Not available Not statistically significant, p ≥ 0.05
Moderate Maternal self-efficacy (Teti scale)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 35.10 Adjusted mean = 34.60 Mean difference = 0.50 Not available Statistically significant,
p < 0.05
Moderate Parenting attitudes (AAPI)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 130.00 Adjusted mean = 125.60 Mean difference = 4.50 Not available Not statistically significant, p ≥ 0.05
Moderate Parenting knowledge (KIDI)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 73.50 Adjusted mean = 70.70 Mean difference = 2.80 Not available Not statistically significant, p ≥ 0.05
Moderate Quality of home environment (HOME)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 36.70 Adjusted mean = 35.90 Mean difference = 0.80 Not available Not statistically significant, p ≥ 0.05
Moderate Recognition of child developmental delay
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers % = 20.00 % = 24.00 Not reported HomeVEE calculated = -0.14 Not statistically significant, p ≥ 0.05
Moderate Response to distress (NCAST)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 9.20 Adjusted mean = 8.90 Mean difference = 0.30 Not available Not statistically significant, p ≥ 0.05
Moderate Sensitivity to cues (NCAST)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 9.40 Adjusted mean = 9.20 Mean difference = 0.20 Not available Not statistically significant, p ≥ 0.05
Moderate Social-emotional growth fostering (NCAST)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 9.00 Adjusted mean = 8.80 Mean difference = 0.20 Not available Not statistically significant, p ≥ 0.05
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
High No ER visits due to injuries
FavorableUnfavorable or ambiguousNo Effect
Families with complete medical record data, Alaska trial Child age 2 268 children % = 19.00 % = 22.00 OR = 0.81 HomeVEE calculated = -0.11 Not statistically significant, p ≥ 0.05
High No hospitalizations due to injuries
FavorableUnfavorable or ambiguousNo Effect
Families with complete medical record data, Alaska trial Child age 2 268 children % = 63.00 % = 58.00 OR = 1.20 HomeVEE calculated = 0.13 Not statistically significant, p ≥ 0.05
High No injuries requiring medical care
FavorableUnfavorable or ambiguousNo Effect
Families with complete medical record data, Alaska trial Child age 2 268 children % = 71.00 % = 68.00 OR = 1.10 HomeVEE calculated = 0.09 Not statistically significant, p ≥ 0.05
Moderate Use of mild physical strategies, frequency (CTS-PC)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 4.00 Adjusted mean = 4.60 Mean difference = -0.50 Not available Not statistically significant, p ≥ 0.05
Moderate Use of nonviolent disciplinary strategies, frequency (CTS-PC)
FavorableUnfavorable or ambiguousNo Effect
Biological mothers with custody of index child at interview, Alaska trial Year 2 249 mothers Adjusted mean = 50.40 Adjusted mean = 50.50 Mean difference = -0.05 Not available Not statistically significant, p ≥ 0.05

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

BSID: MDI and PDI

The BSID tests the mental, motor, and behavioral development and abilities of young children. The researchers examined the MDI and PDI as continuous and binary for scores <85 versus those greater than or equal to 85. Child assessment

Not reported by author

CBCL: Internalizing and Externalizing

The CBCL is a questionnaire that assesses behavioral problems in young children. The internalizing and externalizing scales were measured as continuous and as a binary variable using recommended cut points for normal (<60) versus borderline (60–63) and clinical scores (>63). Parent/caregiver report

Not reported by author

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

Adequate well-child visits

Percentage of children who had adequate well-child visits according to the American Academy of Pediatrics guidelines Review of medical records

Not applicable

Has primary care provider (PCP)

Percentage of children who had a PCP

Parent/caregiver report

Not applicable

Immunizations up-to-date

Percentage of children who had up-to-date immunizations according to the American Academy of Pediatrics guidelines Review of medical records

Not applicable

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

Has health care coverage

Percentage of children who had health care coverage

Parent/caregiver report

Not applicable

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

KIDI

The KIDI measures the parent’s knowledge of childrearing practices and developmental processes. Parent/caregiver report

Not reported by author

NCAST:

  • Caregiver total score
  • Sensitivity to cues
  • Response to distress
  • Social-emotional growth fostering
  • Cognitive growth fostering
  • Child responsiveness

The NCAST assesses the quality of teaching interaction between caregivers and young children. The researchers used the composite caregiver score and caregiver subscales related to sensitivity to cues from the child, response to the child’s distress, and fostering of social-emotional and cognitive development. The caregiver subscales and total scores were analyzed as continuous. The researchers also used a binary measure where those with total scores less than or equal to 35 were defined as having poor interaction.

Observation

Not reported by author

AAPI: Infant Caregiving Inventory

The AAPI assesses parenting and childrearing attitudes. In addition to the total score, the Infant Caregiving Inventory was used to examine caregiver beliefs and understanding of the influences of infant, caregiving practices on child and parental well-being. Parent/caregiver report

Not reported by author

AAPI: Parenting attitudes

The AAPI assesses parenting and childrearing attitudes. Parent/caregiver report

Not reported by author

HOME: Total score

The HOME assesses parenting practices and aspects of the home environment. Parent/caregiver interview and observational assessment

Not reported by author

Recognition of child developmental delay

A measure comparing the child’s development with that of most other children. For children assessed as developmentally delayed, recognition of delay occurred if the parent responded that their child, was developing slower than other children. Parent/caregiver report

Not reported by author

Teti Maternal Self-efficacy Scale

The Teti Maternal Self-efficacy Scale assesses self-evaluated parenting competence and effectiveness. Parent/caregiver report

Not reported by author

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

No ER visits due to injuries

Counts of child injuries that required medical care per medical record for families with complete medical record data Review of medical records

Not applicable

No hospitalizations due to injuries

Hospitalizations per medical record for families with complete medical record data Review of medical records

Not applicable

No injuries requiring medical care

Counts of child injuries that required medical care per medical record for families with complete medical record data Parent/caregiver report

Not applicable

CTS-PC: Use of nonviolent disciplinary strategies CTS-PC: Use of mild physical strategies

The CTS-PC assesses neglectful, psychologically aggressive, and abusive parenting behaviors and acts. The researchers analyzed the frequency with which nonviolent discipline strategies and mild physical strategies were used.

Parent/caregiver report

Not reported by author