Manuscript Detail | Home Visiting Evidence of Effectiveness

Easterbrooks, M. A., Fauth, R. C., Menon, M., Stargel, L. E., & Kotake, C. (n.d.). The Massachusetts Healthy Families Evaluation Phase 2 (MHFE-2): Time 6 summary report. Tufts Interdisciplinary Evaluation Research, Tufts University.

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	High	Established on race/ethnicity and SES; outcomes not feasible to assess at baseline	None	None

Notes:

In addition to the findings that received moderate ratings, 17 findings in the Maternal Health and Family Economic Self-Sufficiency domains received low ratings because the outcomes were assessable at baseline but were not included as controls in the statistical models that produced the study estimates.

Study characteristics
Study participants	The program enrolled participants during pregnancy or as new parents and they were eligible if they were English- or Spanish-speaking females, at least 16 years old, and had not previously received the home visiting program services. Recruitment ended in 2008 and 2009. This study reported follow-up results at 8 years after enrollment, when children were 7.5 years old on average. Maternal age at enrollment was 18.7 years on average. The full study sample was 36 percent Hispanic; 35 percent White, non-Hispanic; and 23 percent Black, non-Hispanic. Of sample members at the time of enrollment, 42 percent had a high school diploma or GED, 25 percent were currently employed, 18 percent had received state cash assistance, and 16 percent had received Supplemental Nutrition Assistance Program (SNAP) benefits.
Setting	Massachusetts
Intervention services	Healthy Families Massachusetts offers its program to new parents from pregnancy through when the child turns 3 years old. The program offers in-home visits and health screenings, screenings for developmental milestones, and referrals for additional supportive services. The goals of Healthy Families Massachusetts include child abuse prevention; healthy childhood growth and development; and support for parents to promote health, well-being, education attainment, and job and life skills. An additional goal of the program is to promote mothers’ ability to navigate the preschool and elementary school systems as their children grow.
Comparison conditions	The comparison condition received only referrals and information.
Staff characteristics and training	Not described.
Funding sources	Children's Trust Massachusetts and U.S. Department of Health and Human Services, Maternal, Infant, and Early Childhood Home Visiting Grant Program (grant no. X10MC29474).
Author affiliation	The authors are affiliated with Tufts University and the study was conducted by the Children's Trust. The authors are not affiliated with the developer or distributer of Healthy Families America.

Study Registration:

Clinicaltrials.gov Identifier: NCT01926223. Study registration was assessed by HomVEE beginning with the 2014 review.

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
Moderate	Child has IEP or 504 plan	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	370 children	Unadjusted proportion = 0.27	Unadjusted proportion = 0.30	Mean difference = -0.02	HomeVEE calculated = -0.07	Not statistically significant, p ≥ 0.05
Moderate	Child in afterschool program	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	368 children	Adjusted proportion = 0.55	Adjusted proportion = 0.42	Odds ratio = 1.71	HomeVEE calculated = 0.32	Statistically significant, p <.05	Effect size based on study OR Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
Moderate	Strengths and Difficulties Questionnaire - externalizing	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	366 children	Unadjusted mean = 5.58	Unadjusted mean = 5.60	Mean difference = -0.02	HomeVEE calculated = -0.01	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Strengths and Difficulties Questionnaire - internalizing	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	360 children	Unadjusted mean = 3.48	Unadjusted mean = 3.51	Mean difference = -0.03	HomeVEE calculated = -0.01	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

Child health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Moderate	Asthma (diagnosed past year)	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	384 children	Adjusted proportion = 0.07	Adjusted proportion = 0.14	Odds ratio = 0.46	HomeVEE calculated = -0.47	Statistically significant, p <.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Effect size based on study OR Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
Moderate	Child had dental visit (past year)	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	379 children	Unadjusted proportion = 0.95	Unadjusted proportion = 0.98	Mean difference = -0.03	HomeVEE calculated = -0.60	Not statistically significant, p ≥ 0.05
Moderate	Child had well visit (past year)	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	383 children	Unadjusted proportion = 0.99	Unadjusted proportion = 0.99	Mean difference = 0.00	HomeVEE calculated = 0.00	Not statistically significant, p ≥ 0.05
Moderate	Child visited emergency room (past year)	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	383 children	Unadjusted proportion = 0.27	Unadjusted proportion = 0.24	Mean difference = 0.03	HomeVEE calculated = 0.11	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Obesity/overweight (past year)	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	384 children	Unadjusted proportion = 0.05	Unadjusted proportion = 0.05	Mean difference = 0.01	HomeVEE calculated = 0.08	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Pediatric Quality of Life Inventory - physical functioning	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	381 children	Adjusted mean = 93.91	Adjusted mean = 91.91	Mean difference = 2.00	Study reported = 0.20	Statistically significant, p <.05	Effect size is the Cohen's d
Moderate	Pediatric Quality of Life Inventory - school functioning	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	383 children	Unadjusted mean = 78.24	Unadjusted mean = 78.06	Mean difference = 0.18	HomeVEE calculated = 0.01	Not statistically significant, p ≥ 0.05

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	Parenting Stress Index - difficult child	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	380 mothers	Unadjusted mean = 24.14	Unadjusted mean = 25.97	Mean difference = -1.83	HomeVEE calculated = -0.24	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Parenting Stress Index - parental child-dysfunctional interaction	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	380 mothers	Unadjusted mean = 18.38	Unadjusted mean = 19.71	Mean difference = -1.33	HomeVEE calculated = -0.22	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Parenting Stress Index - parental distress	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	379 mothers	Unadjusted mean = 24.41	Unadjusted mean = 26.32	Mean difference = -1.91	HomeVEE calculated = -0.22	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

Positive parenting practices
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance
Moderate	Family Involvement Questionnaire - Home-Based Involvement	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	373 mothers	Unadjusted mean = 22.16	Unadjusted mean = 21.74	Mean difference = 0.42	HomeVEE calculated = 0.10	Not statistically significant, p ≥ 0.05
Moderate	Family Involvement Questionnaire - Home-School Conferencing	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	388 mothers	Unadjusted mean = 20.18	Unadjusted mean = 19.34	Mean difference = 0.84	HomeVEE calculated = 0.14	Not statistically significant, p ≥ 0.05
Moderate	Family Involvement Questionnaire: School-Based Involvement	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	341 mothers	Unadjusted mean = 13.30	Unadjusted mean = 13.28	Mean difference = 0.02	HomeVEE calculated = 0.00	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
Moderate	Permanent custody loss	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	408 mother/child dyads	Unadjusted proportion = 0.03	Unadjusted proportion = 0.02	Mean difference = 0.01	HomeVEE calculated = 0.17	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Moderate	Substantiated child maltreatment reports	FavorableUnfavorable or ambiguousNo Effect	HFM vs. comparison, Massachusetts Healthy Families Evaluation 2 (MHFE -2), Tier 6 full sample	8 years	408 mother/child dyads	Unadjusted proportion = 0.36	Unadjusted proportion = 0.39	Mean difference = -0.03	HomeVEE calculated = -0.09	Not statistically significant, p ≥ 0.05	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

Outcome measure summary

Child development and school readiness
Outcome measure	Description of measure	Data collection method	Properties of measure
Child has IEP or 504 plan	Mothers asked if child currently had an Individualized Education Plan or 504 Plan in place (target child)	Parent self-report	Not reported
Child in afterschool program	Mothers asked if target child currently participated in any afterschool programs (target child)	Parent self-report	Not reported
Strengths and Difficulties Questionnaire - externalizing	Strengths and Difficulties Questionnaire - Externalizing subscale	Self-report questionnaire	Not reported
Strengths and Difficulties Questionnaire - internalizing	Strengths and Difficulties Questionnaire - Internalizing subscale	Self-report questionnaire	Not reported

Child health
Outcome measure	Description of measure	Data collection method	Properties of measure
Asthma (diagnosed past year)	Mothers asked if child was diagnosed with asthma in past year (target child)	Parent self-report	Not reported
Child had dental visit (past year)	Mothers reported if their child had visited dentist in the past year (target child)	Parent self-report	Not reported
Child had well visit (past year)	Mothers reported if their child had a well visit in past year (target child)	Parent self-report	Not reported
Child visited emergency room (past year)	Mothers reported if they had been to emergency room for their child in the past year (target child)	Parent self-report	Not reported
Obesity/overweight (past year)	Mothers asked if child had been diagnosed as overweight or obese in past year (target child)	Parent self-report	Not reported
Pediatric Quality of Life Inventory - physical functioning	Pediatric Quality of Life Inventory (PedsQL) - Physical Functioning subscale	Self-report questionnaire	Not reported
Pediatric Quality of Life Inventory - school functioning	Pediatric Quality of Life Inventory (PedsQL) - School Functioning subscale	Self-report questionnaire	Not reported

Maternal health
Outcome measure	Description of measure	Data collection method	Properties of measure
Parenting Stress Index - difficult child	Parenting Stress Index - Difficult Child subscale	Self-report questionnaire	Not reported
Parenting Stress Index - parental child-dysfunctional interaction	Parenting Stress Index - Parental-Child Dysfunctional Interaction subscale	Self-report questionnaire	Not reported
Parenting Stress Index - parental distress	Parenting Stress Index - Parental Distress subscale	Self-report questionnaire	Not reported

Positive parenting practices
Outcome measure	Description of measure	Data collection method	Properties of measure
Family Involvement Questionnaire - Home-Based Involvement	Family Involvement Questionnaire-Short Form (FIQ-SF)	Self-report questionnaire	Not reported
Family Involvement Questionnaire - Home-School Conferencing	Family Involvement Questionnaire-Short Form (FIQ-SF)	Self-report questionnaire	Not reported
Family Involvement Questionnaire: School-Based Involvement	Family Involvement Questionnaire-Short Form (FIQ-SF)	Self-report questionnaire	Not reported

Reductions in child maltreatment
Outcome measure	Description of measure	Data collection method	Properties of measure
Permanent custody loss	Permanent loss of custody (target child)	Agency administrative data	Not reported
Substantiated child maltreatment reports	Substantiated reports of child maltreatment (target child)	Agency administrative data	Not reported