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
| 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 and SES. Baseline equivalence on outcomes not feasible. | None | None |
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.
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.
High rating applies to hospitalization and emergency room visit outcomes. Analyses of other outcomes receive a moderate rating because of high attrition.
| 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. |
| 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. |
| 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 |
| 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 |
| 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 |
| 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 | footnote56Child’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 |
| 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 | 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 |
| 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 |
| 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 |
| 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:
|
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 |
| 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 |
