| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| Moderate | Randomized controlled trial | High | Established on race/ethnicity, SES, and feasible outcomes. Statistical controls for feasible baseline outcomes included. | Yes for some outcomes | None |
Moderate rating applies to outcomes where the analytic sample size is at least 90 percent as large as the sample used to demonstrate baseline equivalence. Other outcomes receive a low rating. The moderate rating applies to the following outcomes: Increase in mother’s highest grade completed (baseline to 24 months); receipt of public assistance (up to 24 months postpartum); number of pediatric emergency room visits (up to 36 months of age); <abbr title="Ages & Stages Questionnaires">ASQ</abbr> communication, gross motor, fine motor, social, and composite score (6 months); perceived social support (6, 12, and 24 months); service referrals (up to 24 months postpartum) for daycare/babysitting, English as a second language, job skills/search, pediatric primary care, <abbr title="Aid to Families with Dependent Children">AFDC</abbr> or food stamps, housing assistance, Medicaid, immigration services, <abbr title="General Equivalency Diploma">GED</abbr> prep, early intervention program, family planning, food pantry, counseling, adult primary care, child health plus, <abbr title="Women, Infants, and Children">WIC</abbr>, parenting education or training, and domestic violence services.
| Study participants | Women who were pregnant or had an infant under 2 months old and who lived in two eligible census tracts were screened using a checklist for risk factors for child abuse and neglect. Women who were deemed at risk were further screened using the Kempe Family Screening Inventory (FSI). Consenting women (n = 672) who received a score of 25 or higher on the FSI were assigned to the program group (n = 329) or the comparison group (n = 343). From November 1994 to November 1995, all women in one tract were assigned to the program group and participants from the other tract were enrolled in the comparison group. If Family Assessment Workers determined during the course of screening that a member of the family was affected by substance use, the family was provided additional Best Beginnings services (regardless of program or comparison group membership). Starting in November 1995, women were randomly assigned to the program group or comparison group within their census tract. Of the women who were randomly assigned, 535 were enrolled in Best Beginnings (273 in the program group, and 262 in the comparison group). Among participating women, 89.9% were born outside the United States and 88.3% were of Dominican ethnicity. On average at baseline, mothers were 26.3 years of age, 19.1% were employed, and 61.4% were receiving public assistance. |
|---|---|
| Setting | Eligible women were recruited from one of two contiguous census tracts in Washington Heights, New York. Most women were receiving health care from the New York Presbyterian Hospital (NYPH) Ambulatory Care Network Corporation (ACNC). |
| Intervention services | Families in the program group received home visits modeled after Healthy Families New York, but modified to meet specific goals. Goals for the visits included (1) assessing family strengths and needs and connecting the families with needed services, (2) improving maternal psychosocial functioning and life course, (3) improving parent-child interactions, and (4) promoting child growth and development. |
| Comparison conditions | Participants in the comparison group received 1-2 home visits every six months until the child was age 5, and were provided with educational materials and information about community services. Assessment, screening and referrals for needed services were provided. |
| Staff characteristics and training | Home visits were conducted by paraprofessionals who were fluent in Spanish. Staff were trained by HFA or the Healthy Families New York training team and protocols for service delivery were reinforced at staff meetings. |
| Funding sources | New York State Office of Children and Family Services; the U.S. Department of Health and Human Services Children’s Bureau Abandoned Infants Assistance Program; and the Smith Richardson Foundation. |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | ASQ Communication score | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
6 months | 359 children | Mean = 55.70 | Mean = 55.30 | Mean difference = 0.40 | HomeVEE calculated = 0.07 | Statistical significance not reported | |
| Moderate | ASQ Composite score | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
6 months | 359 children | Mean = 54.80 | Mean = 54.00 | Mean difference = 0.80 | HomeVEE calculated = 0.15 | Statistical significance not reported | |
| Moderate | ASQ Fine Motor score | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
6 months | 359 children | Mean = 55.10 | Mean = 54.20 | Mean difference = 0.90 | HomeVEE calculated = 0.12 | Statistical significance not reported | |
| Moderate | ASQ Gross Motor score | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
6 months | 359 children | Mean = 52.90 | Mean = 51.80 | Mean difference = 1.10 | HomeVEE calculated = 0.12 | Statistical significance not reported | |
| Moderate | ASQ Social score | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
6 months | 359 children | Mean = 53.70 | Mean = 54.20 | Mean difference = -0.50 | HomeVEE calculated = -0.06 | Statistical significance not reported |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Number of pediatric emergency department visits | FavorableUnfavorable or ambiguousNo Effect |
Program group children not affected by substance abuse, NY Best Beginnings trial |
36 months | 271 children | Not available | Not available | Beta = 0.12 | Not available | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Increased education by year or more since baseline | FavorableUnfavorable or ambiguousNo Effect |
Program group families not affected by substance abuse, NY Best Beginnings trial |
24 months | 512 families | % = 18.40 | % = 7.40 | OR = 2.50 | HomeVEE calculated = 0.63 | Statistically significant, p < 0.05 |
|
| Moderate | Receipt of public assistance | FavorableUnfavorable or ambiguousNo Effect |
Program group families not affected by substance abuse, NY Best Beginnings trial |
24 months | 512 families | Not available | Not available | Beta = 0.02 | Not available | Not statistically significant, p ≥ 0.05 | footnote62Study reports results using a standardized partial regression coefficient. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Referral to AFDC or food stamps | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 33.00 | % = 26.00 | = 7.00 | HomeVEE calculated = 0.20 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to GED prep | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 29.00 | % = 26.00 | = -7.00 | HomeVEE calculated = 0.09 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to WIC | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 19.00 | % = 12.00 | = 7.00 | HomeVEE calculated = 0.33 | Not statistically significant, p > 0.10 |
footnote61In contrast to the study-reported results, HomVEE calculations showed this difference to be statistically significant (p ≤ 0.05). The HomVEE tests of statistical significance are based on the HomVEE calculated effect sizes, whereas authors may have used other techniques to determine statistical significance, such as regression models or analyses of variance (ANOVA). |
| Moderate | Referral to adult primary care | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 20.00 | % = 17.00 | = 3.00 | HomeVEE calculated = 0.12 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to child health plus | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 18.00 | % = 16.00 | = 2.00 | HomeVEE calculated = 0.09 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to counseling | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 28.00 | % = 21.00 | = 7.00 | HomeVEE calculated = 0.23 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to daycare/babysitting | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 52.00 | % = 50.00 | = 2.00 | HomeVEE calculated = 0.05 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to domestic violence services | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 10.00 | % = 5.00 | = 5.00 | HomeVEE calculated = 0.45 | Not statistically significant, p > 0.10 | footnote61In contrast to the study-reported results, HomVEE calculations showed this difference to be statistically significant (p ≤ 0.05). The HomVEE tests of statistical significance are based on the HomVEE calculated effect sizes, whereas authors may have used other techniques to determine statistical significance, such as regression models or analyses of variance (ANOVA). |
| Moderate | Referral to early intervention program | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 28.00 | % = 24.00 | = 4.00 | HomeVEE calculated = 0.13 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to English as a Second Language | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 44.00 | % = 36.00 | = 8.00 | HomeVEE calculated = 0.20 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to family planning | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 25.00 | % = 10.00 | = 15.00 | HomeVEE calculated = 0.67 | Statistically significant, p < 0.01 |
|
| Moderate | Referral to food pantry | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 25.00 | % = 19.00 | = 6.00 | HomeVEE calculated = 0.21 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to housing assistance | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 33.00 | &#; = 37.00 | = -4.00 | HomeVEE calculated = -0.11 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to immigration services | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 30.00 | % = 23.00 | = 7.00 | HomeVEE calculated = 0.22 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to job skills/search | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 43.00 | % = 39.00 | = 4.00 | HomeVEE calculated = 0.10 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to Medicaid | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 30.00 | % = 36.00 | = -6.00 | HomeVEE calculated = -0.16 | Not statistically significant, p > 0.10 |
|
| Moderate | Referral to parenting education or training | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 14.00 | % = 31.00 | = -17.00 | HomeVEE calculated = -0.62 | Statistically significant, p < 0.001 |
|
| Moderate | Referral to pediatric primary care | FavorableUnfavorable or ambiguousNo Effect |
Full sample | 24 months postpartum | 289 families | % = 41.00 | % = 32.00 | = 9.00 | HomeVEE calculated = 0.24 | Not statistically significant, p > 0.10 |
footnote61In contrast to the study-reported results, HomVEE calculations showed this difference to be statistically significant (p ≤ 0.05). The HomVEE tests of statistical significance are based on the HomVEE calculated effect sizes, whereas authors may have used other techniques to determine statistical significance, such as regression models or analyses of variance (ANOVA). |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Perceived social support (MSSI) | FavorableUnfavorable or ambiguousNo Effect |
Program group members not affected by substance abuse, NY Best Beginnings trial |
6 months | 354 mothers | Mean = 6.20 | Mean = 7.20 | Mean difference = -1.00 | HomeVEE calculated = -0.31 | Statistical significance not reported | |
| Moderate | Perceived social support (MSSI) | FavorableUnfavorable or ambiguousNo Effect |
Program group members not affected by substance abuse, NY Best Beginnings trial |
12 months | 325 mothers | Mean = 6.50 | Mean = 6.60 | Mean difference = -0.10 | HomeVEE calculated = -0.03 | Statistical significance not reported | |
| Moderate | Perceived social support (MSSI) | FavorableUnfavorable or ambiguousNo Effect |
Program group members not affected by substance abuse, NY Best Beginnings trial |
24 months | 274 mothers | Mean = 6.20 | Mean = 6.60 | Mean difference = -0.40 | HomeVEE calculated = -0.12 | Statistical significance not reported |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
ASQ:
|
The ASQ assesses the status of development in young children. The researchers examined subscales related to communication, motor development, and social practices. | Parent/caregiver report | Not reported by author |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Number of pediatric emergency department visits |
Number of pediatric emergency department visits between birth and age 36 months | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Receipt of public assistance |
Percentage of households receiving public assistance | Parent/caregiver report | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Referral to AFDC or food stamps |
Percentage of families with one or more service referrals for AFDC or food stamps | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to GED prep |
Percentage of families with one or more service referrals for GED prep | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to WIC |
Percentage of families with one or more service referrals for WIC | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to adult primary care |
Percentage of families with one or more service referrals for adult primary care | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to child health plus |
Percentage of families with one or more service referrals for child health plus | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to counseling |
Percentage of families with one or more service referrals for counseling | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to daycare/babysitting |
Percentage of families with one or more service referrals for daycare/babysitting | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to domestic violence services |
Percentage of families with one or more service referrals for domestic violence services | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to early intervention program |
Percentage of families with one or more service referrals for early intervention program | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to English as a Second Language |
Percentage of families with one or more service referrals for English as a Second Language | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to family planning |
Percentage of families with one or more service referrals for family planning | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to food pantry |
Percentage of families with one or more service referrals for food pantry | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to housing assistance |
Percentage of families with one or more service referrals for housing assistance | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to immigration services |
Percentage of families with one or more service referrals for immigration services | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to job skills/search |
Percentage of families with one or more service referrals for job skills/search | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to Medicaid |
Percentage of families with one or more service referrals for Medicaid | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to parenting education or training |
Percentage of families with one or more service referrals for parenting education or training | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
Referral to pediatric primary care |
Percentage of families with one or more service referrals for pediatric primary care | Review of Service Referral Forms completed by home visitors at the time of referral | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
MSSI: Perceived Social Support |
The MSSI assesses caregiver social support with regard to the division of household tasks and responsibilities for child rearing, access to transportation, interaction with other adults, and community involvement. The researchers analyzed the 3-item Perceived Social Support subscale, with possible scores ranging from 0 to 13. | Parent/caregiver report | Not reported by author |
