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Duggan, A., Fuddy, L., McFarlane, E., Burrell, L., Windham, A., Higman, S., & Sia, C. (2004). Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: Fathers’ participation and outcomes. Child Maltreatment, 9(1), 3–17.

Model(s) Reviewed: Healthy Families America (HFA)®
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 Low Established on race and ethnicity; not established on SES; outcomes not feasible to assess at baseline None None
Notes:

In 2020, HomVEE updated this review to remove a mother's partnership status/family structure finding from the Family Economic Self-Sufficiency domain because ACF determined that mother's partnership status is ineligible for review by HomVEE. 

footnote443

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

Two outcomes (maternally reported father violence and mother’s designation of child’s biological father as her partner) were assessable at baseline. Authors did not establish baseline equivalence or control for baseline differences.

Study characteristics
Study participants Hawaii Healthy Start Program (HSP) staff screened the medical records of mothers from Oahu communities delivering children at Kapiolani Maternity Hospital for risk factors for child abuse and neglect. Families were eligible for HSP if one or both parents scored at least 25 on the Family Stress Checklist, mothers could be interviewed in English, and families were not already enrolled in HSP. If HSP home visiting intake was open on the day a family was deemed eligible, the family was invited to participate. A total of 897 families were eligible to be enrolled, and 730 of them agreed to participate. Using a table of random numbers, families were randomly assigned to one of three groups: a study treatment group or a study control group (both evaluated at one, two, and three years), or a testing control group (evaluated only at three years). The analytic sample for this study does not include families evaluated only at three years. The final analytic sample includes 600 families, 354 in the HSP group and 246 in the control group. Of these, at baseline, approximately 67 percent of mothers were high school graduates, and 49 percent were currently working. Mothers were 44 percent Native Hawaiian, 11 percent Other Pacific Islander, 25 percent Asian, 6 percent white, and 15 percent some other race.
Setting Six Healthy Start Program sites operated by three community-based organizations in Oahu, Hawaii.
Intervention services Home visiting services are provided to the mother and, when possible, also to the father. Home visits are weekly in the beginning, then gradually decrease to quarterly meetings, lasting from three to five years. The goal of home visits is to prevent child abuse and promote child health and development by focusing on improved family functioning. After addressing immediate crises, home visitors work on family functioning through role modeling, problem solving, and accessing social services. Home visitors also identify needs for professional support, such as domestic violence, substance abuse, mental health, and community resources.
Comparison conditions The comparison group was referred to community resources.
Staff characteristics and training Home visitors were trained paraprofessionals with professional supervision. Home visitors attended a five-week training that included such topics as working with men, domestic violence, and community resources.
Funding sources Maternal and Child Health Bureau (R40 MC 00029, formerly MCJ 240637; 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); and the Hawaii State Department of Health (99-29-J).
Author affiliation None of the study authors are developers of this program model.
Study Registration:

Clinicaltrials.gov Identifier: NCT00218751. Study registration was assessed by HomVEE beginning with the 2014 review.

Findings details

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
Moderate Change in father’s engagement score
FavorableUnfavorable or ambiguousNo Effect
All families Years 1-3 600 families Not available Not available OR = 0.20 HomeVEE calculated = -0.97 Not statistically significant, p ≥ 0.05
Moderate Change in father’s responsibility score
FavorableUnfavorable or ambiguousNo Effect
All families Years 1-3 600 families Not available Not available OR = 0.00 Not available Not statistically significant, p ≥ 0.05
Moderate Father has daily contact with child
FavorableUnfavorable or ambiguousNo Effect
All families Years 1-3 600 families Not available Not available OR = 1.12 HomeVEE calculated = 0.07 Not statistically significant, p ≥ 0.05
Reductions in juvenile delinquency, family violence, and crime
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Maternally reported father violence
FavorableUnfavorable or ambiguousNo Effect
All families Years 1-3 600 families Not available Not available OR = 0.78 HomeVEE calculated = -0.15 Not statistically significant, p = 0.12

Outcome measure summary

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

Change in father’s engagement score

A measure based on mother report of how often the father performed five tasks: (1) changing diapers/toilet training, (2) feeding the child, (3) comforting the child, (4) playing with the child, and (5) teaching the child new things. Scores for each item ranged from 0 to 4, with 4 representing the greatest engagement. Parent/caregiver report

Cronbach’s a = 0.86

Change in father’s responsibility score

A measure of the share of responsibility that the father took for the child’s welfare. Mothers reported how the parents shared responsibility in assuring that (1) the child had an appropriate diet, (2) the child was learning and developing appropriately, (3) the child always had a trustworthy caregiver, and (4) the house was safe to prevent injury to the child. Scores for each item ranged from 0 to 4, with 4 representing the greatest level of father responsibility. Parent/caregiver report

Cronbach’s a = 0.89

Father has daily contact with child

Percentage of fathers who had daily contact with the child, as reported by mothers. Parent/caregiver report

Not applicable

Reductions in juvenile delinquency, family violence, and crime
Outcome measure Description of measure Data collection method Properties of measure

Maternally reported father violence

Physical violence towards mother three or more times in year before baseline interview, based on Conflict Tactics Scale. Parent/caregiver report

Not applicable