title: Randomized trial of a statewide home visiting program to prevent child abuse: impact in reducing parental risk factors.
abstract: OBJECTIVE
  To assess the impact of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse.
  
  
  METHODS
  This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on Oahu, HI, USA. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Mothers in both groups were interviewed annually for 3 years (88% follow-up each year) to measure mental health, substance use, and partner violence. HSP records were reviewed to measure home visiting services provided. Home visitors were surveyed annually to measure their perceived competence.
  
  
  RESULTS
  Malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers' desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving > or =75% of visits called for in the model. Home visitors often failed to recognize parental risks and seldom linked families with community resources. HSP training programs were under-developed in preparing staff to address risks and to link families with community resources.
  
  
  CONCLUSIONS
  Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service. Research is needed to develop and test strategies to improve home visiting effectiveness in reducing parental risks for child abuse.
authors.affiliation: Johns Hopkins University School of Medicine, 1620 McElderry Street, Baltimore, MD 21205-1903, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Duggan
authors.forename: Loretta
authors.initials: L
authors.lastname: Fuddy
authors.forename: Lori
authors.initials: L
authors.lastname: Burrell
authors.forename: Susan M
authors.initials: SM
authors.lastname: Higman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McFarlane
authors.forename: Amy
authors.initials: A
authors.lastname: Windham
authors.forename: Calvin
authors.initials: C
authors.lastname: Sia
mesh_terms: D000328:Adult; D002649:Child Abuse / Q000517:prevention & control*; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D017579:Domestic Violence; D005260:Female; D006254:Hawaii; D006792:House Calls; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009034:Mother-Child Relations; D016487:Parenting; D012017:Referral and Consultation; D012307:Risk Factors; D019966:Substance-Related Disorders; D016896:Treatment Outcome