Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation.
OBJECTIVE
To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families.


METHODS
Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n = 67) or standard services (n = 64). Incremental cost analysis.


METHODS
40 general practitioner practices across 2 counties in the UK.


METHODS
131 vulnerable pregnant women.


METHODS
Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally.


METHODS
Mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse.


RESULTS
At 12 months, differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group were found. The mean incremental cost per infant of the home visiting intervention was 3246 pounds sterling (bootstrapped 95% CI for the difference 1645-4803 pounds sterling).


CONCLUSIONS
This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.
Barlow
Jane
J
Warwick Medical School, University of Warwick, Coventry, UK. jane.barlow@warwick.ox.ac.uk
Davis
Hilton
H
McIntosh
Emma
E
Jarrett
Patricia
P
Mockford
Carole
C
Stewart-Brown
Sarah
S
D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000517:prevention & control*; D002669:Child Welfare; D003152:Community Health Nursing / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D005260:Female; D006792:House Calls / Q000191:economics*; D006801:Humans; D007223:Infant; D008427:Maternal Health Services / Q000191:economics / Q000592:standards*; D008603:Mental Health; D009034:Mother-Child Relations; D015999:Multivariate Analysis; D016487:Parenting; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D012649:Self Concept; D020377:Self Efficacy; D012944:Social Support