Impact of a statewide home visiting program to prevent child abuse.
OBJECTIVE
To assess the impact of a voluntary, paraprofessional home visiting program in preventing child maltreatment and reducing the multiple, malleable psychosocial risks for maltreatment for which families had been targeted.


METHODS
This collaborative, experimental study focused on 6 Healthy Families Alaska (HFAK) programs; 325 families were enrolled in 2000-2001, randomized to intervention and control groups, and interviewed to measure baseline attributes. Follow-up data were collected when children were 2 years old (85% follow-up rate). Outcomes included maltreatment reports, measures of potential maltreatment and parental risks, for example, poor mental health, substance use, and partner violence. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure perceived effectiveness and training adequacy.


RESULTS
Parental risks were common at baseline, and one-sixth of families had a substantiated child protective services report in the child's first 2 years of life. There was no overall program effect on maltreatment reports, and most measures of potential maltreatment. Home visited mothers reported using mild forms of physical discipline less often than control mothers. The groups were similar in their use of more severe forms of physical discipline. There was no program impact on parental risks. There was no impact on outcomes for families with a 'high dose' of home visiting. Home visitors often failed to address parental risks and seldom linked families with community resources. Contradictions in the model compromised effectiveness.


CONCLUSIONS
The program did not prevent child maltreatment, nor reduce the parental risks that had made families eligible for service. Research is needed to develop and test strategies to improve the effectiveness of home visiting.
Duggan
Anne
A
General Pediatrics Research Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1903, USA.
Caldera
Debra
D
Rodriguez
Kira
K
Burrell
Lori
L
Rohde
Charles
C
Crowne
Sarah Shea
SS
D000413:Alaska; D000488:Allied Health Personnel / Q000592:standards; D002648:Child; D002649:Child Abuse / Q000517:prevention & control*; D002669:Child Welfare; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards; D017579:Domestic Violence / Q000517:prevention & control; D004493:Education / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006792:House Calls; D006801:Humans; D007223:Infant; D008297:Male; D015397:Program Evaluation / Q000592:standards; D012307:Risk Factors; D014838:Volunteers