Effectiveness of Home Visiting in Improving Child Health and Reducing Child Maltreatment

Abstract

BACKGROUND AND OBJECTIVE: The Patient Protection and Affordable Care Act established the Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion to states over 5 years for home visiting program models serving at-risk pregnant women and children from birth to age 5. The act stipulates that 75% of the funds must be used for programs with evidence of effectiveness based on rigorous evaluation research. Home Visiting Evidence of Effectiveness reviewed the home visiting research literature and provided an assessment of the evidence of effectiveness for program models that serve families with pregnant women and children from birth to age 5. METHODS: Home Visiting Evidence of Effectiveness included a systematic search and screening process, a review of the research quality, and an assessment of program effectiveness. Reviewers rated studies’ capacity to provide unbiased estimates of program impacts and determined whether a program met the Department of Health and Human Services’ criteria for an evidence-based model. RESULTS: As of July 2012, 32 models were reviewed, of which 12 met the Department of Health and Human Services criteria. Most of these models were shown to have favorable effects on child development. Other common favorable effects included health care usage and reductions in child maltreatment. Less common were favorable effects on birth outcomes. CONCLUSIONS: Home visiting is a promising way to serve families who may be difficult to engage in supportive services. Existing rigorous research indicates that home visiting has the potential for positive results among high-risk families, particularly on health care usage and child development.

Nurturing care: promoting early childhood development

“…(25) A meta-analysis of education programmes was conducted to determine non-cognitive developmental benefits of parenting and early childhood education programmes, as this information was not available in existing systematic reviews. The maltreatment review updated the Lancet 2009 series article on prevention of child maltreatment (26) and a systematic review of child maltreatment prevention reviews, (27) by reviewing recent reviews of maltreatment prevention interventions (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)., including home visiting, (28)(29)(30), parenting-training programmes, (31,32) sexual abuse prevention programmes, (33,34) universal campaigns to prevent physical abuse, (35) behavioural and counseling interventions,(36) detection of child maltreatment, (37) and three review studies on prevention of child maltreatment. (38)(39)(40) The social protection review examined five systematic reviews that focused on the effects of social programmes, including conditional and unconditional cash transfers and microcredit schemes.…”

Determinants of Health and Pediatric Primary Care Practices

“…36 Although many programs have evolved to focus on specific needs such as teen parenting, child abuse or neglect, low birth weight or premature infants, and children with developmental delays, others have expanded their focus to general prevention. 37 Evidence suggests that these programs positively affect health outcomes in high-risk families, particularly with respect to health care utilization and child developmental outcomes.…”

“…37 Evidence suggests that these programs positively affect health outcomes in high-risk families, particularly with respect to health care utilization and child developmental outcomes. [36][37][38][39] Indeed, programs such as Early Head Start, Healthy Steps, the Nurse-Family Partnership, and Home Instruction for Parents of Preschool Youngsters have improved adherence to preventive and developmental services and increased satisfaction with primary care. [40][41][42][43] Such programs have been termed a "sound investment" for long-term health and economic outcomes, prompting further expansion into low-income communities.…”

“…[40][41][42][43] Such programs have been termed a "sound investment" for long-term health and economic outcomes, prompting further expansion into low-income communities. 36,44 There has been a parallel push toward evidence generation, with an emphasis on identifying effective "core" components of home visitation (eg, addressing parent-child interaction, identifying and acting on basic social needs, ensuring in-home safety) and on building the infrastructure necessary for research to strengthen and refine strategies for dissemination, implementation, and sustainability. 36,37,45 Practices could begin by coordinating with public or private home visiting programs in their communities or, if able, they could integrate a home visitor into their practice.…”

“…36,44 There has been a parallel push toward evidence generation, with an emphasis on identifying effective "core" components of home visitation (eg, addressing parent-child interaction, identifying and acting on basic social needs, ensuring in-home safety) and on building the infrastructure necessary for research to strengthen and refine strategies for dissemination, implementation, and sustainability. 36,37,45 Practices could begin by coordinating with public or private home visiting programs in their communities or, if able, they could integrate a home visitor into their practice. Relationships built on collaboration and communication between the practice and the home visiting service can improve the care provided while ensuring that specific, consistent health messages and anticipatory guidance are reinforced.…”