Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors

TitleRandomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors
Publication TypeJournal Article
Year of Publication2004
AuthorsDuggan, A, Fuddy, L, Burrell, L, Higman, SM, McFarlane, E, Windham, A, Sia, C
JournalChild Abuse and Neglect
ISBN Number01452134 (ISSN)
KeywordsAdult, alcohol consumption, child abuse, Child abuse prevention, Child, Preschool, clinical trial, Community Health Services, depression, Domestic, Domestic Violence, Female, follow up, Hawaii, health care organization, health program, health survey, Home visiting, House Calls, human, Humans, Infant, Infant, Newborn, interview, Male, medical record, medical staff, Mental Health, mother, Mother-Child Relations, parental behavior, Parenting, Partner violence, population research, professional practice, randomization, Referral and Consultation, review, Risk Assessment, risk factor, Risk Factors, screening, substance abuse, Substance-Related Disorders, Treatment Outcome, United States, Violence

Objectives: 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 ≥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. © 2004 Elsevier Ltd. All rights reserved.