Outcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement

doi:10.1016/0190-7409(96)00003-5

Children and Youth Services Review

Volume 18, Issue 3, 1996, Pages 243-259

https://doi.org/10.1016/0190-7409(96)00003-5 Get rights and content

Abstract

This study is a randomized clinical trial designed to test the psychosocial efficacy of a pre- and postpartum home visitation model for women at-risk for out-of-home placement of their newborns. Two hundred twenty-five pregnant women with high risk pregnancies for psychosocial reasons were recruited into the study and randomly assigned to an experimental ( $n = 125$ ) or control condition ( $n = 100$ ) when they presented for prenatal care at a large urban clinic. After an average of 16 months of exposure to the intervention, women in the experimental group reported significantly greater access to services and there was a trend for the experimental group to show a decrease in psychological distress. At 10 months, there was a trend for experimental group women to experience an increase in social support, but this was not sustained at 16 months. Although the difference was not statistically significant, a higher percentage of women in the experimental group had children in out-of-home living arrangements. There was also a trend among those with children in placement, for children of experimental group women to be placed in extended family care rather than foster care more frequently than controls. The implications of the findings for interventions with at-risk families are discussed.

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Cited by (23)

Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment
2011, Children and Youth Services Review
Citation Excerpt :
Findings from these evaluations have been mixed. Many demonstrate positive effects on maltreatment outcomes (Britner & Reppucci, 1997; Bugental et al., 2002; Duggan et al., 2004; Huxley & Warner, 1993; Olds et al., 1997; Prinz, Sanders, Shapiro, Whitaker, & Lutzker, 2009), while others show inconclusive (DuMont et al., 2008; Wagner & Clayton, 1999) or no effects (Barth, 1991; Duggan et al., 1999; 2007; Marcenko, Spence, & Samost, 1996). To our knowledge, Chaffin et al. (2004) conducted the only published evaluation of parent training using a randomized control design with a child welfare population.
This article uses statewide data on caregivers of young children referred to the Nurturing Parenting Program (NPP) for allegations of abuse and neglect to examine the relationship between program dosage and subsequent maltreatment. At six months after participating in the program, caregivers who attended more sessions were significantly less likely to be reported for child maltreatment, holding other factors constant. At two years after participating, caregivers attending more sessions were significantly less likely to have a substantiated maltreatment incidence, controlling for other characteristics of families associated with maltreatment. These findings demonstrate the program is associated with preventing short-term allegations and longer-term substantiated incidences of maltreatment for a child welfare population. By demonstrating the importance of participation in the NPP, we increase the evidence about effective parent education programs for this population.
Assessing home visiting programs to prevent child abuse: Taking silver and bronze along with gold [1]
2005, Child Abuse and Neglect
The effectiveness of early childhood home visitation in preventing violence: A systematic review
2005, American Journal of Preventive Medicine
Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review
2000, Child Abuse and Neglect
Objective: The objectives were to determine the effectiveness of programs in promoting family wellness and preventing child maltreatment and to identify factors that moderate program success.
Method: Meta-analysis, employing a 3-step model testing procedure, was used to review 56 programs designed to promote family wellness and prevent child maltreatment.
Results: The effect sizes for proactive interventions were larger at follow-up than at post-assessment, while the effect sizes for reactive interventions were higher at post-assessment than follow-up. The lowest effect sizes for home visitation programs on child maltreatment were for programs with 12 or fewer visits and less than a 6-month duration. Intensive family preservation programs with high levels of participant involvement, an empowerment/strengths-based approach, and a component of social support had higher effect sizes than programs without those elements. Also, both home visitation and intensive family preservation interventions achieved higher effect sizes with participants of mixed socioeconomic status (SES) than participants with low SES.
Conclusions: The total mean weighted effect size was .41, indicating that outcomes for the intervention group exceed 66% of those in control/comparison groups. The findings from this review demonstrated that child maltreatment can be prevented and that family wellness can be promoted.
Objectif: Évaluer l’efficacité de sprogrammes qui font la promotion du bien-être familial et de la prévention des mauvais traitements; et identifier les facteurs qui en déterminent le succès.
Méthode: L’étude a passé en revue 56 programmes qui ont pour but de promouvoir le bien-êre familial et prévenir les mauvais traitements, en effectuant une méta-analyse basée sur un modèle comprenant 3 étapes.
Résultats: Les effets des interventions actives sont plus considérables durant la période du suivi que durant la période suivant l’évaluation, tandis que c’est l’inverse pour les effets des interventions réactives. Pour ce qui est des programmes de visites à domicile, les effets les plus modestes se manifestent dans les programmes où il y a 12 visites ou moins et qui durent moins de 6 mois. Les programmes intensifs orientés vers la préservation de la famille et qui sont marqués par un haut degré de participation des sujets ont des effets plus positifs que les programmes dépourvus de ces éléments. On remarque les mêmes observations pour les programmes qui accordent aux participants le sens du pouvoir et qui offrent des appuis sociaux. De plus, les visites à domicile et les interventions intensives pour préserver la famille réalisent des effets supérieurs lorsque les participants sont de couches sociales diverses, comparés aux participants de niveau social défavorisé.
Conclusions: La moyenne des effets au total est de .41, ce qui porte à croire que les effets pour le groupe assujetti à ces interventions dépassent de 66% les effets pour les groupes contrôles ou de comparaison. Les constats démontrent que les mauvais traitements peuvent être prévenus et que le bien-être familial peut bénéficier de ces interventions.
Objetivo: Los objetivos fueron determinar la efectividad de los programas para promover el bienestar familiar y prevenir el maltrato a los niños e identificar los factores que moderan el éxito del programa.
Método: Se utilizó el meta-análisis, empleando un procedimiento del modelo de prueba de 3–pasos, para revisar 56 programas diseñados para promover el bienestar familiar y prevenir el maltrato a los niños.
Resultados: Los efectos del tamaño de las intervenciones proactivas fueron mayores en el seguimiento que en la post-evaluación. Los efectos del tamaño más bajos para los programas de visitas al hogar sobre maltrato infantil fueron para programas con 12 o menos visitas y menos de 6 meses de duración. Los programas intensivos de preservación familiar con altos niveles de participación, un enfoque de empoderamiento/ basado en reforzamiento, y un componente de apoyo social tuvieron los más altos efectos en tamaño que los programas sin estos elementos. También, tanto las visitas como las intervenciones de preservación intensiva familiar alcanzaron los efectos más altos con participantes de condición socioeconómica mixta (SES) que los participantes con bajo SES.
Conclusiones: La media del efecto del tamaño total fue .41, indicando que los resultados del grupo de intervención excedieron el 66% a los de los grupos de control/comparación. Los resultados de esta revisión demostraron que el maltrato a los niños puede ser prevenido y que el bienestar familiar puede ser promovido.
Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the 'universal versus targeted' debate: A meta-analysis of population-based and screening-based programs
1999, Child Abuse and Neglect
Objective: Seeking to discern optimal programmatic strategies and inform the “universal versus targeted” debate in early home visitation services to prevent physical child abuse and neglect, a meta-analysis was conducted examining enrollment approaches in early home visitation studies and their reported outcomes.
Method: Quantitative meta-analytic techniques were used to compare effect sizes from 19 controlled outcome studies across screening-based and population-based enrollment strategies. Effect sizes were calculated on protective services data and on child maltreatment related measures of parenting.
Results: On protective services report data, population-based studies reported a weighted mean effect size attributable to early home visitation of + 3.72%, in comparison to − .07% for screening-based studies. On child maltreatment related measures of parenting, population-based studies reported a weighted mean effect size (r) attributable to early home visitation of + .092, in comparison to + .020 for screening-based studies.
Conclusions: The findings indicate that population-based enrollment strategies appear favorable to screening-based ones in early home visitation programs seeking to prevent physical child abuse and neglect. It may be that psychosocial risk screens serve to enroll higher proportions of families for which early home visitation services are less likely to leverage change, and to exacerbate a mismatch between early home visitation service aims and family needs.
Identifying Effective Components of Child Maltreatment Interventions: A Meta-analysis
2018, Clinical Child and Family Psychology Review

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^☆: This research was funded by a grant from the Department of Health and Human Services (90CB004-01) under the Abandoned Infants Assistance Program.

^∗: The authors wish to thank Cathy Rohweder and Lucienda Smith, research associates, for their assistance in data collection, and the home visitors, social workers and nurses who provided the services to families.

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ArticleOutcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement☆

Abstract

Journal of Nurse Midwifery

Journal of Substance Abuse Treatment

Child Abuse and Neglect

Infants and children with Acquired Immunodeficiency Syndrome: Placement in adoption and foster care

Pediatrics

Home visitors and child health: Analysis of selected programs

Pediatrics

Social support and psychological distress women and men

British Journal of Medical Psychology

Drug exposed infants and children: Service needs and policy questions

Evaluation of Parent and Child Center Program

Child Welfare

Social support in improving perinatal outcome: The resource mothers program

Obstetrics and Gynecology

Infants at social risk: Maternal depression and family support services as mediators of infant development and security attachment

Child Development

Hospital boarder babies and their families: An exploratory study

Social Work in Health Care

The impact of a family centered case management approach

Social Work in Health Care

Psychosocial characteristics of pregnant women with and without a history of substance abuse

Health and Social Work

Article
Outcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement☆