A Critical Review of In-Home Services for Children with Neonatal Abstinence Syndrome and their Families

The rate of Neonatal Abstinence Syndrome (NAS) secondary to Prenatal Substance Exposure (PSE) has been rapidly increasing in the United States (U.S.); as these children age, they are interacting with public health systems such as in-home programs to promote early childhood development. These programs have been studied extensively in the context of their intended primary audiences, but less is known about their implementation or effectiveness relating to this specific subpopulation. Understanding the current literature on this topic can help program planning and service delivery. The purpose of this critical review is to assess trends in research and evaluation of home-based early childhood programs serving children with NAS and associated PSE. To conduct this review, the researcher searched for key phrases and topics in four databases and used a PRISMA diagram to structure the review process. The thirty-two studies that met the inclusion criteria were either formative evaluations of program implementation or summative evaluations that focused on outcomes for families. Areas of focus, definitions, and assessments varied greatly between the studies, making it difficult to generalize findings. From this review, three themes emerged: unmet basic needs threaten well-being and limit the effectiveness of interventions; existing programs are poorly equipped to help the families of children with NAS; and biases at all levels of the public health system may cause families to leave services. These findings are timely and relevant to the many service organizations that are experiencing an influx of potential clients with a history of PSE or NAS.