The effectiveness of early childhood home visitation in preventing violence: A systematic review

doi:10.1016/j.amepre.2004.10.004

American Journal of Preventive Medicine

Volume 28, Issue 2, Supplement 1, February 2005, Pages 11-39

https://doi.org/10.1016/j.amepre.2004.10.004 Get rights and content

Section snippets

Overview

In early childhood home visitation programs, parents and children are visited at home during the child’s first 2 years of life by trained personnel who provide some combination of information, support, or training about child health, development, and care. Home visitation has been used to meet a wide range of objectives, including improvement of the home environment, family development, and the prevention of child behavior problems. The Task Force on Community Preventive Services (the Task

The Guide to Community Preventive Services

The systematic reviews in this report represent the work of the independent, nonfederal Task Force on Community Preventive Services (the Task Force). The Task Force is developing the Guide to Community Preventive Services (the Community Guide) with the support of the U.S. Department of Health and Human Services in collaboration with public and private partners. The Centers for Disease Control and Prevention (CDC) provide staff support to the Task Force for development of the Community Guide. A

Healthy People 2010 goals and objectives

The intervention reviewed here may be useful in reaching several objectives specified in Healthy People 2010,²⁴ the disease prevention and health promotion agenda for the United States. These objectives identify some of the significant preventable threats to health and focus the efforts of public health systems, legislators, and law enforcement officials for addressing those threats. Many of the proposed Healthy People objectives in Chapter 15, “Injury and Violence Prevention,” relate to the

Information from other advisory groups

In 1991, the U.S. Advisory Board on Child Abuse and Neglect, created by Congress, recommended universal home visitation to address maltreatment in the United States,²⁵ but its recommendation was not accepted by the U.S. Department of Health and Human Services or implemented by Congress.

Other reviews have found home visitation effective for preventing youth violence. The recent report titled Youth Violence by the Surgeon General,²⁶ using several measures of violent outcomes, concludes that nurse

Conceptual approach and analytic framework

The general methods for conducting systematic reviews for the Community Guide have been described in detail elsewhere.33, 34, 35, 36, 37 This section briefly describes the conceptual approach and determination of outcomes considered in assessing the effects of home visitation on violence.

The conceptual model (or analytic framework) used to evaluate the effectiveness of home visitation in reducing violence (Figure 1) shows the relationship of the intervention to the intermediate outcomes (i.e.,

Methods

In the Community Guide, evidence is summarized on (1) the effectiveness of interventions; (2) the applicability of evidence data (i.e., the extent to which available effectiveness data might apply to diverse population segments and settings); (3) positive or negative effects of the intervention beyond those assessed for the purpose of determining effectiveness, including positive or negative health and nonhealth outcomes; (4) economic impact; and (5) barriers to implementation of interventions.

Evidence reviews: violence by child

We reviewed the evidence concerning the violent behavior of children who were home-visited early in their lives. Although the prevention of youth suicide (i.e., violence against self) is a plausible outcome of home visitation, we found no study that assessed this outcome. Direct measures for violence by child were reported and observed violence, and violent crime; proxy measures were arrests, convictions, or delinquency as ascertained from official records (all for behavior that might or might

Results: part II—research issues

Strong evidence indicates that early home visitation is effective in preventing child maltreatment in low SES, single mother, and other families that have been targeted by such programs. Currently available evidence is insufficient to determine the effectiveness of early home visitation in preventing violence by visited children or visited parents (i.e., violence other than child maltreatment), or in preventing intimate partner violence in visited families. For all four outcomes reviewed, we

Discussion

This review addresses the effects of early childhood home visitation on child maltreatment and other violent outcomes. Substantial positive effects have been found for the prevention of child maltreatment—a median relative reduction of 39%. This effect estimate is most likely an underestimate, given that ascertainment of violence in the intervention group may actually be increased by the presence of the visitors. The intervention may also change long-term violent behaviors by visited children

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Cited by (168)

Young, low-income mothers’ social relationships and involvement in doula home visiting services
2023, Children and Youth Services Review
Relationships with family, partners and friends may shape mothers’ involvement with home visiting services, and discrepancies exist in the literature regarding whether supportive social relationships are associated with more service involvement or less involvement. Mothers with more support may be more involved in services because their history of support may enable them to build trusting working alliances with service providers (relationships-beget-relationships). Alternatively, mothers with less support may be more involved because they may be in greater needs of services (relationship-compensation). This study examined patterns of mothers’ social relationships and associations with the mothers’ working alliances (agreement on tasks and goals, bonding) and use of home-visiting services provided by doulas in pregnancy and early postpartum. Data were collected from young, low-income mothers (N = 147; mean age = 18.5 years old; 49.7% African American, 41.5% Latina, and 8.8% European American/Other) who participated in doula-enhanced-home-visiting programs and from program administrative systems. Doulas provided home visits starting in pregnancy through six weeks postpartum and provided support during childbirth at the hospital. Eight indicators of mothers’ relationships with their current parent figure (usually their mother; PF), the father of their baby (FOB), and general social network were measured. Latent profile analysis identified four relationship profiles: strong support from PF, FOB and others (27%), moderate support overall (40%), moderate support from FOB but alienation from PF (15%), and moderate support from PF but alienation from FOB (18%). Mothers with strong social relationships reported higher agreement with their doula on tasks/goals both during pregnancy and postpartum; mothers with challenging relationships with their parent figure had fewer pregnancy home visits and were less likely to have doula hospital attendance but had similar frequency of postnatal home visits as other classes. Relationship profiles were not associated with bonding with the doula, postnatal service frequency, or early service discontinuation. This study primarily provided support to the relationships-beget-relationships mechanism, but also suggested that mothers with a challenging history with their parent figure may become more involved in services after the birth of their baby. A deep understanding of young mothers’ relationship history can help home visitors provide equitable and individualized services to promote family and child wellbeing, especially for mothers with challenging histories with their caregiver.
Engaging fathers to strengthen the impact of early home visitation on physical child abuse risk: Findings from the dads matter-HV randomized controlled trial
2023, Child Abuse and Neglect
Despite growing recognition of the importance of fathers in child abuse risk, the field of perinatal home visitation has only begun to consider fathers' roles in the implementation of such services.
This study examines the effectiveness of Dads Matter-HV (“DM-HV”), a father-inclusion enhancement to home visitation, and hypothesized mediators of impact.
A multisite cluster randomized controlled trial was conducted with 17 home visiting program teams serving 204 families across study conditions. Program supervisors and their teams were randomized to deliver home visiting services plus DM-HV enhanced services (intervention) or home visiting services alone (control). Data were collected at three time points: baseline, 4 months post-baseline immediately following the intervention, and 12 months post-baseline. We employed structural equation modeling to estimate the effect of the intervention on physical child abuse risk and to trace hypothesized mediators, including the quality of the father-worker relationship, parents' partner support and abuse, and the timing of service initiation.
Results indicated that the DM-HV enhancement improved home visitor relationships with fathers, but only for families receiving services initiated postnatally. For these families, the improved quality of the father-worker relationship predicted improved parents' support of one another and reduced bidirectional mother-father partner abuse at 4-month follow-up, which in turn lowered maternal physical child abuse risk and paternal physical child abuse risk at 12-month follow-up.
DM-HV can strengthen the impact of home visitation services on physical child abuse risk for families when services are initiated postnatally.
Powering population health research: Considerations for plausible and actionable effect sizes
2021, SSM - Population Health
Citation Excerpt :
Effect sizes for home-visiting vary by program content and duration, and not all formats are effective (Bilukha et al., 2005; Olds et al., 2014). For example, professional home visitors are more effective than paraprofessionals, although longer durations with less-trained implementers can achieve comparable impacts, and programs with longer durations generally produce larger effects (Bilukha et al., 2005). Comprehensive smoke-free air policies and policies targeting specific industries (e.g. restaurant workers) appear to be more effective than partial bans (Community Preventive Services Task Force, 2014b; Faber et al., 2017; Frazer et al., 2016; Hahn, 2010; Hoffman & Tan, 2015; Meyers et al., 2009; Tan & Glantz, 2012).
Evidence for Action (E4A), a signature program of the Robert Wood Johnson Foundation, funds investigator-initiated research on the impacts of social programs and policies on population health and health inequities. Across thousands of letters of intent and full proposals E4A has received since 2015, one of the most common methodological challenges faced by applicants is selecting realistic effect sizes to inform calculations of power, sample size, and minimum detectable effect (MDE). E4A prioritizes health studies that are both (1) adequately powered to detect effect sizes that may reasonably be expected for the given intervention and (2) likely to achieve intervention effects sizes that, if demonstrated, correspond to actionable evidence for population health stakeholders. However, little guidance exists to inform the selection of effect sizes for population health research proposals. We draw on examples of five rigorously evaluated population health interventions. These examples illustrate considerations for selecting realistic and actionable effect sizes as inputs to calculations of power, sample size and MDE for research proposals to study population health interventions. We show that plausible effects sizes for population health interventions may be smaller than commonly cited guidelines suggest. Effect sizes achieved with population health interventions depend on the characteristics of the intervention, the target population, and the outcomes studied. Population health impact depends on the proportion of the population receiving the intervention. When adequately powered, even studies of interventions with small effect sizes can offer valuable evidence to inform population health if such interventions can be implemented broadly. Demonstrating the effectiveness of such interventions, however, requires large sample sizes.
Components associated with the effect of home visiting programs on child maltreatment: A meta-analytic review
2021, Child Abuse and Neglect
Home visiting programs are widely endorsed for preventing child maltreatment. Yet, knowledge is lacking on what and how individual program components are related to the effectiveness of these programs.
The aim of this meta-analysis was to increase this knowledge by summarizing findings on effects of home visiting programs on child maltreatment and by examining potential moderators of this effect, including a range of program components and delivery techniques.
A literature search yielded 77 studies (N=48,761) examining the effectiveness of home visiting programs, producing 174 effect sizes. In total, 35 different program components and delivery techniques were coded.
A small but significant overall effect was found (d=0.135, 95 % CI (0.084, 0.187), p<0.001). Programs that focused on improving parental expectations of the child or parenthood in general (d = 0.308 for programs with this component versus d = 0.112 for programs without this component), programs targeting parental responsiveness or sensitivity to a child’s needs (d = 0.238 versus d = 0.064), and programs using video-based feedback (d = 0.397 versus d = 0.124) yielded relatively larger effects. Providing practical and instrumental assistance was negatively associated with program effectiveness (d=0.044 versus d = 0.168). Further, program effects were larger when percentages of non-Caucasians/non-Whites in samples and follow-up durations increased.
In general, home visiting programs can prevent child maltreatment only to a small extent. However, implementing specific components and techniques can improve program effectiveness.
Do home visiting programmes improve children's language development? A systematic review
2020, International Journal of Nursing Studies
Citation Excerpt :
Systematic reviews such as a study conducted by Peacock et al. (2013) have explored the effectiveness of Home Visiting Programmes across multiple domains of child development. Stamuli et al. (2015) studied the economic effectiveness of Home Visiting Programmes, whilst other reviews have examined specific outcomes such as child maltreatment and violence (Avellar and Supplee, 2013; Bilukha et al., 2005) or improvements in parenting skills and the home environment (Hadian et al., 2018). However, to our knowledge, studies of the impact of Home Visiting Programmes on children's language development have not been systematically examined.
This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development.
A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies.
Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template.
Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development.
Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.
Reflective parenting home visiting program: A longitudinal study on the effects upon depression, anxiety and parenting stress in first-time mothers
2020, Heliyon
Our study aimed to investigate the effects of a reflective parenting home visiting program in first time-mothers at risk for depression, anxiety, and parenting stress, from three to 12 months after their child's birth.
The sample was composed by 77 first-time mothers and their healthy babies (53% boys and 47% girls). Mothers filled out the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, and the Parenting Stress Index-SF at 3, 6 and 12 months of the child. Thirty-six mothers were assigned to the experimental group and received the reflective parenting home-visiting program, the other 36 constituted the control group.
Analyses showed a significant higher reduction in the level of depression, anxiety and parenting stress among mothers belonging to the experimental group, compared to the control group.
Our findings confirm the benefits of reflective parenting home visiting programs and underline the need to constantly evaluate the levels of depression, anxiety and parenting stress throughout the perinatal period to target effective prevention programs to foster early mother-child attachment bond.

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ArticlesThe effectiveness of early childhood home visitation in preventing violence: A systematic review

Section snippets

Overview

The Guide to Community Preventive Services

Healthy People 2010 goals and objectives

Information from other advisory groups

Conceptual approach and analytic framework

Methods

Evidence reviews: violence by child

Results: part II—research issues

Discussion

First page preview

Am J Prev Med

Am J Prev Med

Am J Prev Med

Am J Prev Med

Child Abuse Neglect

Child Abuse Neglect

J Pediatr

J Pediatr

Child Youth Services Rev

Child Abuse Neglect

Long-term effects of early childhood programs on social outcomes and delinquency

Future Child

Long-term effects of early childhood programs on cognitive and school outcomes

Future Child

Home health visiting in Europe

Future Child

Two-generation programsdesign, cost, and short-term effectiveness

Educ Child Dev

Theoretical foundations of a program of home visitation for pregnant women and parents of young children

J Community Psychol

The Syracuse University Family Development Research Programlong-range impact of an early intervention with low-income children and their families

The ecology of human developmentexperiments by nature and design

Predictors of youth violence

Self-efficacytoward a unifying theory of behavioral change

Psychol Rev

Juvenile offenders and victims1999 national report

Childhood and society

Attachment and loss. Vol. 1. Attachment

Reducing risks for antisocial behavior with a program of prenatal and early childhood home visitation

J Community Psychol

Rates of homicide, suicide, and firearm-related death among children—26 industrialized countries

MMWR Morb Mortal Wkly Rep

Deathsfinal data for 2000

Natl Vital Stat Rep

Sourcebook of criminal justice statistics—1999

Violence against womenRelevance for medical practitioners

JAMA

Understanding child abuse and neglect

Third national incidence study of child abuse and neglect

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life spanfindings from the Adverse Childhood Experiences study

JAMA

In the wake of child maltreatment

Mechanisms in the cycle of violence

Science

Introducing the Guide to Community Preventive Servicesmethods, first recommendations, and expert commentary

Am J Prev Med

Healthy people 2010

Universal home visitinga recommendation from the U.S. Advisory Board on Child Abuse and Neglect

Future Child

Youth violencea report of the Surgeon General

Prenatal and infancy home visitation by nurses

Articles
The effectiveness of early childhood home visitation in preventing violence: A systematic review