Randomized Control Trial of a Child Abuse Prevention Program

Purpose:Home visitation programs have grown dramatically in the past several years spurred in part by increased federal funding. Home visitation programs are intended to impact a wide variety of outcomes such as child abuse and neglect, parent-child attachment, parenting behaviors, parent self-efficacy, self-sufficiency, child development, and school readiness (Tschudy, et al., 2013). The driving motivation behind these programs is the belief that early childhood constitutes an ideal opportunity to identify at-risk families and improve future outcomes through home-based interventions.  Currently there are several home visiting programs being implemented on a national level (e.g., Healthy Families America, Nurse Family Partnership, and Parents as Teachers). Given the widespread adoption of home visitation as a prevention strategy, there continues to be a national focus on the effectiveness of such programs (Filene, 2013). This study focuses on the evaluation of the Healthy Families America program model.  The present study adds to existing research by conducting a rigorous evaluation of a program that has statewide accreditation and an ongoing quality assurance program.

Method: A randomized experimental design was used whereby following assessment and meeting inclusion criteria families were randomly assigned to either the Healthy Families experimental group or the child development control group. Those assigned to the experimental group received the normal course of services from the Healthy Families Arizona program and those assigned to the child development group received assessment information about their child's developmental progress. This was deemed a minimal level of information that would still be valuable enough for participants to agree to participate in the study and agree to continue participation throughout the study period.  Follow up assessments at 6 months were completed on 77.3% of the Healthy Families participants and 81.8% of the control group.  Outcome measures examined parenting (parent child interactions, parenting routines); health (breastfeeding, use of contraception); Linkages/referral (use of resources, ability to mobilize resources); mental health (depression, overall mental health, problem solving); home environment (safety, positive environment) and child development (reading to child).

Results:Comparisons between the treatment and control group revealed program impacts on several of the outcome measures across multiple outcome domains.  For example, significant differences were found on parent child interactions (p<.06), home environment (p<.003), parenting routines (p<.01), parenting efficacy (p<.08), reading to baby (p<.03), breastfeeding (p<.04), and mobilizing resources (p<.007).  Effect sizes are also reported.  There were no significant differences between the two groups on measures of depression, emotional loneliness, immunizations, corporal punishment, and well-baby checks.

Conclusions and Implications: This study found the child abuse prevention program had impacts across a number of domains such as parenting, home environment, mental health and coping, and health.  Past research has not included such a comprehensive assessment of potential impacts across different domains.  This study found broad based home visitation programs can be effective across many different domains.  Implications for improving practice based on the results are provided.