Evidence Needed: Utilizing Home Visiting Programs to Prevent Child Maltreatment

Background and Purpose: Home visiting programs have been widely used to provide parent education and support. Although few home visiting programs were specifically designed to prevent child maltreatment, Texas’ child maltreatment prevention efforts have largely funded home visiting programs because they are considered evidence-based programs (EBPs). However, evidence does not necessarily support the programs’ success in preventing child maltreatment. This study is part of a larger multi-site, multi-intervention program evaluation of Project HOPES, a child maltreatment prevention program in Texas.

Methods: A mixed-methods approach for data collection was used to gather information for this evaluation. Online surveys were completed by 110 staff and 132 community members. The staff survey included 11 selected questions from the 50-item Evidence-Based Practice Attitude Scale (EBPAS) and the community survey included questions about the importance of having evidence-based practices in the community. Interviews and focus groups were conducted with 52 parents, 116 staff members and 42 coalition and/or community members. Qualitative data was coded using conventional content analysis. Quantitative data was analyzed to produce descriptive statistics.

Results: Staff who completed the online survey reported being satisfied with the curriculum they were implementing. The majority of staff did not find that EBPs were too limiting in meeting client needs. Parents expressed that they learned from the curriculum, but that their relationship with the home visitor was the key to keeping them involved in the program.  Staff believed that the EBP curriculum and materials were a strength of Project HOPES. Specifically, parent-child interaction activities and education, including discipline, were mentioned 43 times in 20 interviews/focus groups at seven sites. However, the difficulty balancing case management with parent education was mentioned 24 times in 13 staff interviews/focus groups across six sites. Parents also mentioned many case management activities they received from home visitors such as warm referrals to other providers, assistance getting diapers or food and/or help reading documents. Despite the strengths of the EBP curricula, staff also discussed drawbacks such as curricula not meeting the needs of diverse client populations or immediate family needs.  The needs of certain types of families and scenarios were provided 28 times in 10 interviews/focus groups across six sites. Staff felt that EBPs were designed assuming a perfect family situation where education was only needed.  Thus, staff highlighted ways that they make modifications to the EBPs to tailor services to the unique needs of the families served by Project HOPES.

Conclusions and Implications: Requirements that a program must adhere to a specific evidence-based model should be balanced with the specific program and family needs. In this project, communities often selected sub-optimal models that were not tailored to meet the needs of families most at risk of child maltreatment. Concerns about maintaining fidelity of evidence-based program models occasionally constrained parent educators from addressing crises that families had, while other parent educators chose to make adaptations to the models to address client needs. A more rational approach is to ask programs to be evidence-informed, with a strong theoretical foundation and program guidelines that match that foundation.