Home Visiting and Parenting Stress: Results from a Randomized Field Trial

Background: Home visiting (HV) programs are a broad class of interventions that typically target services to low-income women during pregnancy and the postpartum period. Although findings have been mixed to date, some evidence indicates that HV programs have the potential to prevent child maltreatment. Few studies have examined the effects of home visiting on parenting stress, a key indicator of maltreatment risk, and no known studies have examined whether effects vary across different types of HV programs. This study tested the impact of two HV programs on parenting stress in a low-income, urban sample.

Methods: Data were analyzed from a field trial at an urban health department. The sample (N = 237) consisted of low-income, pregnant women who were referred to the health department’s centralized intake unit for HV services. From April 2014 to March 2017, eligible women were randomly assigned to one of two HV programs. The first was a Healthy Families America (HFA) program, which is a comprehensive, long-term HV model, while the second was a less intensive Prenatal Care Coordination (PNCC) nurse home visiting program that lasts up to 60 days postpartum. Families that did not accept HV services were recruited to be part of a third, quasi-experimental comparison group.

Post-baseline parenting stress was measured at 14-60 days postpartum and 6 months postpartum using the Parenting Stress Index-Short Form (PSI-SF), a well validated measure that produces a total scale and three subscales: Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child. OLS regressions were performed to test for group differences in all four measures of parenting stress while controlling for maternal age, race/ethnicity, and exposure to adverse childhood experiences (ACEs).

Results: At 14-60 days postpartum, the PNCC group reported significantly lower scores than the quasi-experimental comparison group on the PSI-SF total scale (95% CI = -17.2, -3.6; p < .05) and the Parental Distress subscale (95% CI = -8.3, -2.6; p < .01). Effects associated with the long-term HV program trended in the same direction but did not reach statistical significance; no differences in parenting stress between the two HV treatment groups. At six months postpartum, there were no differences in parenting stress between participants in the HV programs and participants in the non-service group. However, compared to participants in the HFA program, PNCC participants reported significantly lower levels of Parental Distress (95% CI = -6.8, -0.7; p < .05). Notably, maternal ACEs were strongly associated with all indicators of parenting stress but only at 14-60 postpartum time point (p < .01).

Conclusions and Implications: Home visiting has some potential to reduce parenting stress, though effects may vary along with program and provider characteristics. The current study suggests that briefer and less intensive HV interventions warrant further exploration alongside more intensive and longer-term HV interventions. Dismantling studies are needed to identify common factors that account for successful outcomes across home visiting models. Robust effects associated with maternal ACEs point to the need for trauma-responsive interventions that mitigate parenting stress among low-income caregivers.