The evaluation of evidence-based home visiting programs supported by federal agencies has documented individual-level improvement in a range of domains, including child maltreatment. However, from a public health perspective, evaluating community-level effects is necessary to understand the impact of a program on a greater community as a whole beyond individual clients. Further, provision of home visiting programs in a community can have additional contextual impacts by encouraging the development of positive parenting norms and strengthening collective efficacy among residents. To address this knowledge gap, this study examined the association between provision of evidence-based home visiting programs and child maltreatment report (CMR) rates at the county level in the United States from 2016–2018, overall and within urbanicity and demographic subgroups.
We linked the National Home Visiting Resource Center (NHVRC) data, national CMR data, and Census data at the county level from 2016–2018. NHVRC provided a county-level binary measure for the presence of a local agency providing at least one of the following 15 evidence-based home visiting models: Attachment and Biobehavioral Catch-Up, Child First, Early Head Start Home-Based Option, Family Check-Up, Family Connects (not measured in 2016 and 2018), Family Spirit, Health Access Nurturing Development Services, Healthy Families America, Home Instruction for Parents of Preschool Youngsters, Maternal Early Childhood Sustained Home-Visiting, Minding the Baby, Nurse-Family Partnership, Parents as Teachers, Play and Learning Strategies (not measured in 2018), and SafeCare. We examined both within-county longitudinal changes and between-county differences in the evidence-based home visiting provision and estimated their associations with CMR rates based on within-between random effects models. All estimates were adjusted for urbanicity and a range of confounders (i.e., median household income, % single parent, % Black, % Latino, % foreign-born, % child, % disability, and % moved).
The within-county longitudinal change of home visiting provision (from no provision to provision) was significantly associated with a 2.37-point decrease in the CMR rate per 1,000 children (coefficient = -2.37; 95% CI = -3.95, -0.94). This association did not significantly differ by urbanicity, child gender, child age, and child race/ethnicity. The between-county home visiting provision showed no significant association.
We found that after counties had a local agency(ies) providing an evidence-based home visiting model(s), CMR rates significantly decreased in those counties. Our findings support the generalizability of local individual-level relationships to the national county-level relationships. Evidence-based home visiting programs mostly target families with children under 6 years and serve about 0.3 million families annually, which is less than 2% of 16 million families with related children under 6 years in the United States. This suggests that while the estimated effect size (2.37-point decrease) in this study is small relative to the national CMR rate (47.8 per 1,000 children in 2018), to the extent causality is present, there may be room to increase the effect size by expanding evidence-based home visiting programs. Further research is warranted to understand community-level processes from home visiting provision to child maltreatment.