The Assignment (2 page paper APA Style format): Title " Role of Change Theory in Social Change. Briefly describe the issues you anticipate encountering in your strategic plan for the United Nations Environmental Protection . Explain the change you thin
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TheoryTheMissingLinkinUnderstanding.pdf
Theory! The Missing Link in Understanding the Performance of Neonate/Infant Home-Visiting Programs to Prevent Child Maltreatment: A Systematic Review
L E O N I E S E G A L , 1 R A C H E L L E S A R A O P I E , 1,2,3
and K I M D A L Z I E L 1
1University of South Australia; 2Alfred Hospital; 3Caulfield Hospital
Context: Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment.
Methods: We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis.
Findings: Having a stated objective of reducing child maltreatment—a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change—considerably increased the chance of success. We found that only seven of fifty-three programs demon- strated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Pro- grams with a partial match had an intermediate success rate. The relation- ship between program success and full, partial or no match was statistically significant.
Conclusions: Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting
Address correspondence to: Leonie Segal, Health Economics & Social Policy Group, Division of Health Sciences, University of South Australia, Box 2471 Adelaide, South Australia, Australia 5001 (email: [email protected]).
The Milbank Quarterly, Vol. 90, No. 1, 2012 (pp. 47–106) c© 2012 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
47
THE
MILBANK QUARTERLY A MULTIDISCIPLINARY JOURNAL OF POPULATION HEALTH AND HEALTH POLICY
48 L. Segal, R.S. Opie, and K. Dalziel
programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic frame- work provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical.
Keywords: Policy-relevant evidence synthesis, complex interventions, infant home visiting.
Background
H ome-visiting programs have been offered for more than sixty years, with the aim of creating a safe and nurturing environment for newborns and infants and preventing child
abuse and neglect. Home-visiting programs involve the use of a pro- fessional (such as a nurse or social worker) or a trained paraprofessional or layperson to make regular visits in the home of a mother (or family) commencing prenatally or soon after the birth of a baby. Home visits are provided for anything from a few months to two or more years, with more visits (e.g., weekly) closer to the birth and fewer (e.g., monthly) as the child grows. The general aim is to improve outcomes for mothers and babies.
The Nurse Family Partnership (NFP) developed by Olds (Olds et al. 1986, 1997) is perhaps the best-known home-visiting program. Home-visiting programs are now implemented widely, covering many thousands of families across the United States (Barth 1991; Bugental and Schwartz 2009; Duggan et al. 2004; Gessner 2008; Hardy and Streett 1989; Lutzker and Rice 1984; Schuler et al. 2000), the United Kingdom (Barlow et al. 2007; Wiggins et al. 2005), Canada (Infante- Rivard et al. 1989; Larson 1980; Steel O’Connor et al. 2003), Australia (Armstrong et al. 1999; Kemp et al. 2008), and elsewhere, includ- ing Syria (Bashour et al. 2008), New Zealand (Fergusson et al. 2005), Norway (Kaaresen et al. 2006) and Japan (Cheng et al. 2007).
Home-visiting programs have a number of possible objectives, includ- ing the health of the baby (e.g., immunization, breast-feeding), safety
Home-Visiting Programs to Prevent Child Maltreatment 49
(e.g. general risks, maltreatment), school readiness, and positive parent- ing (e.g. infant mother bonding and responding to cues). The focus of this article is home visiting for the prevention of child maltreatment. Child maltreatment—defined as any act of commission or omission by a parent or caregiver that results in harm, or the threat of harm, to a child—is widespread and of global concern (WHO 2006). As reported by Gilbert and colleagues (Gilbert et al. 2009a, 2009b), population surveys in countries in the Organization for Economic Cooperation and Development put rates of child physical abuse at 4 to 16 percent and neglect at 1.4 to 15.4 percent.
In Australia, rates of child physical and/or sexual abuse are estimated at 15.5 percent, based on the national mental health and well-being survey (ABS 2008; Reeve and van Gool 2010). Furthermore, rates of child maltreatment notifications in Australia nearly trebled between 2000/2001 and 2008/2009, from 115,471 to 339,454 (Productivity Commission 2011), placing considerable pressure on child protection services and calls for investment in preventive services.
Child maltreatment has well-documented adverse outcomes across many domains, contemporaneous with the abuse and extending many years into the future. It is associated with poor mental and physical health, high rates of suicide, poor physical health, low educational out- comes, high involvement in crime, incarceration, substance abuse, be- havioral problems, homelessness, welfare dependency, and unemploy- ment (Dube et al. 2003; Eckersley 1988; Evans, Hawton, and Rodham 2005; Gilbert et al. 2009b; Peden et al. 2008; Pinheiro 2006; Reeve and van Gool 2010; Thornberry et al. 2010; WHO 2010).
Home visiting in the prenatal and early childhood period is an iden- tified strategy for reducing child abuse and neglect. But despite decades of experience with the delivery of home-visiting programs and more than sixty published controlled trials and numerous literature reviews, the performance of home visiting is still reported as equivocal. In this article, we review the literature using a theory-driven framework in an attempt to bring greater clarity to understanding the disparate evidence base.
Existing Evidence Base
Using a standard search strategy (described later), we identified fifteen systematic literature reviews (including two meta-analyses) with a focus
50 L. Segal, R.S. Opie, and K. Dalziel
on home visiting as an intervention to prevent child maltreatment or risk factors for maltreatment. The number of programs covered in the reviews varied from two to sixty, reflecting distinct inclusion and exclusion criteria (see table 1).
Most of the reviews reported on many outcomes. These might include one or more direct child maltreatment measures (child abuse reports or substantiations, out-of-home placement) plus predictors of child mal- treatment (such as parenting knowledge, attitudes, or behaviors) or in- direct evidence of maltreatment (such as injury hospitalizations or child health development).
All the reviews sought to assess the overall performance of home vis- iting, for programs “within scope,” with some also seeking to describe the characteristics predictive of success (Drummond, Weir, and Kysela 2002; Kearney, York, and Deatrick 2000; Sweet and Appelbaum 2004). The reviews generally reported mixed results across outcome measures and struggled to generate meaning from the mixed findings. As re- ported in table 1, the conclusion of most of the reviews, including the high quality comprehensive review by Sweet and Appelbaum (2004), was that the evidence of success was equivocal. Only the review by Kendrick and colleagues (Kendrick et al. 2000) concluded that home visiting was successful, although their review was restricted to studies reporting HOME scores (a multicomponent questionnaire measuring the nurturing potential of the home/parenting environment).
A range of reasons were offered to explain why the performance of home-visiting programs might appear inconclusive. These included pos- sible error that was caused by the poor reliability and validity of measures (McNaughton 2004), the possibility that “certain outcome data are se- lectively omitted from published reports because the results fail to reach significance” (Roberts, Kramer, and Suissa 1996, 31), a follow-up period that was too short (McNaughton 2004), and possible “surveillance bias” (a higher rate of abuse notification related to contact with the home visitor). More commonly, the reviewers postulated that the considerable diversity in home-visiting programs was largely responsible for the con- fusion. The programs varied with respect to models of service delivery (when commenced and at what age concluded, number and length of home visits), target population (risk profile, cultural group), home visi- tor (qualifications, training, supervision), and program components (use of multidisciplinary team, access to specialist services such as counseling, drug and alcohol services, job placement, child care).
Home-Visiting Programs to Prevent Child Maltreatment 51
T A
B L E
1 K
ey C
on cl
u si
on s
of F
if te
en R
ev ie
w s
of N
eo n
at e/
In fa
n t
H om
e- V
is it
in g
St u
d ie
s
R ev
ie w
an d
N u
m b
er of
P ri
m ar
y St
u d ie
s F oc
u s
of R
ev ie
w C
on cl
u si
on s
B il
u k
h a
et al
. 2
0 0
5 ;
2 5
st u
d ie
s T
o as
se ss
th e
ef fe
ct iv
en es
s of
h om
e- vi
si ta
ti on
p ro
g ra
m s
in p
re ve
n ti
n g
vi ol
en ce
.
“S tu
d y
fi n
d in
g s
ar e
in co
n si
st en
t. ”.
. .“
T h
e ev
id en
ce is
in su
ff ic
ie n
t to
d et
er m
in e
th e
ef fe
ct iv
en es
s of
ea rl
y h
om e
in te
rv en
ti on
s in
p re
ve n
ti n
g vi
ol en
ce b
y vi
si te
d ch
il d
re n
or vi
si te
d p
ar en
ts or
in p
re ve
n ti
n g
in ti
m at
e p
ar tn
er vi
ol en
ce ”
(p .
1 7
). D
og g
et t,
B u
rr et
t, an
d O
sb or
n 2 0 0 5 ;
6 st
u d ie
s E
ff ec
t of
p re
- an
d /o
r p
os tn
at al
h om
e vi
si ts
fo r
w om
en w
it h
a d ru
g or
al co
h ol
p ro
b le
m .
“T h
is re
vi ew
fa il
ed to
fi n
d ev
id en
ce th
at h
om e
vi si
ts re
d u ce
d th
e ri
sk of
co n ti
n u in
g d ru
g or
al co
h ol
u se
” (p
. 1
8 ).
D ru
m m
on d ,
W ei
r, an
d K
ys el
a 2 0 0 2 ;
1 4
ar ti
cl es
on 9
p ro
g ra
m s.
F oc
u se
s on
p ro
g ra
m co
m p
on en
ts ,
p ra
ct ic
es , ou
tc om
es an
d q
u al
it y
to u
n d
er st
an d
co n
si d
er ab
le va
ri at
io n
ac ro
ss st
u d
ie s.
“P ro
g re
ss in
ev al
u at
io n
of h
om e
vi si
ta ti
on h as
b ee
n m
ad e,
b u
t m
u ch
re m
ai n
s to
b e
cl ar
if ie
d ”
(p .
1 5
7 ).
G on
za le
z an
d M
ac M
il la
n 2
0 0
8 ;
3 h
om e
vi si
ti n
g st
u d
ie s
R es
tr ic
te d
to co
n tr
ol le
d tr
ia ls
of ve
ry st
ri n
g en
t m
et h
od ol
og ic
al cr
it er
ia .
“T h
e d
ev el
op m
en t
of fu
tu re
p ro
g ra
m s
n ee
d s
to b e
th eo
re ti
ca ll
y d
ri ve
n ”
(p .
2 8
4 ).
G u
te rm
an 1
9 9
9 ;
1 9
st u
d ie
s E
xa m
in es
ou tc
om es
li n
k ed
w it
h d
if fe
ri n
g sc
re en
in g
an d
en ro
lm en
t st
ra te
g ie
s.
“P op
u la
ti on
-b as
ed en
ro lm
en t
st ra
te g
ie s
ap p
ea r
fa vo
u ra
b le
to sc
re en
in g
-b as
ed on
es in
ea rl
y h
om e
vi si
ta ti
on p
ro g
ra m
s se
ek in
g to
p re
ve n
t p
h ys
ic al
ch il
d ab
u se
an d
n eg
le ct
” (p
. 8
6 3
).
C on
ti nu
ed
52 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
1 —
C on
ti nu
ed
R ev
ie w
an d
N u
m b
er of
P ri
m ar
y St
u d ie
s F oc
u s
of R
ev ie
w C
on cl
u si
on s
H ah
n et
al . 2
0 0
3 ; 2
1 st
u d
ie s
an d
2 6
in te
rv en
ti on
ar m
s E
ff ec
ti ve
n es
s of
ea rl
y ch
il d
h oo
d h
om e
vi si
ti n
g in
p re
ve n
ti n
g vi
ol en
ce .
“T h
e T
as k
F or
ce fo
u n
d in
su ff
ic ie
n t
ev id
en ce
to d
et er
m in
e th
e ef
fe ct
iv en
es s
of ea
rl y
ch il
d h
oo d
h om
e vi
si ta
ti on
in p
re ve
n ti
n g
vi ol
en ce
b y
vi si
te d
ch il
d re
n an
d b et
w ee
n ad
u lt
s” (p
. 7 ).
H ow
ar d
an d
B ro
ok s-
G u n n
2 0 0 9 ;
9 R
C T
s E
ar ly
in te
rv en
ti on
– fa
m il
ie s
re cr
u it
ed p
re n
at al
ly or
ar ou
n d
b ir
th , st
at ed
ai m
to im
p ro
ve p
ar en
ti n
g an
d p
re ve
n t
ch il
d ab
u se
an d
n eg
le ct
.
“A re
vi ew
of th
e li
te ra
tu re
re ve
al s
a m
ix ed
p ic
tu re
re g
ar d
in g
th e
ef fi
ca cy
of h
om e-
vi si
ti n
g p
ro g
ra m
s” (p
. 1
7 ).
K ea
rn ey
, Y
or k
, an
d D
ea tr
ic k
2 0 0 0 ;
2 0
ra n d om
or q u as
i- R
C T
s
T h
e ch
ar ac
te ri
st ic
s of
n u
rs e-
d el
iv er
ed h om
e vi
si ti
n g
in th
e U
.S .
an d
C an
ad a
th at
im p
ro ve
m at
er n
al h
ea lt
h ,
p ar
en ti
n g
sk il
ls , m
at er
n al
-c h
il d
in te
ra ct
io n
, ch
il d
h ea
lt h
an d
d ev
el op
m en
t, an
d u se
of w
el l
ch il
d h
ea lt
h ca
re .
“I n
n u
rs e-
d el
iv er
ed h
om e
vi si
ti n
g in
te rv
en ti
on s
to yo
u n
g fa
m il
ie s
an d
p re
te rm
an d
fu ll
-t er
m in
fa n
ts , m
at er
n al
w el
l- b
ei n
g an
d li
fe co
u rs
e d
ev el
op m
en t,
m at
er n
al -i
n fa
n t
in te
ra ct
io n
, an
d p
ar en
ti n
g of
te n
im p
ro ve
d ,
b u
t ch
il d
d ev
el op
m en
t g ai
n s
m ai
n ly
w er
e li
m it
ed to
p re
te rm
in fa
n ts
” (p
. 3
7 5
). K
en d ri
ck et
al . 2 0 0 0 ;
1 7
st u d ie
s re
p or
ti n
g H
O M
E sc
or es
. R
es tr
ic te
d to
st u
d ie
s re
p or
ti n
g H
O M
E sc
or e
(t h
at m
ea su
re s
p ar
en ti
n g
q u
al it
y an
d sa
fe ty
of h om
e en
vi ro
n m
en t
fo r
ra is
in g
ch il
d re
n ).
“O u
r re
vi ew
of th
e ef
fe ct
iv en
es s
of h
om e
vi si
ti n
g p
ro g
ra m
m es
su g
g es
ts th
ey ar
e ef
fe ct
iv e
in in
cr ea
si n
g th
e q
u al
it y
of th
e h
om e
en vi
ro n
m en
t as
m ea
su re
d b
y H
O M
E sc
or es
” (p
. 4
4 7
).
Home-Visiting Programs to Prevent Child Maltreatment 53
M ac
M il
la n
et al
. 2 0 0 9 ;
2 h om
e vi
si ti
n g
m od
el s
(N F P
& E
ar ly
St ar
t)
E ff
ec t
on th
e fi
ve m
aj or
su b
ty p
es of
ch il
d m
al tr
ea tm
en t
of tw
o h
ig h
-p ro
fi le
n u
rs e-
vi si
ti n
g p ro
g ra
m s;
N u
rs e
F am
il y
P ar
tn er
sh ip
an d
E ar
ly St
ar t
(F er
g u
ss on
et al
. 2
0 0
5 ).
“D es
p it
e th
e p ro
m ot
io n
of a
b ro
ad ra
n g
e of
ea rl
y ch
il d
h oo
d h
om e
vi si
ti n
g p ro
g ra
m m
es , m
os t
of th
es e
h av
e n
ot b
ee n
sh ow
n to
re d
u ce
p h
ys ic
al ab
u se
an d
n eg
le ct
w h
en as
se ss
ed u
si n
g R
C T
s” (p
. 2
5 1
).
M cN
au g
h to
n 2
0 0
4 ;
1 3
st u
d ie
s N
u rs
e h
om e-
vi si
ti n
g in
te rv
en ti
on s.
“M an
y im
p or
ta n
t is
su es
ab ou
t th
e im
p le
m en
ta ti
on of
h om
e- vi
si ti
n g
p ro
g ra
m s
th at
im p
ac t
th ei
r su
cc es
s or
fa il
u re
re m
ai n
u n
cl ea
r” (p
. 2
1 7
). M
ik to
n an
d B
u tc
h ar
t 2 0 0 9 ;
2 6
re vi
ew s
of 1 7
h om
e vi
si ti
n g
p ro
g ra
m s
Sy n
th es
iz e
re ce
n t
ev id
en ce
fr om
re vi
ew s
on th
e ef
fe ct
iv en
es s
of u
n iv
er sa
l an
d se
le ct
iv e
ch il
d m
al tr
ea tm
en t
p re
ve n
ti on
, ev
al u
at in
g m
et h
od ol
og ic
al q
u al
it y.
“R ev
ie w
s su
g g
es t
th at
ea rl
y h
om e
vi si
ta ti
on p
ro g
ra m
m es
ar e
ef fe
ct iv
e in
re d
u ci
n g
ri sk
fa ct
or s
fo r
ch il
d m
al tr
ea tm
en t,
b u
t w
h et
h er
th ey
re d
u ce
d ir
ec t
m ea
su re
s is
le ss
cl ea
r- cu
t” (p
. 3
5 4
).
R ob
er ts
, K
ra m
er , an
d Su
is sa
1 9 9 6 ;
1 1
ra n d om
or q u as
i- R
C T
s
Q u
an ti
fy th
e ef
fe ct
iv en
es s
of h
om e
vi si
ti n
g p
ro g
ra m
s in
p re
ve n
ti n
g ch
il d
in ju
ry an
d ch
il d
ab u
se .
“T h
e ef
fe ct
of h
om e
vi si
ti n
g on
th e
oc cu
rr en
ce of
ch il
d ab
u se
va ri
ed ac
ro ss
st u
d ie
s in
b ot
h m
ag n it
u d e
an d
d ir
ec ti
on ”
(p .
3 1 2 ).
Sh aw
et al
. 2 0 0 6 ;
2 2
st u d ie
s in
th ei
r re
vi ew
; 8
w er
e of
h om
e vi
si ti
n g
fo r
n eo
n at
es or
in fa
n ts
P os
tp ar
tu m
su p
p or
t st
ra te
g ie
s an
d m
at er
n al
k n
ow le
d g
e, at
ti tu
d es
, an
d “N
o R
C T
ev id
en ce
is av
ai la
b le
to en
d or
se u
n iv
er sa
l p ro
vi si
on of
p os
tp ar
tu m
su p p or
t to
im p ro
ve p
ar en
ti n
g , m
at er
n al
m en
ta l
C on
ti nu
ed
54 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
1 —
C on
ti nu
ed
R ev
ie w
an d
N u
m b
er of
P ri
m ar
y St
u d ie
s F oc
u s
of R
ev ie
w C
on cl
u si
on s
sk il
ls re
la te
d to
p ar
en ti
n g
, m
at er
n al
m en
ta l
an d
p h
ys ic
al h
ea lt
h , an
d q
u al
it y
of li
fe .
h ea
lt h
, m
at er
n al
q u
al it
y of
li fe
, or
m at
er n
al p
h ys
ic al
h ea
lt h
.” . . . “T
h er
e is
so m
e ev
id en
ce th
at h
ig h
-r is
k p
op u
la ti
on s
m ay
b en
ef it
fr om
p os
tp ar
tu m
su p p or
t” (p
. 2 1 9 ).
Sw ee
t an
d A
p p el
b au
m 2 0 0 4 ;
6 0
p ro
g ra
m s
A d d re
ss th
e b ro
ad q u es
ti on
of w
h et
h er
h om
e- vi
si ti
n g
p ro
g ra
m s
h el
p fa
m il
ie s
ac ro
ss a
va ri
et y
of ch
il d
an d
p ar
en t/
m at
er n
al ou
tc om
es .
“W h
at ex
ac tl
y m
ak es
a h
om e
vi si
ti n
g p ro
g ra
m su
cc es
sf u
l is
u n
cl ea
r at
th is
ti m
e. ” . . . “H
om e
vi si
ti n
g d
oe s
se em
to h
el p
fa m
il ie
s w
it h
yo u
n g
ch il
d re
n , b
u t
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Home-Visiting Programs to Prevent Child Maltreatment 55
Several reviewers reported specific program features predictive of suc- cess, such as targeting of low-income, first time adolescent mothers (Howard and Brooks-Gunn 2009) or those “at elevated risk of maltreat- ment” (Bilukha et al. 2005, 22); or when the program was delivered by professional visitors (Bilukha et al. 2005; Hahn et al. 2003) or when families received a longer and/or more intensive program (Bilukha et al. 2005; Howard and Brooks-Gunn 2009). Kearney and colleagues con- clude that “effective nurse home visiting included nurses with advanced education, frequent visits over a long period of time, and were focused less on building parent resources, as in the social ecology model, and more on building a relationship with the mother and providing her with coaching in maternal-infant interaction and cognitive develop- ment” (Kearney, York, and Deatrick 2000, 375). But they also report uncertainty in the determinants of success. Sweet and Appelbaum, who reviewed sixty controlled trials, conclude that “what exactly makes a home visiting program successful is unclear at this time” (Sweet and Appelbaum 2004, 1448). Yet none of the reviews consider this issue in a rigorous way.
In short, despite the expectation that the attributes of home-visiting programs will affect performance, the reviews published to date have not established the determinants of success nor have they considered this question in a rigorous way. So despite dozens of random controlled trials (RCTs) and nearly as many reviews of home-visiting programs for neonates and infants, the current state of knowledge leaves policymakers without clear evidence-based advice.
Aim of Study
The aim of our study was to gain a new understanding of the home- visiting literature for the prevention of child maltreatment by taking a program logic approach that incorporated a theory of change.
We hypothesized that the success of home-visiting programs would reflect the consistency between (1) the stated or implied theory (mech- anism) of change underpinning the program, (2) the target population and their specific needs, (3) the program components/activities, and (4) the program objectives. Figure 1 depicts the overall program logic incorporating these four levels. We sought to test this proposition by an- alyzing all the published control studies of infant/neonate home-visiting
56 L. Segal, R.S. Opie, and K. Dalziel
figure 1. Program Logic Model for Reviewing Complex Interventions
interventions to prevent child maltreatment or known risk factors that met our inclusion criteria.
The approach is complementary to theory-driven evaluation, in which the underlying theory and fidelity of implementation are central to ex- planations of program performance (Coryn et al. 2011). An overarching
Home-Visiting Programs to Prevent Child Maltreatment 57
aim of our article is to encourage the use of program logic in the sys- tematic review of complex interventions and to demonstrate how this may be achieved. Adopting a theory-driven approach to understanding the complex home-visiting literature has a powerful internal logic. It is also supported by evidence that behavior change programs developed according to a defined theory are more likely to be successful than those not so developed (Noar and Zimmerman 2005). Painter and colleagues (2008) estimated that only one-third of health-related behavior change studies explicitly identify an underlying theory, and that such identifi- cation affects success. In relation to infant home visiting, we postulate that greater attention to the underlying theory and the integrity of the theory with program components, target population, and objectives will provide a more coherent explanation of the observed results. For example, Gardner and colleagues used a theory-driven approach to ev- idence synthesis to review audit and feedback mechanisms in chronic disease management (Gardner et al. 2003) and it was found to assist in understanding program performance.
We are not aware that a program logic approach incorporating a theory of change has been applied previously to a review of the home-visiting literature in neonates and infants. Even though some of the reviews identify whether individual programs specify and use a theory (of change) in program development and implementation (McNaughton 2004) and others specify objectives for each program that may imply a theory of change (Drummond, Weir, and Kysela 2002; Howard and Brooks- Gunn 2009; Sweet and Appelbaum 2004), none formally connects these observations to the programs’ success.
In the evaluation of individual programs, it is not uncommon for a theory of change to be considered in assessing performance (e.g., Barnard et al. 1988), or for a theory-driven (program logic) approach to be adopted (Rogers et al. 2000). However, it is the use of a program logic framework for a systematic review, the approach taken here, that is unique.
Our program logic–based review, though consistent with the growing realist synthesis literature in arguing for a theory-driven approach to the review of complex interventions (Pawson et al. 2005), has some impor- tant differences. The realist synthesis approach proposes that context is paramount, such that universal conclusions are unlikely to be possible. Instead, our expectation is that by using a theory-driven approach, the importance of context—albeit central—will not preclude overarching
58 L. Segal, R.S. Opie, and K. Dalziel
conclusions being drawn, but that this is unlikely to be a set of uni- versally effective program elements. That is, by using a theory-driven approach, what currently seems confusing in understanding predictors of success will become clear.
Methods
Our research had four phases:
1. Developing the criteria for the literature review, data extraction, and analysis for a systematic review of home visiting based on the program logic approach shown in figure 1.
2. Conducting a comprehensive literature search to identify all home-visiting programs meeting our inclusion criteria.
3. Extracting data using the established criteria including data on the programs’ performance.
4. Testing whether a match of the program theory, the program components, the target population, and the child maltreatment objective predicts success.
Criteria for Analyzing Home-Visiting Programs Using a Theory-Driven Approach
We developed a classification system to describe (1) the underlying the- ory or mechanism of change, (2) the target population, (3) the program components, (4) the program objective, (5) the definition of a program’s success, and (6) the basis for classifying a match.
Theory Underpinning Home-Visiting Programs. The underlying theo- ries of home-visiting programs to prevent child maltreatment draw on various literatures, including child development, attachment, health promotion, mental health, neuroscience, education and learning, and evolutionary biology. The discussion in this article represents a start on this complex area. It concentrates on the theories described in the child protection literature, for example drawing on the psychodynamic, sociological, social-psychological, and ecological theories (Sidebotham 2001).
We found that six reasonably distinct theoretical mechanisms (and associated theories of change) are commonly used to explain poor par- enting and poor child outcomes. These were based on (modified and
Home-Visiting Programs to Prevent Child Maltreatment 59
further developed) the state of Georgia’s Child Abuse Prevention The- ory of Change and Logic Model Early Childhood comprehensive systems implementation project, supported by the World Health Organization (WHO) (WHO 2011).
1. Lack of knowledge and skills regarding important topics like normal child development or how to look after or relate to a young infant by some mothers (and fathers) that undermines the quality of their parenting. For example, some of the early infant home-visiting programs reflect a knowledge and skills deficit model, such as the Parents as Teachers program developed in 1981 (Wagner and Clayton 1999).
2. Limited access to health care due to financial, cultural, logistical barriers, and/or competing priorities or chaotic life circumstances that compromises the physical health of the mother and baby (as might be seen in failure to thrive, failure to achieve baby milestones). Home visiting seeks to address this by providing direct access to the health and welfare system in the family’s home (through the visitor/team) and through facilitating referral/access to other health and welfare services.
3. Social isolation of mothers as a predictor of child maltreatment (Runyan et al. 2002), reflecting the importance of good emotional and social support for new mothers when they are particularly vulnerable and at high risk of postpartum depression.
4. Disruptions to the mother-infant interaction and bonding and low maternal sensitivity affecting the ability to be a good parent, de- scribed in the attachment theory literature (Bowlby 1969/1982; Lyons-Ruth 2008). The crucial importance of early infancy (in- cluding in utero) and the mother-child relationship is emerging also from the neuroscience literature (Schore 2005).
5. A poor or compromised psychological state that undermines a mother’s capacity to parent and poses a direct threat to the mother-infant attachment and meeting of the infant’s basic physi- cal and emotional needs. This risk can be exacerbated by drug and alcohol misuse and mental illness, especially when the mother was abused or neglected as a child (Amos, Furber, and Segal 2011). This would suggest a home-visiting program with a strong men- tal health capability.
60 L. Segal, R.S. Opie, and K. Dalziel
6. Some home-visiting programs refer to an “ecological model,” which places the mother and child within the family, commu- nity, and societal context. The premise is that there are factors beyond the individual mother or child that limit the mother’s ca- pacity to parent. These factors could include a lack of employment opportunities, poor access to affordable housing, or inadequate social welfare support (Sidebotham 2001). Home-visiting pro- grams that take an “ecological approach” may provide initiatives to support the wider economic and social context, for instance, supporting education or access to employment for the mother.
Target Population. Target populations were classified according to characteristics correlated to risk of abuse or threats to a safe and nurturing environment for the child (Runyan et al. 2002) in a way that would establish a hierarchical schema. We sought to balance complexity in the classification system with relative homogeneity within each population subgroup, resulting in five population subgroups, ranging from (1) low- risk / general population to (5) active abuse / domestic violence, with three intermediate risk levels. The specific characteristics of the five population risk levels are listed in the notes to table 2.
Program Components. Programs have been described in terms of their constituent components using a classification system designed to capture program diversity but limited to ten broad components (see table 3).
Program Objective. We wanted to establish whether the reduction of child abuse and/or neglect was an explicit program objective, which was not a criterion for inclusion in our review, although reporting at least one direct or indirect child abuse outcome was.
Program Performance. We created a protocol to classify programs as “successful or not” that was designed to weigh up all the relevant out- comes that were measured, rather than to selectively report only those that were statistically significant, without reference to those that were not. Our aim was to assess whether, on balance, there was likely to be a positive and important impact for the client population. Surprisingly little attention has been paid to this task. Instead, most reviewers as- sess performance one outcome measure at a time, collating the evidence across all programs reporting that outcome. The general absence of prespecified protocols for defining program success leaves considerable opportunity for selective outcome reporting and interpretation. In their 2010 review of sixty-six home-visiting programs for infants, children,
Home-Visiting Programs to Prevent Child Maltreatment 61
TABLE 2 Match between Target Population and Program Theory
Population Target Matching Theorya
1. Low risk 1. Mothers lack parenting knowledge and skills. 2. Some elevated risk 2. Access to health care for health/developmental
milestones. 3. Mothers lack emotional/social support.
3. High risk 2. Access to health care for health/developmental milestones.
3. Mothers lack emotional/social support. 4. Mother-infant interaction/attachment.
4. Very high risk 5. Poor mental health/therapeutic/psychological model.
5. Current abuse 6. Ecological model.
Notes: aA match requires one of the theories in the matching theory column to be applied, although a higher level theory also is acceptable. More complete descriptors of theory categories are provided in the text and table 3. Low risk: General population of families with neonates. Some elevated risk: One of the following: mothers < 19 years old, racial minority group, low income, low socioeconomic status, unemployed, limited education, lack of social support / social isolation, single parent, unmarried, financial stress, underuse of needed community services, low self-esteem. High risk: Mental illness, unstable housing, chaotic lifestyle, low intelligence / low IQ, difficult child, ambivalence to pregnancy (sought termination / no antenatal care), ≥ two of “some elevated risk.” Very high risk: Criminal record, in-utero drug exposure, prenatal drug use, drug abuse, parent history of childhood abuse, suspicion of previous abuse by parent, or 3 or more combinations of level 3. Current abuse: At least one previous incident of child abuse or neglect and/or evidence of domestic violence.
and adolescents, Kahn and Moore (2010) defined the program’s suc- cess by the report of at least one positive outcome (intervention group statistically significantly better than control), regardless of the num- ber of reported outcomes or the existence of negative results. This might be considered a minimum hurdle for potential classification as successful.
We adopted an approach to defining success that was based on the primacy of outcome and the number and proportion of statistically significant (p < 0.05) positive (or negative) outcomes, relative to all outcomes reported. The precise protocol adopted is described in the section “Approach to Data Extraction.”
62 L. Segal, R.S. Opie, and K. Dalziel
TABLE 3 Match between Program Theory and Program Components
Program Theorya Program Components
1. Mothers lack parenting knowledge and 1. Education, training, information∗
skills. 6. Problem solving/goal settingb
2. Limited access to health services pose a threat to health of mother and baby.
5. Referral and linking to health services/advocacy∗
6. Problem solving/goal settingb
9. Clinical services responsive to mother/child family circumstance∗
3. Social isolation: mothers lack social 2. Emotional support∗
and emotional resources. 5. Referral and linking to health services/advocacyb
6. Problem solving/goal settingb
4. Disruption to the mother-infant 3. Modeling/mentoring∗
interaction and bonding or of maternal sensitivity.
4. Counseling/therapy by mental health worker∗
6. Problem solving/goal settingb
5. A compromised psychological state/poor mental health undermine the capacity to parent.
4. Counseling (including drug and alcohol)/therapeutic support by a mental health worker (psychiatrist, psychologist, mental health nurse)∗
8. Case management involving mental health worker∗
6. Ecological modelc: ecological factors 5. Referral/link to services/advocacy∗
(social, community, and family level) have a core influence on capacity of mothers to parent.
7. Provision of goods and services (food, contraception, transport, access to education, training, job placement)
9. Clinical services responsive to mother/child circumstanceb
10. Child careb
Notes: Match: At least one core component (identified with an asterisk, ∗) must be present for a match. aWhen more than one program theory is identified, a match requires a core (identified with an asterisk, ∗) program component to be present for each theory. bUseful but not sufficient. cFor the ecological model, the core component plus ≥ 1b must be present for a match.
Home-Visiting Programs to Prevent Child Maltreatment 63
Definition of a “Match” between Program Theory, Components, and Popu- lation. For each of these six theories, we selected those program com- ponents that were consistent with the theory, based on the postulated mechanisms of action. A match between program theory and program components was tied to the mechanism inherent in the theory. At least one “critical program component” needed to be present to yield a match with the program theory. A match between the target population and the theory was defined according to a hierarchy, starting with the sim- ple knowledge deficit model matched with low-risk populations and advancing to a therapeutic or ecological model matched with higher- risk populations. For this purpose, the target populations were collapsed from five to three. How we defined a match between population and program theory is described in table 2 and that between theory and components in table 3.
Literature Search
We conducted a literature search to identify all published controlled studies of home visiting for neonates/infants at risk of child maltreat- ment, searching electronic databases using key terms for “home visiting” and “child.” Owing to the large number of published systematic reviews of home-visiting programs, we used a three-step process:
Step 1: Search for systematic reviews using search filters and pertinent databases—Cochrane, Medline, Embase, Meditext, and Social Sciences Citation Index—locating all individual home- visiting trials included in these reviews fitting our inclusion criteria. Step 2: Search for RCTs using search filters for 2000 onward from Cochrane, Medline, Embase, PsychInfo, Meditext, and So- cial Sciences Index (assuming earlier studies would have been included in at least one of the several published reviews). Step 3: Search of bibliographies, key authors, key journals (Child Abuse & Neglect, Child Maltreatment) and the gray literature via the National Child Protection Clearinghouse of Australia. The full details of our search strategy and search filters are available from the authors.
64 L. Segal, R.S. Opie, and K. Dalziel
Eligibility Criteria. One of us (Opie) excluded those articles that were obviously irrelevant, based on an inspection of the abstract and title. We then obtained the full articles that appeared to meet our broad selection criteria or whose relevance could not be assessed from the abstract and title. Opie and Dalziel assessed them separately for inclusion, reading a total of 143 full text studies. Initial agreement was obtained on all but five studies, which were discussed with Segal and agreement reached on all studies.
Our inclusion criteria were the following:
• A randomized controlled trial or quasi-experimental design with a control or comparison group.
• Home visiting (defined as at least two home visits by someone other than a relative).
• Visits commencing during pregnancy or within six months of birth for the purpose of reducing the risk of child maltreatment or related outcome.
• At least one quantifiable outcome related to maltreatment or the risk of maltreatment, primarily the notification or substantiation of child abuse or neglect, out-of-home placement, cases of in- tentional injury, hospitalization, ED visits, Child Abuse Potential Inventory (CAPI), Conflict Tactics Scale (CTS), Home Observation for Measurement of the Environment (HOME) inventory, Family Stress Checklist (FSC), Parenting Stress Index, rapid repeat births, substance misuse, Parent-Infant Relationship Global Assessment Scale (PIRGAS), and Mother Infant Interaction Scale.
• Published in the English language.
Quality Assessment
Table 1 summarizes the study design and rating of each program’s potential for bias. Dalziel formally assessed each included study for bias, using criteria developed from the Cochrane Handbook (Higgins and Green 2009), the Centre for Reviews and Dissemination’s guidelines (2009), and Edgeworth and Carr’s criteria specific to child abuse research (2000). Each study was classified as of “good quality” (zero or one potential for bias), “adequate quality” (two potentials for bias), or “poor quality” (three or more potentials for bias). Potentials for bias were restricted to quality items most likely to compromise study results: specifically
Home-Visiting Programs to Prevent Child Maltreatment 65
unadjusted group differences at baseline, failure to conduct intention to treat analysis, outcome assessors not blinded to group status, provision of intervention and control services by the same nurses, and nonrandom allocation to groups. The quality of the studies were considered good for fourteen (27%) programs, adequate for twenty-five (48%), and poor for thirteen (25%).
Approach to Data Extraction
We created several tables to classify the programs by the underlying the- ory (six options), program components (ten options), population target (1 to 5), and objective (child abuse yes or no) according to the preceding definitions. Dalziel and Opie independently double-extracted the data for program theory, program components, and child abuse objectives. When they differed, Segal helped them agree on an allocation. In every case, the data were extracted based on what actually occurred (notably the population who participated in the program and the program com- ponents as delivered).
Underpinning Program Theory. The underpinning program theory was directly obtained from the stated theory when it was described, or it was drawn from the reported program goals or intention. In other words, in the absence of an explicitly stated theory, a theory was inferred from other related information. In most cases, one of the six theories was identified as predominant and allocated to the program, but we allowed up to three to be identified.
Population Target. The population target(s) for each program were se- lected from the five options described in table 2, based on the character- istics of the enrolled population. For example, a program that recruited pregnant teenagers in Baltimore might be allocated to risk level 2, but if the enrolled population included 75 percent with a drug addiction, the program would be allocated to risk level 4. The allocation was made independently by Rachelle Sara Opie and Kim Dalziel, with any differ- ences resolved through discussion with Leonie Segal. Classification to more than one population target was allowed.
Program Components. The program components were determined based on the description of the service delivery components/activities described for the intervention arm and allocated to one or more of the ten categories listed in table 3. The components as delivered, even if they differed from what was intended, were used.
66 L. Segal, R.S. Opie, and K. Dalziel
Objective of Child Maltreatment Prevention. A program was classified as “yes” if any program reports stated that an objective was to prevent child maltreatment or “no” if they did not.
Overall Success of the Program/Intervention Arm. We analyzed the pro- gram results in two steps: first outcomes were classified as either (1) a direct measure of child abuse, defined to include child protection ser- vice reports, reports or substantiated cases of abuse or neglect (including domestic violence), out-of-home placement, nonaccidental injury (cap- tured in hospital admissions or hospital emergency department visits) or Child Abuse Potential Inventory (CAPI) score; or (2) indicator or risk for child maltreatment, primarily the HOME score, rapid repeat births, substance abuse, parent-child conflict tactics scales, mother-infant inter- action rating scale, family stress checklist, and/or parenting stress index (PSI).
The second task was to look for consistency in the direction of out- come (positive or negative). Subgroup analyses were not considered, only main program effects. For a program to be classified as having an overall “positive outcome” and thus designated as a “success,” the following protocol was adopted: If only one variable was reported, it had to be statistically significantly positive. If two or more variables were reported, at least one needed to be statistically significantly pos- itive if all other variables showed, at worst, no difference. In all cases, success required the absence of any reported statistically significant neg- ative outcomes. Indicators of or risks for child maltreatment (considered proxy outcomes) were considered only if no direct child maltreatment variables were reported. Success was then defined using the same proto- col described above. This approach to defining success was designed to ensure that studies that collected many outcomes were not more likely to be identified as successful simply because of the greater likelihood of a chance positive finding. The approach also placed the greatest weight on more direct child maltreatment outcomes as the best indicator of child abuse or neglect. Although these might be considered low-risk events, in the typically higher-risk populations that receive home visiting, they are not uncommon.
Defining a Match. Once each program was allocated to a program theory (1 to 6), a set of program components (1 to 10) and population (1 to 5), as well as a child abuse objective (yes or no), the existence of a match was assigned according to the protocols defined in tables 2 and 3. The programs were then classified as one of three categories: (1) a
Home-Visiting Programs to Prevent Child Maltreatment 67
“full match” across program theory, components, population, and yes for stated child abuse objective; (2) a “partial match,” involving a match of theory, components, and population but without a child abuse objective or a match of theory, components, and child abuse objective but only for part of the population; or (3) “no match,” a residual category. If a program offered additional components beyond those deemed a necessary minimum for the target population, this was recorded as a full match. This may affect cost-effectiveness but seemed unlikely to undermine a positive outcome.
Relationship between Match and Program Success. We hypothesized that if the program components, population, and child abuse objec- tive matched the underlying theory, the program was more likely to be successful. If there was no match across these variables, we hypothesized that the program was less likely to be successful. We then observed whether there was a difference in rates of program success across the “three defined match categories.” We also formally tested the relation- ship by modeling program success against the match results.
Data Analysis
We used standard tests of statistical significance (Pearson’s chi-square and Fisher’s exact) to test the relationship between program classification as successful; and having a full, partial, or no match between theory and program components and population.
Results
Study Selection
Our literature search yielded 2,243 articles, of which we examined 143 papers in full text (see appendix A), and identified fifty-two “dis- tinct” home-visiting programs meeting the inclusion criteria (associ- ated with forty-five models). Programs implemented in a unique set- ting and/or with different populations were treated as distinct, even if based on the one overarching model (e.g., three programs applied the Olds’s Nurse Family Partnership model but in different settings and for distinct populations). References to included programs are listed in appendix B.
68 L. Segal, R.S. Opie, and K. Dalziel
Program Characteristics
Study Design. Of the fifty-two included programs, fourteen were nonrandomized controlled studies; two were cohort studies; and the remaining thirty-six were randomized controlled trials. Thirty-seven programs were delivered in the United States, three in Australia, six in Canada, two in the United Kingdom, and one each in New Zealand, Syria, Japan, and Norway. The studies were published between 1969 and 2009.
Type of Home Visitor. Many programs used nurses for home visiting (n = 19), but the use of other professionals (e.g., social workers n = 15), “paraprofessionals” (n = 9) or laypersons (n = 6) for visiting was also common. A formal multidisciplinary team was used for three programs. Twenty programs used more than one discipline group on their team for the home visit or for training and/or support.
Program Intensity. There was considerable diversity in program in- tensity. Twenty-five home-visiting programs commenced during preg- nancy, and the others began after birth. The child’s age at exit from the program varied from one month up to five years. The mean number of visits ranged from two to forty-one, and the length of visit varied from twenty minutes to four hours, resulting in considerable variation in the potential (as well as actual) hours of home visiting for the family.
Population Characteristics. Seven programs exclusively targeted teenage/adolescent parents; four programs targeted high-risk families defined by the Kempe Family Stress checklist; and four programs re- cruited parents using illicit drugs. Many programs drew their popula- tions from two or three risk categories. Most programs targeted persons at considerably elevated risk, including current abuse, current drug or alcohol problems, or existence of several risk characteristics (n = 23). Often, the enrolled populations exhibited higher-risk attributes than suggested by the enrollment criteria. Only two programs included the entire range of population categories (see ).
Program Theoretical Underpinning. The predominant theory (or the- ories) assigned to each program is reported in table 4. The four most commonly defined theories, covering 80 percent of the programs, were “mothers lack knowledge/skills,” “limited access to health care under- mining the physical health of the mother and baby,” “mothers are isolated and lack social/emotional resources,” and “disruption to mother-infant interaction and bonding.” Only 10 percent drew on a theory related to “compromised mental health” (n = 5).
Home-Visiting Programs to Prevent Child Maltreatment 69
Program Components/Activities. The program components identified in the home-visiting programs were, in order of frequency: educa- tion/training/information (n = 46), emotional support (n = 43), re- ferral and linking to services/advocacy (n = 38), modeling/role model (n = 19), problem solving (n = 16), counseling/therapy (n = 16), case management (n = 5), provision of goods and services (n = 5), responsive clinical services (n = 2), and provision of child care (n = 2) (see table 4).
Objective of Child Maltreatment Prevention. Twenty-five out of the fifty- two programs had a stated objective of preventing child maltreatment, and all of these reported direct child abuse outcomes. Of those that did not identify a child abuse and neglect objective, 42 percent still reported a “direct” child abuse outcome.
Program Success. A total of twenty-five (48%) of programs were de- fined as successful and twenty-seven (52%) as not successful, using the criteria described earlier. Outcomes were more likely to be indirect where reducing child abuse and neglect was not a stated aim.
Match between Theory, Population, and Program Components. Only seven of the fifty-two programs (13.5%) were described as having a complete match for theory, population and program components, and a stated aim to reduce child abuse and neglect. Thirty programs (58%) were classified as a partial match, and fifteen programs (29%) as a clear mismatch.
Likelihood of Program Success and Observed Match between Theory, Population, Program Components, and Child Abuse Prevention Objective
For the seven programs for which a complete match was observed, all—that is, 100 percent—were defined as successful. For the fifteen programs for which a clear mismatch was observed, none was defined as successful; that is, the home-visiting group did no better than the control in any of these programs. Those that had a complete match for part of the target population or a match of the theory, target population, and components but not an objective of reducing child abuse or neglect had an intermediate success rate of 60 percent. For the programs that did not have a child abuse objective, success was typically based on intermediate outcomes, which have a less certain relationship with child maltreatment (see table 5).
70 L. Segal, R.S. Opie, and K. Dalziel
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5 .
H om
e vi
si ti
n g ,
B al
ti m
or e
(N ai
r et
al .
2 0 0 3 ;
Sc h u le
r et
al .
2 0 0 0 )
4 (d
ru g
u se
) 4
N o
1 ,
2 , 5 ,
6 N
o N
o N
o N
A †N
ar co
ti c,
al co
h ol
, or
m ar
ij u
an a
u se
†M at
er n
al re
sp on
si ve
- n es
s or
in fa
n t
w ar
m th
N o
0
Home-Visiting Programs to Prevent Child Maltreatment 71
6 .
H ea
lt h y
F am
il ie
s A
m er
ic a
(H FA
), H
ea lt
h y
F am
il ie
s N
ew Y
or k
(D u M
on t
et al
. 2 0 0 8 )
3 – 5
4 , 5 ,
6 Y
es 1 ,
2 ,
3 ,
5 N
o Y
es N
o Y
ea r
2 :
†C om
p os
it e
sc or
e se
ri ou
s ab
u se
or n
eg le
ct ,
p re
va le
n ce
, or
fr eq
u en
cy †F
re q u en
cy of
su b
st an
ti at
ed C
P S
re p
or ts
N o
0
3 1 .
N u rs
e V
is it
in g ,
B al
ti m
or e
(B la
ck et
al . 1 9 9 4 )
4 , 5
(p re
n at
al il
li ci
t d ru
g u
se )
6 Y
es 1 ,
2 ,
3 ,
4 , 5 ,
6 Y
es Y
es F u ll
∗ C A
P I
∗ D ru
g fr
ee ∗ O
ve ra
ll h om
e sc
or e
†P SI
Y es
0
H ig
h to
ve ry
h ig
h ri
sk ta
rg et
p op
u la
ti on
3 .
H om
e vi
si ti
n g ,
D en
ve r
(G ra
y et
al .
1 9 7 7 )
3 – 5
4 Y
es 1 ,
2 ,
3 ,
5 , 9
Y es
P ar
t P
ar ti
al ∗ H
os p
it al
at te
n d
an ce
fo r
in ju
ri es
d u e
to ab
n or
m al
p ar
en ti
n g
p ra
ct ic
es
Y es
2
7 .
H om
e vi
si ti
n g ,
Q u ee
n sl
an d ,
A u
st ra
li a
(A rm
st ro
n g
et al
. 1 9 9 9 )
3 – 5
4 Y
es 1 ,
2 ,
3 ,
4 , 5
Y es
P ar
t P
ar ti
al ∗ C
A P
I (b
as el
in e
to 7
m on
th s)
∗ S el
f- re
p or
te d
fe w
er in
ju ri
es an
d b ru
is es
†U se
of h ea
lt h
se rv
ic es
∗ I m
p ro
ve m
en t
in ov
er al
l P
D sc
or e
(P SI
) ∗ H
O M
E (a
ll su
b sc
al es
an d
to ta
l H
O M
E sc
or e)
Y es
0
C on
ti nu
ed
72 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed
A im
: M
at ch
f R
ed u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
8 .
C h il
d P
ar en
t E
n ri
ch m
en t
P ro
je ct
, C
on tr
a C
os ta
C ou
n ty
, C
A (B
ar th
1 9 9 1 )
3 – 5
(m os
t ve
ry h ig
h ri
sk )
6 Y
es 1 ,
2 ,
3 ,
5 N
o Y
es N
o †U
n su
b st
an ti
at ed
re p
or ts
†C A
P I
†Il ln
es s/
E D
vi si
ts
N o
1
9 .
C om
m u n it
y In
fa n
t P
ro je
ct ,
B ou
ld er
, C
O (H
u xl
ey an
d W
ar n er
1 9 9 3 )
3 – 5
3 Y
es 1 ,
2 ,
4 ,
5 , 8
Y es
P ar
t P
ar ti
al ∗ E
m er
g en
cy ro
om u se
∗ C on
fi rm
ed ch
il d
ab u se
ep is
od e
†C h il
d ab
u se
or n
eg le
ct re
p or
t
∗ H O
M E
: to
ta l
H O
M E
sc or
e, +
so m
e su
b sc
or es
†H O
M E
ot h er
su b
sc al
es
Y es
2
1 0 .
E ar
ly In
te rv
en ti
on P
ro g
ra m
, Sa
n B
er n ar
d in
o, C
A (K
on ia
k -G
ri ff
in et
al . 2 0 0 2 )
3 – 5
3 Y
es 1 ,
2 ,
4 ,
5 , 6 ,
8 Y
es P
ar t
P ar
ti al
∗ T ot
al d ay
s h os
p it
al iz
at io
n ∗ N
u m
b er
of ep
is od
es of
h os
p it
al iz
at io
n †T
ot al
n u
m b
er of
E D
vi si
ts ∗ N
ev er
u se
d E
D
∗ N ex
t co
n ce
p ti
on †T
im e
to re
p ea
t p re
g n an
cy ∗ M
ar ij
u an
a u se
†A lc
oh ol
an d
to b
ac co
†H O
M E
sc or
es
Y es
1
1 1 .
H aw
ai i
H ea
lt h y
St ar
t P
ro g
ra m
, H
I (D
u g g an
et al
. 1 9 9 9 )
3 – 5
1 ,
3 ,
4 Y
es 1 ,
2 ,
3 ,
5 , 6
Y es
P ar
t P
ar ti
al †F
re q u en
t an
d se
ve re
se lf
-r ep
or te
d ab
u se
b eh
av io
rs †M
at er
n al
n eg
le ct
†S u
b st
an ti
at ed
C P
S re
p or
t ra
te s
†H os
p it
al iz
at io
n s
†M ot
h er
re li
n q u is
h p
ri m
ar y
ca re
g iv
er
†H O
M E
: ac
ce p
ta n
ce of
ch il
d †P
C -C
T S
†R R
B
N o
1
Home-Visiting Programs to Prevent Child Maltreatment 73
1 2 .
H ea
lt h y
F am
il ie
s A
m er
ic a
(H FA
), H
ea lt
h y
F am
il ie
s A
la sk
a (G
es sn
er 2 0 0 8 )k
3 – 4
3 ,
5 Y
es 1 ,
2 , 3 ,
5 ,
6 N
o Y
es N
o H
FA ve
rs u s
h ig
h ri
sk m
at ch
ed co
n tr
ol †C
P S
re fe
rr al
†S u
b st
an ti
at ed
n eg
le ct
an d
ab u se
N o
2
3 2 .
(H FA
), H
ea lt
h y
F am
il ie
s A
la sk
a (D
u g g an
et al
. 2 0 0 7 )
R C
T k
3 – 4
3 ,
5 Y
es 1 ,
2 , 3 ,
5 ,
6 N
o Y
es N
o †C
P S
R ep
or ts
an d
N eg
le ct
†H os
p it
al iz
at io
n an
d E
D vi
si ts
†B ir
th m
ot h
er re
li n q u is
h ed
h er
ro le
∗ F ew
er ex
tr em
el y
p oo
r to
ta l
H O
M E
sc or
es †G
ro u p
sc or
es fo
r H
O M
E su
b sc
al e
†S u b st
an ce
ab u se
†T ot
al P
SI sc
or es
N o
0
1 3 .
H om
e vi
si ti
n g ,
W es
te rn
A u
st ra
li a
(Q u in
li va
n ,
B ox
, an
d E
va n s
2 0 0 3 )
3 – 5
1 ,
2 , 3
Y es
1 ,
2 , 3 ,
5 Y
es P
ar t
P ar
ti al
∗ N eo
n at
al ad
ve rs
e ou
tc om
e (d
ea th
s, in
ju ry
, n on
-v ol
u n ta
ry fo
st er
ca re
p la
ce m
en t)
Y es
0
C on
ti nu
ed
74 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed
A im
: M
at ch
f R
ed u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
1 4
. E
ar ly
St ar
t, N
ew Z
ea la
n d
(F er
g u ss
on et
al . 2 0 0 5 )
3 – 5
1 ,
3 Y
es 1 ,
2 , 3 ,
6 Y
es P
ar t
P ar
ti al
∗ S ev
er e
p h
ys ic
al as
sa u
lt †R
at es
of ag
en cy
co n ta
ct fo
r ch
il d
ab u se
an d
n eg
le ct
∗ F ew
er h os
p it
al at
te n
d an
ce s
fo r
in ju
ry
∗ N on
p u n it
iv e
p ar
en ti
n g
†N ex
t p re
g n an
cy †A
lc oh
ol /
su b
st an
ce u se
†L if
e st
re ss
es ,
fa m
il y
fu n ct
io n in
g
Y es
1
1 5 .
F am
il y
P ar
tn er
sh ip
M od
el ,
tw o
co u n ti
es in
th e
U K
(B ar
lo w
et al
. 2 0 0 7 )
3 – 5
(6 5 %
m en
ta l
h ea
lt h , 3 4 %
D V
)
3 Y
es 1
N o
P ar
t N
o †H
os p
it al
iz at
io n
at 6
m on
th s
†C h il
d p ro
te ct
io n
re g
is te
r or
ca re
p ro
ce ed
in g s
†C h
il d
re n
re m
ov ed
fr om
h om
e
†H O
M E
∗ ( M
C I–
C A
R E
In d ex
) se
n si
ti ve
to b ab
ie s,
w h o
w er
e m
or e
co op
er at
iv e
N o
0
1 6 a
N u rs
e F am
il y
P ar
tn er
sh ip
(N F
P )
N u
rs e
h om
e- vi
si ti
n g ,
D en
ve r
(O ld
s 2 0 0 2 )
2 – 5
(l ow
in co
m e
+/ −
D V
) 1
, 2
, 4
N o
1 ,
2 , 5
Y es
Y es
P ar
ti al
∗ A n
y d om
es ti
c vi
ol en
ce
∗ T im
in g
n ex
t b ir
th s
†M ar
ij u an
a †A
lc oh
ol u se
†H O
M E
sc or
e
Y es
1
Home-Visiting Programs to Prevent Child Maltreatment 75
1 6 b .
(N F P
) P
ar ap
ro fe
ss io
n al
h om
e vi
si ti
n g ,
D en
ve r
(O ld
s 2 0 0 2 )
2 – 5
1 ,
2 ,
4 N
o 1 ,
2 ,
5 Y
es Y
es P
ar ti
al †A
n y
d om
es ti
c vi
ol en
ce †S
u b se
q u en
t p re
g n an
ci es
an d
b ir
th s
†M ar
ij u an
a/ al
co h ol
u se
†H O
M E
sc or
e ∗ M
or e
se n
si ti
ve an
d re
sp on
si ve
in te
ra ct
io n
N o
1
1 7 .
P ar
en ti
n g
on E
d g e,
G A
(M u ls
ow an
d M
u rr
ay 1 9 9 6 )
3 – 4
6 Y
es 1 ,
2 N
o Y
es N
o †In
ci d en
ce of
ab u se
or n eg
le ct
re p
or ts
†N re
p or
ts p
er m
ot h
er
N o
2
1 8 .
L in
k ag
es fo
r P
re ve
n ti
on P
ro je
ct ,
D u rh
am ,
N C
(M ar
g ol
is et
al .
2 0 0 1 )
3 – 4
6 N
o 1 ,
2 ,
5 N
o Y
es N
o †S
u b
st an
ti at
ed n eg
le ct
†S u
b st
an ti
at ed
ca se
s of
ab u
se †E
D or
h os
p it
al iz
ed
†D ru
g or
al co
h ol
u se
∗ 3 /5
sa fe
ty m
ea su
re s
ch il
d h
om e
en vi
ro n m
en t
∗ H O
M E
sc al
e
N o
2
3 3 .
A d d it
io n
of in
te n si
ve h om
e vi
si ti
n g
to (C
A M
P ),
D en
ve r
(S te
ve n s-
Si m
on ,
N el
li g an
, an
d K
el ly
2 0 0 1 )
4 , 5
4 Y
es 1 ,
2 ,
3 ,
4 ,
5 Y
es P
ar t
P ar
ti al
†A ll
m al
tr ea
tm en
t, (p
h ys
ic al
ab u se
, n eg
le ct
, ab
an d on
m en
t)
†R ep
ea t
p re
g n an
cy ra
te N
o 1
C on
ti nu
ed
76 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed
A im
: M
at ch
f R
ed u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
3 4 .
H om
e vi
si ti
n g ,
P h il
ad el
p h ia
, (M
ar ce
n k o
an d
Sp en
ce 1 9 9 4 )
3 – 5
(h ig
h -r
is k
fo r
p sy
ch os
oc ia
l re
as on
s)
3 Y
es 1
, 2
, 3
, 4
, 5
, 6
Y es
P ar
t P
ar ti
al †P
la ce
d in
ou t-
of -h
om e
ca re
†H om
e In
ve n
to ry
N o
1
M od
er at
e- ri
sk ta
rg et
p op
u la
ti on
1 9 .
C h il
d an
d Y
ou th
P ro
g ra
m M
od u
le ,
B al
ti m
or e
(H ar
d y
an d
St re
et t
1 9 8 9 )
2 ,
3 1
Y es
1 ,
2 , 5
Y es
P ar
t P
ar ti
al ∗ C
h il
d ab
u se
an d
n eg
le ct
∗ I n
p at
ie n
t ca
re ∗ C
li n ic
or E
D vi
si t
fo r
fa ll
or h ea
d in
ju ry
Y es
1
2 0 .
(N F P
), O
ld s
N u
rs e
F am
il y
p ar
tn er
sh ip
, M
em p h is
(K it
zm an
et al
. 1 9 9 7 )
3 6
N o
1 ,
5 , 6
, 7
Y es
Y es
P ar
ti al
F ir
st 2
ye ar
s: ∗ I
n ju
ri es
an d
in g es
ti on
s †E
D vi
si ts
†H os
p it
al iz
at io
n s
∗ L es
s h
os p
it al
iz at
io n
fo r
in ju
ry an
d in
g es
ti on
B ir
th to
ag e
9 :
∗ D ea
th
F ir
st 2
ye ar
s: ∗ S
ec on
d p re
g n an
cy an
d su
b se
q u en
t li
ve b ir
th s
∗ H O
M E
sc or
es B
ir th
to ag
e 9 :
∗ S u b se
q u en
t b ir
th s
∗ S u
b st
an ce
u se
Y es
1
2 6 a.
(N F P
), O
ld s
N u
rs e
F am
il y
P ar
tn er
sh ip
, p re
- an
d p os
tn at
al ,
E lm
ir a,
N Y
(O ld
s et
al .
1 9 9 7 )
2 – 3
1 ,
2 ,
3 Y
es 1 ,
2 , 5
Y es
Y es
Y es
2 5
to 5 0
m on
th s:
†N ew
ca se
s ch
il d
ab u se
an d
n eg
le ct
∗ I n ju
ri es
an d
in g es
ti on
s ∗ E
D vi
si ts
†H os
p it
al iz
at io
n s
1 5
ye ar
s: ∗ C
h il
d ab
u se
an d
n eg
le ct
su b
st an
ti at
io n
s
2 5
to 5 0
m on
th s:
†H O
M E
to ta
l sc
or e
1 5
ye ar
s: †N
ex t
p re
g n an
cy an
d b ir
th †S
u b
st an
ce u se
Y es
0
Home-Visiting Programs to Prevent Child Maltreatment 77
2 6 b .
(N F P
) O
ld s
N u rs
e F am
il y
P ar
tn er
sh ip
, p
re n
at al
, E
lm ir
a, N
Y (O
ld s
et al
. 1 9 9 7 )
2 – 3
1 ,
2 ,
3 Y
es 1 , 2 ,
5 Y
es Y
es Y
es 2 5
to 5 0
m on
th s:
†N ew
ch il
d ab
u se
an d
n eg
le ct
ca se
s ∗ I
n ju
ri es
an d
in g es
ti on
s ∗ E
D vi
si ts
†H os
p it
al iz
at io
n s
1 5
ye ar
s: ∗ C
h il
d ab
u se
an d
n eg
le ct
su b
st an
ti at
io n
s
2 5
to 5 0
m on
th s:
†H O
M E
to ta
l sc
or e
1 5
ye ar
s: †N
ex t
p re
g n an
cy an
d b ir
th s
†S u
b st
an ce
u se
Y es
0
2 1 .
T h re
e G
en er
at io
n St
u d
y, B
al ti
m or
e (B
la ck
et al
.2 0 0 6 )
3 3
N o
1 , 2
, 3
, 6
, 7
Y es
Y es
P ar
ti al
N A
∗ E xt
en d
ti m
e to
se co
n d
b ir
th Y
es 0
2 2 .
P ar
en t
T ra
in in
g b y
C E
T A
ai d e,
M ia
m i
(F ie
ld et
al . 1 9 8 2 )
3 4
N o
1 , 3
Y es
Y es
P ar
ti al
N A
∗ R ep
ea t
p re
g n
an cy
Y es
1
2 3 .
C om
p re
h en
si ve
C h il
d D
ev el
op m
en t
P ro
g ra
m , U
SA (S
t. P
ie rr
e an
d L ay
ze r
1 9 9 9 )
2 – 3
6 N
o 1 ,
2 ,
4 ,
5 ,
6 ,
7 ,
8 Y
es Y
es P
ar ti
al N
A †H
O M
E sc
or e
†P C
I N
o 2
C on
ti nu
ed
78 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed
A im
: M
at ch
f R
ed u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
2 4 .
H om
e vi
si ti
n g ,
C O
(D aw
so n ,
va n
D oo
rn in
ck ,
an d
R ob
in so
n 1 9 8 9 )
2 – 3
3 N
o 1 ,
2 ,
5 ,
7 Y
es Y
es P
ar ti
al †C
h il
d ab
u se
an d
n eg
le ct
re p
or ts
†A cc
id en
ts or
h os
p it
al iz
at io
n
†S u b se
q u en
t ch
il d b ea
ri n g
N o
2
2 5
a. P
ar en
ts as
T ea
ch er
s (P
A T
) P
ro g
ra m
— T
ee n
s C
om b in
ed =
b as
ic +
ca se
m an
ag em
en t,
C A
(W ag
n er
an d
C la
yt on
1 9 9 9 )
2 – 3
1 ,
6 Y
es 1 , 2 ,
3 ,
5 ,
7 , 8
Y es
Y es
Y es
∗ O p
en ed
ca se
s of
ch il
d ab
u se
or n eg
le ct
†C h il
d ab
u se
†C h
il d
tr ea
te d
fo r
in ju
ry
†T ot
al H
O M
E sc
or e
Y es
1
2 5 b .
P ar
en ts
as T
ea ch
er s
(P A
T )
P ro
g ra
m –
b as
ic p
ro g
ra m
, C
A (W
ag n er
an d
C la
yt on
1 9 9 9 )
2 – 3
1 N
o 1 ,
2 ,
3 ,
5 Y
es Y
es P
ar ti
al †T
re at
ed fo
r in
ju ry
†E D
vi si
ts †T
ot al
H O
M E
sc or
e N
o 1
2 5
c. P
ar en
ts as
T ea
ch er
s (P
A T
) P
ro g
ra m
, T
ee n
P A
T (b
as ic
te en
ag e
p ro
g ra
m ),
C A
(W ag
n er
an d
C la
yt on
1 9 9 9 )
2 – 3
(t ee
n ag
e p
ar en
ts )
1 N
o 1 ,
2 ,
3 ,
5 Y
es Y
es P
ar ti
al †O
p en
ed ca
se s
of ch
il d
ab u se
or n eg
le ct
†C h il
d ab
u se
†C h
il d
tr ea
te d
fo r
in ju
ry
†T ot
al H
O M
E sc
or e
N o
1
Home-Visiting Programs to Prevent Child Maltreatment 79
2 7 .
So ci
al Su
p p or
t an
d F am
il y
H ea
lt h
St u
d y,
L on
d on
(W ig
g in
s et
al . 2 0 0 4 )
2 –
3 3
N o
1 ,
2 Y
es Y
es P
ar ti
al †in
ju ri
es re
q u ir
in g
m ed
ic al
at te
n ti
on †m
at er
n al
sm ok
in g
N o
1
2 8 .
H om
e vi
si ti
n g ,
Q u eb
ec ,
C an
ad a
(I n
fa n
te -R
iv ar
d et
al . 1 9 8 9 )
2 – 3
1 N
o 1 ,
4 Y
es P
ar t
N o
†H os
p it
al iz
at io
n †T
ot al
H O
M E
sc or
e ‡a
n d
∗ H O
M E
sc or
e co
m p
on en
ts
N o
1
2 9
a. P
os tn
at al
h om
e vi
si ti
n g ,
M on
tr ea
l (L
ar so
n 1 9 8 0 )
2 ,
3 4
N o
1 ,
2 ,
4 Y
es Y
es P
ar ti
al ∗ A
cc id
en t
ra te
@ 1 2
m on
th s
†A cc
id en
t ra
te @
6 an
d 1 8
m on
th s
†R at
e of
E D
vi si
ts ov
er 1 8
m on
th s
†H O
M E
N o
2
2 9 b .
P re
an d
p os
tn at
al vi
si ti
n g ,
M on
tr ea
l (L
ar so
n 1 9 8 0 )
2 ,
3 4
N o
1 ,
2 ,
4 Y
es Y
es P
ar ti
al ∗ A
cc id
en t
ra te
@ 6
m on
th s
∗ A cc
id en
t ra
te @
1 2 m
on th
s †A
cc id
en t
ra te
@ 1 8 m
on th
s †R
at e
of E
D vi
si ts
ov er
1 8
m on
th s
∗ H O
M E
sc or
e Y
es 2
C on
ti nu
ed
80 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed A
im :
M at
ch f
R ed
u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
3 5
. R
E A
C H
-F u
tu re
s p
ro g
ra m
, C
h ic
ag o
(N or
r et
al . 2 0 0 3 )
3 2 ,
6 N
o 1
N o
Y es
N o
†H ea
lt h
p ro
b le
m va
ri ab
le s
†F or
m al
or in
fo rm
al fo
st er
ca re
†R ep
ea t
p re
g n an
cy †H
O M
E : p ar
en ti
n g
at ti
tu d
es ∗ H
O M
E :
ap p ro
p ri
at e
p la
y m
at er
ia ls
†O th
er H
O M
E su
b sc
al es
N o
1
3 6 .
N ew
M ex
ic o
an d
A ri
zo n a
H FA
(B ar
lo w
et al
. 2 0 0 6 )
2 – 3
(A m
er ic
an In
d ia
n ad
ol es
ce n
ts )
2 N
o 1
N o
Y es
N o
N A
†L ow
er d ru
g u se
b u t
n o
d if
fe re
n ce
N o
1
3 7
a. E
ar ly
H ea
d St
ar t,
h om
e- b as
ed on
ly ,
1 7
si te
s ac
ro ss
U SA
(L ov
e et
al . 2 0 0 5 )
2 –
3 1
, 2
N o
1 , 2 ,
5 ,
8 , 1 0
Y es
Y es
P ar
ti al
N A
∗ H O
M E
sc or
e ∗ P
C I
Y es
0
3 7
b .
E ar
ly H
ea d
St ar
t, m
ix ed
(h om
e- +
ce n
te r-
b as
ed ),
1 7
si te
s ac
ro ss
U SA
(L ov
e et
al . 2 0 0 5 )
2 –
3 1
, 2
N o
1 , 2 ,
5 ,
8 , 1 0
Y es
Y es
P ar
ti al
N A
∗ H O
M E
sc or
e †P
C I
Y es
0
G en
er al
p op
u la
ti on
+ lo
w to
m ed
iu m
ri sk
3 0 .
H om
e vi
si ti
n g ,
G re
en sb
or o,
N C
(S ie
g el
et al
. 1 9 8 0 )
1 – 3
4 Y
es 1 , 2 ,
5 ,
9 N
o P
ar ti
al N
o †R
ep or
ts of
ab u
se an
d n eg
le ct
†H os
p it
al iz
at io
n an
d E
D vi
si ts
†M II
: th
re e
at ta
ch m
en t
m ea
su re
s
N o
2
Home-Visiting Programs to Prevent Child Maltreatment 81
3 8 .
H ea
lt h y
St ep
s fo
r Y
ou n g
C h il
d re
n P
ro g
ra m
(H S)
,k
P ac
if ic
N or
th w
es t
(U SA
an d
C an
ad a)
(J oh
n st
on et
al .
2 0 0 6 )
1 5
N o
1 , 2
N o
N o
N o
†E xp
os u
re to
si g n if
ic an
t p
h ys
ic al
d om
es ti
c vi
ol en
ce
†U se
of il
li ci
t d ru
g s
†S m
ok in
g ∗ I
n ju
ry co
n tr
ol b eh
av io
rs
N o
2
3 9 .
H om
e vi
si ti
n g ,
D am
as cu
s, Sy
ri a
(B as
h ou
r et
al .
2 0 0 8 )
1 2
N o
1 , 2
, 5
, 6
Y es
Y es
P ar
ti al
†S ee
k in
g m
ed ic
al tr
ea tm
en t
N o
0
4 0 .
C og
n it
iv e
ex te
n si
on of
th e
H ea
lt h
y St
ar t
P ro
g ra
m , Sa
n ta
B ar
b ar
a, C
A (B
u g en
ta l
an d
Sc h w
ar tz
2 0 0 9 )
1 ,
2 (c h il
d re
n b or
n at
m ed
ic al
ri sk
)
4 Y
es 1
, 4
, 5
, 6
Y es
P ar
t P
ar ti
al ∗ I
n ju
ry †P
h ys
ic al
ab u
se
∗ C T
S P
C : co
rp or
al p u n is
h m
en t
∗ H om
e sa
fe ty
Y es
1
4 1
. H
om e
vi si
t- in
g ,Y
am an
as h i,
Ja p an
(C h en
g et
al . 2 0 0 7 )
1 4
N o
1 , 2
, 3
, 4
, 6
Y es
N o
N o
N A
P IR
G A
S ∗ R
el at
io n sh
ip g ro
u p
†a d
ap te
d re
la ti
on sh
ip g ro
u p
N o
1
C on
ti nu
ed
82 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
4 —
C on
ti nu
ed
A im
: M
at ch
f R
ed u ce
C h il
d T
h eo
ry T
h eo
ry F u ll
/ P
ot en
ti al
P ro
g ra
m , L
oc at
io n
T ar
g et
C or
e A
b u
se P
ro g
ra m
an d
an d
P ar
ti al
/ P
ri m
ar y
O th
er Su
cc es
s fo
r (k
ey re
fe re
n ce
)a P
op u la
ti on
b T
h eo
ry c
(y es
/n o)
d C
om p on
en ts
e C
om p
on en
ts P
op u
la ti
on N
o M
at ch
O u
tc om
eg O
u tc
om es
h (y
es /n
o) i
B ia
sj
4 2 .
M od
if ie
d M
ot h er
-I n fa
n t
T ra
n sa
ct io
n P
ro g
ra m
(M IT
P ),
N or
w ay
(K aa
re se
n et
al .
2 0 0 6 )
2 ,
3 (b ir
th w
ei g h t
b el
ow 2 0 0 0 g )
4 N
o 1 ,
2 , 3
Y es
Y es
P ar
ti al
N A
P SI
: ∗ T
ot al
st re
ss 6
, 1
2 m
on th
s, m
ot h
er ;
1 2
m on
th s,
fa th
er ∗ C
h il
d d om
ai n ,
6 m
on th
s, m
ot h
er ;
1 2
m on
th s,
fa th
er ∗ P
ar en
t d om
ai n ,
6 m
on th
s, m
ot h
er ;
1 2
m on
th s
fa th
er
Y es
0
4 3 .
R E
ST , U
SA (K
ee fe
et al
.2 0 0 6 )
1 ,
2 (i n fa
n ts
w it
h .
ir ri
ta b il
it y
or co
li c)
3 ,
2 N
o 1 ,
2 ,
3 ,
4 ,
5 Y
es Y
es P
ar ti
al N
A ∗ P
SI to
ta l
sc or
e @
8 w
ee k s
∗ P -C
D I
su b
sc al
e †O
th er
tw o
su b
sc al
es :
p ar
en ta
l d
is tr
es s
an d
d if
fi cu
lt ch
il d
Y es
1
4 4 .
H om
e vi
si ti
n g ,
O n ta
ri o,
C an
ad a
(S te
el O
’C on
n or
et al
. 2 0 0 3 )
1 2
N o
2 ,
5 Y
es Y
es P
ar ti
al †H
ea lt
h p
ro b
le m
s †N
u m
b er
of E
D vi
si ts
†N u
m b
er of
h os
p it
al ad
m is
si on
s
N o
2
Home-Visiting Programs to Prevent Child Maltreatment 83
N ot
es :
a D ef
in ed
in te
xt .
b T
ar g
et p op
u la
ti on
d ef
in ed
in ta
b le
2 .
c C or
e th
eo ry
d ef
in ed
in ta
b le
3 .
d A
im as
st at
ed in
th e
or ig
in al
m an
u sc
ri p ts
re p or
ti n g
on ea
ch p ro
g ra
m .
e C om
p on
en ts
d ef
in ed
in ta
b le
3 .
f M at
ch d
ef in
ed in
te xt
in M
et h od
s. g P
ri m
ar y
ou tc
om e
is a
d ir
ec t
or su
rr og
at e
ch il
d ab
u se
ou tc
om e.
T h e
ou tc
om e
m ea
su re
sy m
b ol
s ar
e as
fo ll
ow s:
∗ : In
te rv
en ti
on g ro
u p
st at
is ti
ca ll
y si
g n if
ic an
tl y
b et
te r
th an
co n tr
ol g
ro u p .
†: N
o st
at is
ti ca
ll y
si g n if
ic an
t d
if fe
re n ce
b et
w ee
n in
te rv
en ti
on an
d co
n tr
ol g
ro u p .
‡: In
te rv
en ti
on g ro
u p
st at
is ti
ca ll
y si
g n if
ic an
tl y
w or
se th
an co
n tr
ol g
ro u p .
h O
th er
ou tc
om es
: R
is k
fa ct
or s
fo r
ch il
d ab
u se
an d
n eg
le ct
. O
u tc
om e
sy m
b ol
s sa
m e
as in
n ot
e g .
i S u cc
es s
d ef
in ed
in te
xt ,
in M
et h od
s. j P
ot en
ti al
fo r
b ia
s (s
ee u n d er
M et
h od
s Q
u al
it y
A ss
es sm
en t
li st
of p
ot en
ti al
s fo
r b ia
s) .
0 =
St u d y
w it
h ze
ro or
on e
p ot
en ti
al s
fo r
b ia
s (c
la ss
if ie
d as
g oo
d q u al
it y)
. 1
= St
u d y
w it
h tw
o p
ot en
ti al
s fo
r b ia
s (c
la ss
if ie
d as
ad eq
u at
e q u al
it y)
. 2
= St
u d
y w
it h
th re
e +
p ot
en ti
al s
fo r
b ia
s (c
la ss
if ie
d as
p oo
r q u al
it y)
. k B
ot h
p ro
g ra
m s
1 2
an d
3 2
ar e
H ea
lt h y
F am
il ie
s A
la sk
a b u t
ev al
u at
ed th
ro u g h
d if
fe re
n t
m et
h od
s, on
e th
ro u g h
d at
a li
n k ag
e an
d m
at ch
ed d es
ig n ,
an d
th e
ot h er
an R
C T
, co
ve ri
n g
so m
ew h at
d if
fe re
n t
p op
u la
ti on
s. P
ro g ra
m 3 8 ,
H ea
lt h y
St ep
s, w
as th
e on
ly p
ro g ra
m w
h os
e p
ro g ra
m co
m p on
en ts
ot h er
th an
h om
e vi
si ti
n g
co u
ld p la
y a
la rg
er ro
le th
an th
e h
om e
vi si
ts (o
f w
h ic
h th
er e
w er
e on
ly th
re e)
. N
A : N
o d
ir ec
t ch
il d
m al
tr ea
tm en
t ou
tc om
es re
p or
te d .
C A
P I:
C h
il d
A b
u se
P ot
en ti
al In
ve n
to ry
. H
O M
E :
T h e
H om
e O
b se
rv at
io n
fo r
M ea
su re
m en
t of
th e
E n vi
ro n m
en t
in ve
n to
ry .
P SI
: P
ar en
ti n g
St re
ss In
d ex
. D
V :
D om
es ti
c V
io le
n ce
. M
C I-
C A
R E
: M
at er
n al
C h
il d
In te
ra ct
io n
-C A
R E
In d
ex .
R R
B : R
ap id
R ep
ea t
B ir
th s.
P IR
G A
S: P
ar en
t- In
fa n t
R el
at io
n sh
ip G
lo b al
A ss
es sm
en t
Sc al
e. M
II : M
ot h
er -I
n fa
n t
In te
ra ct
io n
. P
C I:
P ar
en t
C h il
d In
te ra
ct io
n Sc
or e.
C T
S- P
C :
P ar
en t
C h il
d C
on fl
ic t
T ac
ti cs
Sc al
e.
84 L. Segal, R.S. Opie, and K. Dalziel
T A
B L E
5 “M
at ch
” an
d Su
cc es
s of
H om
e V
is it
in g
fo r
F if
ty -T
w o
In cl
u d
ed P
ro g
ra m
s
P er
fo rm
an ce
of H
om e
V is
it in
g Su
cc es
sf u
la N
ot Su
cc es
sf u
la T
ot al
s M
at ch
N u m
b er
(% )
P ro
g ra
m s
N u m
b er
(% )
P ro
g ra
m s
N u m
b er
(% )
F u
ll m
at ch
: th
eo ry
, co
m p on
en ts
, p op
u la
ti on
, ch
il d
ab u
se ob
je ct
iv e
7 (1
0 0 )
1 ,
2 ,
2 5 a,
2 6 a,
2 6 b ,
3 1 ,
4 5 a
0 (0
) 7
(1 3 .5
)
P ar
ti al
m at
ch :
1 8
(6 0 )
1 2
(4 0 )
3 0
(5 7 .7
) th
eo ry
, co
m p
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Home-Visiting Programs to Prevent Child Maltreatment 85
TABLE 6 Relationship between Program Success and Full, Partial, or No Match for
Theory, Components, Population, and Child Abuse Objective
Successful Not Successful Fisher’s Exact p (n = 25) (n = 27) Value (two sided)
Full match (n = 7) Yes 7 0 No 18 27 0.004a
Partial match (n = 30) Yes 18 12 No 7 15 0.055
No match (n = 15) Yes 0 15 No 25 12 <0.0001a
Note: aStatistically significant (p < 0.05).
Statistical Analysis
We used Fisher’s exact test, owing to our small sample size and the small number of observations (<5) occurring in some cells. The data analysis was consistent with the preceding descriptive analysis, with statistically significant (at p < 0.05) associations found between program success and full, partial, and no match (see table 6).
Discussion
Key Findings
We found that a match between the underpinning theory and program components together with a match between the theory and target pop- ulation did predict program success. This result is consistent with our hypothesis, that the combination of program theory, program compo- nents, and target population is critical. In line with other reviewers, we failed to find any single program component, such as type of profes- sional, timing of intervention, or target population that predicted the success of home visiting (see table 4).
Limitations
Our model did not capture all aspects of program delivery that may be important to program success, such as fidelity in program delivery,
86 L. Segal, R.S. Opie, and K. Dalziel
program intensity and resourcing, quality of management and staff training, and staff values and approach to their work. However, finding a clear relationship between theory, program components, population, and objective despite this gap might be seen as enhancing the strength of this finding.
Our classification of programs according to a defined theory and, to some extent, program components, lacks precision because of un- clear reporting. But two reviewers independently assessed all programs in this regard, with a third reviewer brought in when differences emerged. Defining the target populations tends to be a simpler task, although we often found a difference between the initial description of the target population and the characteristics of persons enrolled in the program.
A dichotomous classification of the performance of individual pro- grams into success or failure necessarily represents a simplification of something that is quite complex. However, we suggest that it is de- sirable to report on whether or not an individual program worked—or at least to make clear if this cannot be established with certainty. This classification is not a simple matter of looking at statistical signifi- cance but of balancing often divergent results across possibly dozens of outcomes, measured at different time points in various subpopulations. Greater attention to this issue in original study reports and by reviewers is warranted.
There is also debate about the outcome measures themselves. For instance, it is argued that home visiting may increase child abuse re- ports, owing to surveillance bias, whereas self-report also suffers from incompleteness and possible bias. The definition and reporting of child maltreatment are also known to differ across jurisdictions and across countries.
Further exploration of the value of the proposed hierarchy in outcome measures would be useful, to explore more fully how to give the greatest weight to the more robust, objective, and meaningful measures, such as childhood injury or failure to thrive resulting in a hospital visit or admission. We have made a start by describing a clear process for classifying programs as successful, which uses a two-step hierarchy that incorporates in a stepwise fashion both direct and indirect child abuse and neglect outcomes.
As we noted, our measure of success says nothing about value for money, which we have explored elsewhere through a comparative
Home-Visiting Programs to Prevent Child Maltreatment 87
cost-effectiveness analysis in those programs reporting a direct child abuse outcome (Dalziel and Segal forthcoming).
Policy Implications for Home Visiting
This review has a number of key messages for policymakers seeking to implement programs to reduce rates of child maltreatment in vul- nerable families. Because it is known that neonate/infant home-visiting programs are not always successful, care must be taken in their design and implementation. Our study suggests that a way to maximize success is through fidelity to a program logic model. Specifically, in designing a home-visiting program, it is important to be clear about the objective (in our review, to reduce child maltreatment) to ensure a sound under- standing of the client population and its needs and strengths (the nature of the threats to a safe and nurturing environment), the associated theory or mechanism of change, and the program components that can deliver the change mechanism. Adequate resources and an appropriately skilled team with access to requisite training and quality assurance processes are also crucial. We note that if there is little understanding about how to work with a particular population to achieve a safe and nurturing en- vironment, then it is unlikely that a successful home-visiting program can be developed and delivered.
Even though manualized programs can support fidelity in program delivery, adopting “off-the-shelf program models” is no guarantee of success, particularly if they are not designed for the target population and their specific circumstances.
Conclusion
Our research supports the value of a program logic approach, incor- porating a theory (or mechanism) of action, for the review of complex human services interventions to yield new insights. We postulate that the approach will have wide applicability to a range of contexts, partic- ularly for assessing the performance of multifaceted interventions that can target different populations.
A program logic–based systematic review can enhance policy rel- evance and will be most valuable to policymakers seeking to design and implement effective and efficient programs for improving societal
88 L. Segal, R.S. Opie, and K. Dalziel
well-being, to ensure that scarce resources are not wasted, and to offer the best prospect of improving outcomes for vulnerable families.
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96 L. Segal, R.S. Opie, and K. Dalziel
World Health Organization, jointly sponsored by the WHO and the International Society for the Prevention of Child Abuse and Neglect.
WHO (World Health Organization). 2010. World Health Orga- nization Fact Sheet no. 150: Child Maltreatment. Available at http://www.who.int/mediacentre/factsheets/fs150/en/ (accessed August 9, 2010).
WHO (World Health Organization). 2011. Georgia’s Early Child- hood Comprehensive System (GECCS) Implementation Project, Children’s Trust Fund of Washington. Available at http://www. familytreemd.org/files/414_ChildAbusePrevTheoryofChangeLogic Model.pdf (accessed March 10, 2011).
Wiggins, M., A. Oakley, I. Roberts, H. Turner, L. Rajan, H. Austerberry, R. Mujica, and M. Mugford. 2004. The Social Support and Family Health Study: A Randomised Controlled Trial and Economic Eval- uation of Two Alternative Forms of Postnatal Support for Mothers Living in Disadvantaged Inner-City Areas. Health Technology Assess- ment 8(32):iii–107.
Wiggins, M., A. Oakley, I. Roberts, H. Turner, L. Rajan, H. Auster- berry, R. Mujica, M. Mugford, and M. Barker. 2005. Postnatal Support for Mothers Living in Disadvantaged Inner City Areas: A Randomised Controlled Trial. Journal of Epidemiology and Community Health 59(4):288–95.
Acknowledgments: This study was funded by the Australian Research Council (ARC) as a linkage grant, ID LP0883743, from 2008 to 2012. The funding source played no role in the study’s design, conduct, interpretation, writing, or the decision to submit it for publication. The authors declare that they have no conflicts of interest.
We would also like to acknowledge the very generous and detailed comments from Karen Monsen and two anonymous reviewers that have contributed to the clarity of our argument.
Home-Visiting Programs to Prevent Child Maltreatment 97
APPENDIX A
Search Results and Inclusion/Exclusion
Titles & Abstracts identified + screened: • Databases (RCTs & Reviews) 1557 hits • Key Journals 625 hits • Key Author 61 hits (Medline Only) • Bibliographies
Full text retrieved and assessed: • Systematic reviews 40 • RCTs and Controlled Trials 143
Included: RCTs and controlled studies 67 papers covering 52 distinct programs
Excluded: • not controlled study (n = 25) • not home visiting (n = 17) • not mother/child at risk of abuse or
neglect (n = 4) • (n 8
Excluded: • not systematic review, meta-analysis, or
controlled trial • not home visiting • not child at risk of abuse or neglect • duplicates
wron outcomes = 1 )g
98 L. Segal, R.S. Opie, and K. Dalziel
A P
P E
N D
IX B
H om
e- V
is it
in g
P ro
g ra
m s:
K ey
R ef
er en
ce s
P ro
g ra
m N
u m
b er
, N
am e,
an d
L oc
at io
n R
ef er
en ce
1 .
Sp ec
ia l
F am
il ie
s C
ar e
P ro
je ct
, M
in n
es ot
a V
el as
q u
ez , J.
, M
. C
h ri
st en
se n
, an
d B
.L .
Sc h
om m
er .
1 9
8 4
. P
ar t
II : In
te n
si ve
Se rv
ic es
H el
p P
re ve
n t
C h
il d
A b
u se
. A
m er
ic an
Jo ur
na l
of M
at er
na l
C hi
ld N
ur si
ng 9
(2 ):
1 3 – 1 1 7 .
C h
ri st
en se
n , M
.L .,
B .L
. Sc
h om
m er
, an
d J.
V el
as q
u ez
. 1
9 8
4 .
P ar
t I:
A n
In te
rd is
ci p
li n
ar y
A p
p ro
ac h
to P
re ve
n ti
n g
C h
il d
A b
u se
. A
m er
ic an
Jo ur
na l
of M
at er
na l
C hi
ld N
ur si
ng 9
(2 ):
1 0 8 – 1 2 .
2 .
P ro
je ct
1 2
-W ay
s, Il
li n
oi s
L u
tz k
er ,
J. R
., an
d J.
M . R
ic e.
1 9
8 4
. P
ro je
ct 1
2 -W
ay s:
M ea
su ri
n g
O u
tc om
e of
a L ar
g e
In -H
om e
Se rv
ic e
fo r
T re
at m
en t
an d
P re
ve n
ti on
of C
h il
d A
b u
se an
d N
eg le
ct . C
hi ld
A bu
se &
N eg
le ct
8 (4
): 5 1 9 – 2 4 .
3 .
H ea
lt h
y F am
il ie
s, N
ew Y
or k
D u
M on
t, K
., S.
M it
ch el
l- H
er zf
el d
, R
. G
re en
e, E
. L
ee , A
. L
ow en
fe ls
, M
. R
od ri
g u
ez ,
an d
V .
D or
ab aw
il a.
2 0
0 8
. H
ea lt
h y
F am
il ie
s N
ew Y
or k
(H F
N Y
) R
an d
om iz
ed T
ri al
: E
ff ec
ts on
E ar
ly C
h il
d A
b u
se an
d N
eg le
ct . C
hi ld
A bu
se &
N eg
le ct
3 2
(3 ):
2 9 5 – 3 1 5 .
4 .
H om
e vi
si ti
n g
, P
er th
, W
es te
rn A
u st
ra li
a B
ar tu
, A
., J.
Sh ar
p ,
J. L u d lo
w ,
an d
D .A
. D
oh er
ty .
2 0 0 6 .
P os
tn at
al H
om e
V is
it in
g fo
r Il
li ci
t D
ru g
-U si
n g
M ot
h er
s an
d T
h ei
r In
fa n
ts : A
R an
d om
is ed
C on
tr ol
le d
T ri
al .
A us
tr al
ia n
an d
N ew
Z ea
la nd
Jo ur
na l
of O
bs te
tr ic
s an
d G
yn ae
co lo
gy 4 6
(5 ):
4 1 9 – 2 6 .
5 .
H om
e vi
si ti
n g
, B
al ti
m or
e Sc
h u
le r,
M .E
., P.
N ai
r, M
.M .
B la
ck , an
d L
. K
et ti
n g
er . 2
0 0
0 .
M ot
h er
-I n
fa n
t In
te ra
ct io
n :
E ff
ec ts
of a
H om
e In
te rv
en ti
on an
d O
n g
oi n
g M
at er
n al
D ru
g U
se . Jo
ur na
l of
C li
ni ca
l C
hi ld
P sy
ch ol
og y
2 9
(3 ):
4 2 4 – 3 1 .
N ai
r, P.
, M
.E .
Sc h
u le
r, M
.M .
B la
ck , L .
K et
ti n
g er
, an
d D
. H
ar ri
n g
to n
. 2
0 0
3 .
C u
m u
la ti
ve E
n vi
ro n
m en
ta l
R is
k in
Su b
st an
ce A
b u
si n
g W
om en
: E
ar ly
In te
rv en
ti on
, P
ar en
ti n
g St
re ss
, C
h il
d A
b u
se P
ot en
ti al
an d
C h
il d
D ev
el op
m en
t. C
hi ld
A bu
se &
N eg
le ct
2 7
(9 ):
9 9 7 – 1 0 1 7 .
Home-Visiting Programs to Prevent Child Maltreatment 99
6 .
H om
e vi
si ti
n g
, D
en ve
r G
ra y,
J. D
., C
.A .
C u
tl er
, J.
G . D
ea n
, an
d C
. H
en ry
K em
p e.
1 9
7 7
. P
re d
ic ti
on an
d P
re ve
n ti
on of
C h
il d
A b
u se
an d
N eg
le ct
. C
hi ld
A bu
se &
N eg
le ct
1 (1
): 4 5 – 5 8 .
7 .
H om
e vi
si ti
n g ,
Q u ee
n sl
an d ,
A u
st ra
li a
A rm
st ro
n g
, K
.L .,
J. A
. F ra
se r,
M .R
. D
ad d
s, an
d J.
M or
ri s.
1 9
9 9
. A
R an
d om
iz ed
, C
on tr
ol le
d T
ri al
of N
u rs
e H
om e
V is
it in
g to
V u
ln er
ab le
F am
il ie
s w
it h
N ew
b or
n s.
Jo ur
na l
of P
ae di
at ri
cs &
C hi
ld H
ea lt
h 3 5
(3 ):
2 3 7 – 4 4 .
A rm
st ro
n g
, K
.L .,
J. A
. F ra
se r,
M .R
. D
ad d
s, an
d J.
M or
ri s.
2 0
0 0
. P
ro m
ot in
g Se
cu re
A tt
ac h
m en
t, M
at er
n al
M oo
d an
d C
h il
d H
ea lt
h in
a V
u ln
er ab
le P
op u
la ti
on :
A R
an d
om iz
ed C
on tr
ol le
d T
ri al
. Jo
ur na
l of
P ae
di at
ri cs
an d
C hi
ld H
ea lt
h 3 6
(6 ):
5 5 5 – 6 2 .
F ra
se r,
J. A
., K
.L .
A rm
st ro
n g
, J.
P. M
or ri
s, an
d M
.R . D
ad d
s. 2
0 0
0 .
H om
e V
is it
in g
In te
rv en
ti on
fo r
V u ln
er ab
le F
am il
ie s
w it
h N
ew b
or n
s: F
ol lo
w -U
p R
es u
lt s
of a
R an
d om
iz ed
C on
tr ol
le d
T ri
al . C
hi ld
A bu
se &
N eg
le ct
2 4
(1 1 ):
1 3 9 9 – 1 4 2 9 .
8 .
C h il
d P
ar en
t E
n ri
ch m
en t
P ro
je ct
, C
on tr
a C
os ta
C ou
n ty
, C
al if
or n
ia
B ar
th , R
.P .
1 9 9 1 .
A n
E xp
er im
en ta
l E
va lu
at io
n of
In -H
om e
C h il
d A
b u se
P re
ve n ti
on Se
rv ic
es . C
hi ld
A bu
se &
N eg
le ct
1 5
(4 ):
3 6 3 – 7 5 .
9 .
C om
m u n it
y In
fa n t
P ro
je ct
, B
ou ld
er ,
C ol
or ad
o H
u xl
ey ,
P. ,
an d
R .
W ar
n er
. 1
9 9
3 .
P ri
m ar
y P
re ve
n ti
on of
P ar
en ti
n g
D ys
fu n
ct io
n in
H ig
h -R
is k
C as
es . A
m er
ic an
Jo ur
na l
of O
rt ho
ps yc
hi at
ry 6 3
(4 ):
5 8 2 – 8 8 .
1 0
. E
ar ly
In te
rv en
ti on
P ro
g ra
m ,
Sa n
B er
n ar
d in
o, C
al if
or n
ia K
on ia
k -G
ri ff
in , D
., I.
L . V
er ze
m n
ie k
s, N
.L .R
. A
n d
er so
n , M
.L . B
re ch
t, J.
L es
se r,
S. K
im ,
an d
C . T
u rn
er -P
lu ta
. 2
0 0
3 .
N u
rs e
V is
it at
io n
fo r
A d
ol es
ce n
t M
ot h
er s—
T w
o- Y
ea r
In fa
n t
H ea
lt h
an d
M at
er n
al O
u tc
om es
. N
ur si
ng R
es ea
rc h
5 2
(2 ):
1 2 7 – 3 6 .
K on
ia k
-G ri
ff in
, D
., N
.L .R
. A
n d
er so
n ,
M .L
. B
re ch
t, I.
V er
ze m
n ie
k s,
J. L
es se
r, an
d S.
K im
. 2
0 0
2 .
P u
b li
c H
ea lt
h N
u rs
in g
C ar
e fo
r A
d ol
es ce
n t
M ot
h er
s: Im
p ac
t on
In fa
n t
H ea
lt h
an d
Se le
ct ed
M at
er n
al O
u tc
om es
at 1
Y ea
r P
os tb
ir th
. Jo
ur na
l of
A do
le sc
en t
H ea
lt h
3 0
(1 ):
4 4 – 5 4 .
C on
ti nu
ed
100 L. Segal, R.S. Opie, and K. Dalziel A
P P
E N
D IX
B —
C on
ti nu
ed
P ro
g ra
m N
u m
b er
,N am
e, an
d L
oc at
io n
R ef
er en
ce
1 1
. H
aw ai
i H
ea lt
h y
St ar
t P
ro g
ra m
, H
aw ai
i D
u g g an
, A
., E
. M
cF ar
la n e,
L .
F u d d y,
L .
B u rr
el l,
S. M
. H
ig m
an ,
A .
W in
d h am
, an
d C
. Si
a. 2
0 0
4 .
R an
d om
iz ed
T ri
al of
a St
at ew
id e
H om
e V
is it
in g
P ro
g ra
m :
Im p
ac t
in P
re ve
n ti
n g
C h
il d
A b
u se
an d
N eg
le ct
. C
hi ld
A bu
se &
N eg
le ct
2 8
(6 ):
5 9 7 – 6 2 2 .
D u g g an
, A
.K .,
E .C
. M
cF ar
la n e,
A .M
. W
in d h am
, C
.A . R
oh d e,
D .S
. Sa
lk ev
er ,
L . F u d d y,
L .A
. R
os en
b er
g ,
S. B
. B
u ch
b in
d er
, an
d C
.C .
Si a.
1 9 9 9 .
E va
lu at
io n
of H
aw ai
i’s H
ea lt
h y
St ar
t P
ro g
ra m
. F
ut ur
e of
C hi
ld re
n 9
(1 ):
6 6 – 9 0 ,
d is
cu ss
io n
1 7 7 – 7 8 .
E l-
K am
ar y,
S. S.
, S.
M .
H ig
m an
, L .
F u d d y,
E .
M cF
ar la
n e,
C .
Si a,
an d
A .K
. D
u g g an
. 2
0 0
4 .
H aw
ai i’s
H ea
lt h
y St
ar t
H om
e V
is it
in g
P ro
g ra
m :
D et
er m
in an
ts an
d Im
p ac
t of
R ap
id R
ep ea
t B
ir th
. P
ed ia
tr ic
s 1 1 4
(3 ):
e3 1 7 – 2 6 .
1 2
. H
ea lt
h y
F am
il ie
s A
la sk
a G
es sn
er , B
.D . 2
0 0
8 .
T h
e E
ff ec
t of
A la
sk a’
s H
om e
V is
it at
io n
P ro
g ra
m fo
r H
ig h
-R is
k F
am il
ie s
on T
re n
d s
in A
b u
se an
d N
eg le
ct . C
hi ld
A bu
se &
N eg
le ct
3 2
(3 ):
3 1 7 – 3 3 .
1 3
. H
om e
vi si
ti n
g , W
es te
rn A
u st
ra li
a Q
u in
li va
n ,
J. A
., H
. B
ox ,
an d
S. F.
E va
n s.
2 0
0 3
. P
os tn
at al
H om
e V
is it
s in
T ee
n ag
e M
ot h
er s:
A R
an d
om is
ed C
on tr
ol le
d T
ri al
. T
he L
an ce
t 3 6 1
(9 3 6 1 ):
8 9 3 – 9 0 0 .
1 4
. E
ar ly
St ar
t, N
ew Z
ea la
n d
F er
g u
ss on
, D
.M .,
H .
G ra
n t,
L .J
. H
or w
oo d
, an
d E
.M .
R id
d er
. 2
0 0
5 .
R an
d om
iz ed
T ri
al of
th e
E ar
ly St
ar t
P ro
g ra
m of
H om
e V
is it
at io
n .
P ed
ia tr
ic s
1 1 6
(6 ):
e8 0 3 – 9 .
1 5
. F
am il
y P
ar tn
er sh
ip M
od el
, tw
o co
u n ti
es in
th e
U K
B ar
lo w
,J .,
H .D
av is
,E .M
cI n
to sh
,P .J
ar re
tt ,C
.M oc
k fo
rd ,a
n d
S. St
ew ar
t- B
ro w
n .2
0 0
7 .
R ol
e of
H om
e V
is it
in g
in Im
p ro
vi n
g P
ar en
ti n
g an
d H
ea lt
h in
F am
il ie
s at
R is
k of
A b
u se
an d
N eg
le ct
: R
es u
lt s
of a
M u
lt ic
en tr
e R
an d
om is
ed C
on tr
ol le
d T
ri al
an d
E co
n om
ic E
va lu
at io
n .
A rc
hi ve
s of
D is
ea se
in C
hi ld
ho od
9 2
(3 ):
2 2 9 – 3 3 .
1 6
a. N
u rs
e fa
m il
y p
ar tn
er sh
ip h
om e
vi si
ti n
g , D
en ve
r O
ld s,
D .L
., J.
R ob
in so
n ,
L .
P et
ti tt
, D
.W . L
u ck
ey ,
J. H
ol m
b er
g ,
R .K
. N
g ,
K . Is
ac k
s, K
. Sh
ef f,
an d
C .R
. H
en d
er so
n Jr
. 2
0 0
4 .
E ff
ec ts
of H
om e
V is
it s
b y
P ar
ap ro
fe ss
io n
al s
an d
b y
N u
rs es
: A
g e
4 F
ol lo
w -U
p R
es u
lt s
of a
R an
d om
iz ed
T ri
al . P
ed ia
tr ic
s 1 1 4
(6 ):
1 5 6 0 – 6 8 .
1 6
b .
P ar
ap ro
fe ss
io n
al h
om e
vi si
ti n
g ,
D en
ve r
O ld
s, D
.L .,
J. R
ob in
so n
, R
. O
’B ri
en , D
.W .
L u
ck ey
, L
.M . P
et ti
tt , C
.R .
H en
d er
so n
Jr .,
R .K
. N
g , K
.L . Sh
ef f,
J. K
or fm
ac h
er , S.
H ia
tt ,a
n d
A . T
al m
i. 2
0 0
2 . H
om e
V is
it in
g b
y P
ar ap
ro fe
ss io
n al
s an
d b y
N u
rs es
: A
R an
d om
iz ed
, C
on tr
ol le
d T
ri al
. P
ed ia
tr ic
s 1 1 0
(3 ):
4 8 6 – 9 6 .
Home-Visiting Programs to Prevent Child Maltreatment 101
1 7
. P
ar en
ti n
g on
E d
g e,
G eo
rg ia
M u
ls ow
, M
.H .,
an d
V .M
. M
u rr
ay .
1 9
9 6
. P
ar en
ti n
g on
E d
g e:
E co
n om
ic al
ly St
re ss
ed ,
Si n
g le
, A
fr ic
an A
m er
ic an
A d
ol es
ce n
t M
ot h
er s.
Jo ur
na l
of F
am il
y Is
su es
1 7
(5 ):
7 0 4 – 2 1 .
1 8 .
L in
k ag
es fo
r P
re ve
n ti
on P
ro je
ct , D
u rh
am ,
N or
th C
ar ol
in a
M ar
g ol
is , P.
A .,
R .
St ev
en s,
W .C
. B
or d
le y,
J. St
u ar
t, C
. H
ar la
n , L .
K ey
es -E
ls te
in , an
d S.
W is
se h . 2 0 0 1 .
F ro
m C
on ce
p t
to A
p p li
ca ti
on :
T h e
Im p ac
t of
a C
om m
u n it
y- W
id e
In te
rv en
ti on
to Im
p ro
ve th
e D
el iv
er y
of P
re ve
n ti
ve Se
rv ic
es to
C h
il d
re n
. P
ed ia
tr ic
s 1 0 8
(3 ):
e4 2 .
1 9 .
C h il
d an
d Y
ou th
P ro
g ra
m M
od u
le ,
B al
ti m
or e
H ar
d y,
J. B
., an
d R
. St
re et
t. 1 9 8 9 .
F am
il y
Su p p or
t an
d P
ar en
ti n g
E d u ca
ti on
in th
e H
om e:
A n
E ff
ec ti
ve E
xt en
si on
of C
li n
ic -B
as ed
P re
ve n
ti ve
H ea
lt h
C ar
e Se
rv ic
es fo
r P
oo r
C h il
d re
n .
Jo ur
na l
of P
ed ia
tr ic
s 1 1 5
(6 ):
9 2 7 – 3 1 .
2 0
. H
om e
vi si
ti n
g ,
M em
p h
is K
it zm
an , H
., D
.L .
O ld
s, C
.R .
H en
d er
so n
Jr .,
C .
H an
k s,
R . C
ol e,
R .
T at
el b
au m
, K
.M .
M cC
on n
oc h
ie ,
K . Si
d or
a, D
.W .
L u
ck ey
, D
. Sh
av er
, K
. E
n g
el h
ar d
t, D
. Ja
m es
, an
d K
. B
ar n
ar d
. 1
9 9
7 .
E ff
ec t
of P
re n
at al
an d
In fa
n cy
H om
e V
is it
at io
n b
y N
u rs
es on
P re
g n
an cy
O u
tc om
es , C
h il
d h
oo d
In ju
ri es
, an
d R
ep ea
te d
C h
il d
b ea
ri n
g .
A R
an d
om iz
ed C
on tr
ol le
d T
ri al
. JA
M A
2 7 8
(8 ):
6 4 4 – 5 2 .
K it
zm an
, H
., D
.L .
O ld
s, K
. Si
d or
a, C
.R .
H en
d er
so n
Jr .,
C . H
an k
s, R
. C
ol e,
D .W
. L
u ck
ey ,
J. B
on d
y, K
. C
ol e,
an d
J. G
la zn
er . 2
0 0
0 .
E n
d u
ri n
g E
ff ec
ts of
N u
rs e
H om
e V
is it
at io
n on
M at
er n
al L
if e
C ou
rs e—
A 3 -Y
ea r
F ol
lo w
-U p
of a
R an
d om
iz ed
T ri
al .
JA M
A 2 8 3
(1 5 ):
1 9 8 3 – 8 9 .
O ld
s, D
.L .,
H .
K it
zm an
, R
. C
ol e,
J. R
ob in
so n ,
K .
Si d or
a, D
.W .
L u ck
ey ,
C .R
. H
en d er
so n
Jr .,
C .
H an
k s,
J. B
on d y,
an d
J. H
ol m
b er
g .
2 0 0 4 .
E ff
ec ts
of N
u rs
e H
om e-
V is
it in
g on
M at
er n
al L if
e C
ou rs
e an
d C
h il
d D
ev el
op m
en t:
A g
e 6
F ol
lo w
-U p
R es
u lt
s of
a R
an d
om iz
ed T
ri al
. P
ed ia
tr ic
s 1 1 4
(6 ):
1 5 5 0 – 5 9 .
O ld
s, D
.L .,
H .
K it
zm an
, C
. H
an k s,
R .
C ol
e, E
. A
n so
n ,
K .
Si d or
a- A
rc ol
eo , D
.W .
L u
ck ey
, C
.R .
H en
d er
so n
Jr .,
J. H
ol m
b er
g ,
R .A
. T
u tt
, A
.J . St
ev en
so n
, an
d J.
B on
d y.
2 0
0 7
. E
ff ec
ts of
N u
rs e
H om
e V
is it
in g
on M
at er
n al
an d
C h
il d
F u
n ct
io n
in g
: A
g e-
9 F
ol lo
w -U
p of
a R
an d
om iz
ed T
ri al
. P
ed ia
tr ic
s 1 2 0
(4 ):
e8 3 2 – 4 5 .
C on
ti nu
ed
102 L. Segal, R.S. Opie, and K. Dalziel A
P P
E N
D IX
B —
C on
ti nu
ed
P ro
g ra
m N
u m
b er
,N am
e, an
d L
oc at
io n
R ef
er en
ce
2 1 .
T h re
e G
en er
at io
n St
u d y,
B al
ti m
or e
B la
ck , M
.M .,
M .E
. B
en tl
ey ,
M .A
. P
ap as
, S.
O b
er la
n d
er , L
.O .
T et
i, S.
M cN
ar y,
K .
L e,
an d
M .
O ’C
on n el
l. 2 0 0 6 .
D el
ay in
g Se
co n d
B ir
th s
am on
g A
d ol
es ce
n t
M ot
h er
s: A
R an
d om
iz ed
, C
on tr
ol le
d T
ri al
of a
H om
e- B
as ed
M en
to ri
n g
P ro
g ra
m .
P ed
ia tr
ic s
1 1 8
(4 ):
e1 0 8 7 – 9 9 .
2 2 .
P ar
en t
T ra
in in
g b y
C E
T A
ai d e,
M ia
m i
F ie
ld ,
T .,
S. W
id m
ay er
, R
. G
re en
b er
g , an
d S.
St ol
le r.
1 9
8 2
. E
ff ec
ts of
P ar
en t
T ra
in in
g on
T ee
n ag
e M
ot h
er s
an d
T h
ei r
In fa
n ts
. P
ed ia
tr ic
s 6 9
(6 ):
7 0 3 – 7 .
2 3 .
C om
p re
h en
si ve
C h il
d D
ev el
op m
en t
P ro
g ra
m ,
U SA
St .
P ie
rr e,
R .G
., an
d J.
I. L
ay ze
r. 1
9 9
9 .
U si
n g
H om
e V
is it
s fo
r M
u lt
ip le
P u
rp os
es : T
h e
C om
p re
h en
si ve
C h
il d
D ev
el op
m en
t P
ro g
ra m
. F
ut ur
e of
C hi
ld re
n 9
(1 ):
1 3 4 – 5 1 .
2 4 .
H om
e vi
si ti
n g , C
ol or
ad o
D aw
so n ,
P. ,
W .J
. va
n D
oo rn
in ck
, an
d J.
L . R
ob in
so n .
1 9 8 9 .
E ff
ec ts
of H
om e-
B as
ed ,
In fo
rm al
So ci
al Su
p p
or t
on C
h il
d H
ea lt
h . Jo
ur na
l of
D ev
el op
m en
ta l
& B
eh av
io ra
l P
ed ia
tr ic
s 1 0
(2 ):
6 3 – 6 7 .
2 5
a. T
h e
P ar
en ts
as T
ea ch
er s
(P A
T )
(a )
T ee
n s
C om
b in
ed (i
n cl
u d
in g
ca se
m an
ag em
en t)
, So
u th
er n
C al
if or
n ia
W ag
n er
,M .M
., an
d S.
C la
yt on
,L .1
9 9
9 .T
h e
P ar
en ts
as T
ea ch
er s
P ro
g ra
m :R
es u
lt s
fr om
T w
o D
em on
st ra
ti on
s. F
ut ur
e of
C hi
ld re
n 9
(1 ):
9 1 – 1 1 5 .
2 5
b .
(b )
B as
ic p
ro g
ra m
, Sa
li n
as V
al le
y, N
or th
er n
C al
if or
n ia
2 5
c. (c
) T
ee n
P A
T ,
So u
th er
n C
al if
or n
ia 2
6 a.
(a )
N u
rs e
F am
il y
P ar
tn er
sh ip
, p
re -
an d
p os
tn at
al , E
lm ir
a, N
ew Y
or k
E ck
en ro
d e,
J. , B
. G
an ze
l, C
.R .
H en
d er
so n
Jr .,
E .
Sm it
h ,
D .L
. O
ld s,
J. P
ow er
s, R
. C
ol e,
H .
K it
zm an
, an
d K
. Si
d or
a. 2
0 0
0 .
P re
ve n
ti n
g C
h il
d A
b u
se an
d N
eg le
ct w
it h
a P
ro g
ra m
of N
u rs
e H
om e
V is
it at
io n
: T
h e
L im
it in
g E
ff ec
ts of
D om
es ti
c V
io le
n ce
. JA
M A
2 8 4
(1 1 ):
1 3 8 5 – 9 1 .
Home-Visiting Programs to Prevent Child Maltreatment 103
2 6
b .
N u
rs e
F am
il y
P ar
tn er
sh ip
, (b
) p re
n at
al on
ly ,
E lm
ir a,
N ew
Y or
k
E ck
en ro
d e,
J. , D
. Z
ie li
n sk
i, E
. Sm
it h
, L
.A .
M ar
cy n
ys zy
n ,
C .R
. H
en d
er so
n Jr
., H
. K
it zm
an , R
. C
ol e,
J. P
ow er
s, an
d D
.L .
O ld
s. 2
0 0
1 .
C h
il d
M al
tr ea
tm en
t an
d th
e E
ar ly
O n
se t
of P
ro b
le m
B eh
av io
rs : C
an a
P ro
g ra
m of
N u
rs e
H om
e V
is it
at io
n B
re ak
th e
L in
k ?
D ev
el op
m en
t &
P sy
ch op
at ho
lo gy
1 3
(4 ):
8 7 3 – 9 0 .
Iz zo
, C
.V .,
J. J.
E ck
en ro
d e,
E .G
. Sm
it h
, C
.R .
H en
d er
so n
Jr .,
R .
C ol
e, H
. K
it zm
an , an
d D
.L .
O ld
s. 2 0 0 5 .
R ed
u ci
n g
th e
Im p ac
t of
U n co
n tr
ol la
b le
St re
ss fu
l L if
e E
ve n ts
th ro
u g
h a
P ro
g ra
m of
N u
rs e
H om
e V
is it
at io
n fo
r N
ew P
ar en
ts .
P re
ve nt
io n
Sc ie
nc e
6 (4
): 2 6 9 – 7 4 .
O ld
s, D
.L .,
C .R
. H
en d er
so n
Jr .,
R .
T at
el b au
m , an
d R
. C
h am
b er
li n . 1 9 8 6 .
Im p ro
vi n g
th e
D el
iv er
y of
P re
n at
al C
ar e
an d
O u
tc om
es of
P re
g n
an cy
: A
R an
d om
iz ed
T ri
al of
N u
rs e
H om
e V
is it
at io
n . [e
rr at
u m
ap p
ea rs
in P
ed ia
tr ic
s, Ju
ly 1 9 8 6 ,
7 8
(1 ):
1 3 8 ].
P ed
ia tr
ic s
7 7
(1 ):
1 6 – 2 8 .
O ld
s, D
., C
.R .
H en
d er
so n
Jr .,
H .
K it
zm an
, an
d R
. C
ol e.
1 9
9 5
. E
ff ec
ts of
P re
n at
al an
d In
fa n
cy N
u rs
e H
om e
V is
it at
io n
on Su
rv ei
ll an
ce of
C h
il d
M al
tr ea
tm en
t. P
ed ia
tr ic
s 9 5
(3 ):
3 6 5 – 7 2 .
O ld
s, D
.L .,
J. E
ck en
ro d
e, C
.R .
H en
d er
so n
Jr .,
H . K
it zm
an , J.
P ow
er s,
R .
C ol
e, K
. Si
d or
a, P.
M or
ri s,
L .M
. P
et ti
tt , an
d D
. L
u ck
ey .
1 9
9 7
. L
on g
-T er
m E
ff ec
ts of
H om
e V
is it
at io
n on
M at
er n
al L
if e
C ou
rs e
an d
C h
il d
A b
u se
an d
N eg
le ct
. F if
te en
-Y ea
r F
ol lo
w -U
p of
a R
an d
om iz
ed T
ri al
. JA
M A
2 7 8
(8 ):
6 3 7 – 4 3 .
O ld
s, D
.L .,
C .R
. H
en d
er so
n Jr
., an
d H
. K
it zm
an . 1
9 9
4 .
D oe
s P
re n
at al
an d
In fa
n cy
N u
rs e
H om
e V
is it
at io
n H
av e
E n
d u
ri n
g E
ff ec
ts on
Q u
al it
ie s
of P
ar en
ta l
C ar
eg iv
in g
an d
C h
il d
H ea
lt h
at 2
5 to
5 0
M on
th s
of L
if e?
P ed
ia tr
ic s
9 3
(1 ):
8 9 – 9 8 .
2 7 .
So ci
al Su
p p or
t an
d F am
il y
H ea
lt h
St u d y,
L on
d on
W ig
g in
s, M
., A
.O ak
le y,
I. R
ob er
ts ,H
.T u rn
er ,L
. R
aj an
,H .A
u st
er b
er ry
,R . M
u ji
ca ,M
. M
u g fo
rd ,
an d
M .
B ar
k er
. 2 0 0 5 .
P os
tn at
al Su
p p or
t fo
r M
ot h er
s L iv
in g
in D
is ad
va n
ta g
ed In
n er
C it
y A
re as
: A
R an
d om
is ed
C on
tr ol
le d
T ri
al . Jo
ur na
l of
E pi
de m
io lo
gy an
d C
om m
un it
y H
ea lt
h 5 9
(4 ):
2 8 8 – 9 5 .
C on
ti nu
ed
104 L. Segal, R.S. Opie, and K. Dalziel
A P
P E
N D
IX B
— C
on ti
nu ed
P ro
g ra
m N
u m
b er
,N am
e, an
d L
oc at
io n
R ef
er en
ce
W ig
g in
s, M
., A
. O
ak le
y, I.
R ob
er ts
, H
. T
u rn
er ,
L .
R aj
an , H
. A
u st
er b
er ry
, R
. M
u ji
ca ,
an d
M .M
u g fo
rd .2
0 0 4 .T
h e
So ci
al Su
p p or
t an
d F am
il y
H ea
lt h
St u d y:
A R
an d om
is ed
C on
tr ol
le d
T ri
al an
d E
co n
om ic
E va
lu at
io n
of T w
o A
lt er
n at
iv e
F or
m s
of P
os tn
at al
Su p
p or
t fo
r M
ot h
er s
L iv
in g
in D
is ad
va n
ta g
ed In
n er
-C it
y A
re as
. H
ea lt
h T
ec hn
ol og
y A
ss es
sm en
t 8
(3 2 ):
ii i–
1 0 7 .
2 8 .
H om
e vi
si ti
n g , Q
u eb
ec ,
C an
ad a
In fa
n te
-R iv
ar d
, C
., G
. F
il io
n ,
M .
B au
m g
ar te
n , M
. B
ou ra
ss a,
J. L
ab el
le , an
d M
. M
es si
er .
1 9 8 9 .
A P
u b li
c H
ea lt
h H
om e
In te
rv en
ti on
am on
g F am
il ie
s of
L ow
So ci
oe co
n om
ic St
at u
s. C
hi ld
re n’
s H
ea lt
h C
ar e
1 8
(2 ):
1 0 2 – 7 .
2 9
a. P
os tn
at al
h om
e vi
si ti
n g
, M
on tr
ea l
L ar
so n
, C
.P .
1 9
8 0
. E
ff ic
ac y
of P
re n
at al
an d
P os
tp ar
tu m
H om
e V
is it
s on
C h
il d
H ea
lt h
an d
D ev
el op
m en
t. P
ed ia
tr ic
s 6 6
(2 ):
1 9 1 – 9 7 .
2 9
b .
P re
- an
d p
os tn
at al
vi si
ti n
g ,
M on
tr ea
l 3 0 .
H om
e vi
si ti
n g , G
re en
sb or
o, N
or th
C ar
ol in
a Si
eg el
, E
., K
.E .
B au
m an
, E
.S .
Sc h
ae fe
r, M
.M . Sa
u n
d er
s, an
d D
.D .
In g
ra m
. 1
9 8
0 .
H os
p it
al an
d H
om e
Su p
p or
t d
u ri
n g
In fa
n cy
: Im
p ac
t on
M at
er n
al A
tt ac
h m
en t,
C h
il d
A b
u se
an d
N eg
le ct
, an
d H
ea lt
h C
ar e
U ti
li za
ti on
. P
ed ia
tr ic
s 6 6
(2 ):
1 8 3 – 9 0 .
3 1
. H
om e
vi si
ti n
g , B
al ti
m or
e B
la ck
, M
.M .,
P. N
ai r,
C . K
ig h
t, R
. W
ac h
te l,
P. R
ob y,
an d
M .
Sc h
u le
r. 1
9 9
4 .
P ar
en ti
n g
an d
E ar
ly D
ev el
op m
en t
am on
g C
h il
d re
n of
D ru
g -A
b u
si n
g W
om en
: E
ff ec
ts of
H om
e In
te rv
en ti
on . P
ed ia
tr ic
s 9 4
(4 ):
4 4 0 – 4 8 .
3 2
. H
ea lt
h y
F am
il ie
s A
la sk
a (H
FA K
) D
u g g an
, A
., D
. C
al d er
a, K
. R
od ri
g u ez
, L .
B u rr
el l,
C .
R oh
d e,
an d
S. S.
C ro
w n e.
2 0 0 7 .
Im p
ac t
of a
St at
ew id
e H
om e
V is
it in
g P
ro g
ra m
to P
re ve
n t
C h
il d
A b
u se
. C
hi ld
A bu
se &
N eg
le ct
3 1
(8 ):
8 0 1 – 2 7 .
C al
d er
a, D
., L .
B u rr
el l,
K . R
od ri
g u ez
, S.
S. C
ro w
n e,
C .
R oh
d e,
an d
A .
D u g g an
. 2 0 0 7 .
Im p
ac t
of a
St at
ew id
e H
om e
V is
it in
g P
ro g
ra m
on P
ar en
ti n
g an
d on
C h
il d
H ea
lt h
an d
D ev
el op
m en
t. C
hi ld
A bu
se &
N eg
le ct
3 1
(8 ):
8 2 9 – 5 2 .
Home-Visiting Programs to Prevent Child Maltreatment 105
3 3 .
A d d it
io n
of in
te n si
ve h om
e vi
si ta
ti on
co m
p on
en t
to (C
A M
P ),
C ol
or ad
o
St ev
en s-
Si m
on ,
C .,
D .
N el
li g
an , an
d L
. K
el ly
. 2
0 0
1 .
A d
ol es
ce n
ts at
R is
k fo
r M
is tr
ea ti
n g
T h
ei r
C h
il d
re n
:P ar
t II
:A H
om e-
an d
C li
n ic
-B as
ed P
re ve
n ti
on P
ro g
ra m
. C
hi ld
A bu
se &
N eg
le ct
2 5
(6 ):
7 5 3 – 6 9 .
3 4
. H
om e
vi si
ti n
g , P
h il
ad el
p h
ia M
ar ce
n k
o, M
.O .,
an d
M .
Sp en
ce .
1 9
9 4
. H
om e
V is
it at
io n
Se rv
ic es
fo r
A t-
R is
k P
re g
n an
t an
d P
os tp
ar tu
m W
om en
: A
R an
d om
iz ed
T ri
al . A
m er
ic an
Jo ur
na l
of O
rt ho
ps yc
hi at
ry 6 4
(3 ):
4 6 8 – 7 8 .
3 5 .
R E
A C
H -F
u tu
re s
p ro
g ra
m ,
C h
ic ag
o N
or r,
K .F
., K
.S .
C ri
tt en
d en
, E
.L .
L eh
re r,
O .
R ey
es , C
.B .
B oy
d ,
K .W
. N
ac io
n ,
an d
K .
W at
an ab
e. 2
0 0
3 .
M at
er n
al an
d In
fa n
t O
u tc
om es
at O
n e
Y ea
r fo
r a
N u
rs e-
H ea
lt h
A d
vo ca
te H
om e
V is
it in
g P
ro g
ra m
Se rv
in g
A fr
ic an
A m
er ic
an s
an d
M ex
ic an
A m
er ic
an s.
P ub
li c
H ea
lt h
N ur
si ng
2 0
(3 ):
1 9 0 – 2 0 3 .
3 6 .
N ew
M ex
ic o
an d
A ri
zo n a
H ea
lt h
y F am
il ie
s A
m er
ic a
B ar
lo w
, A
., E
. V
ar ip
at is
-B ak
er , K
. Sp
ea k m
an ,
G .
G in
sb u rg
, I.
F ri
b er
g ,
N .
G ok
li sh
, B
. C
ow b oy
, P.
F ie
ld s,
R . H
as ti
n g s,
W .
P an
, R
. R
ei d , M
. Sa
n to
sh am
, an
d J.
W al
k u p .
2 0
0 6
. H
om e-
V is
it in
g In
te rv
en ti
on to
Im p
ro ve
C h
il d
C ar
e am
on g
A m
er ic
an In
d ia
n A
d ol
es ce
n t
M ot
h er
s— A
R an
d om
iz ed
T ri
al . A
rc hi
ve s
of P
ed ia
tr ic
s &
A do
le sc
en t
M ed
ic in
e 1 6 0
(1 1 ):
1 1 0 1 – 7 .
3 7
a. E
ar ly
H ea
d St
ar t,
h om
e- b
as ed
on ly
, 1
7 si
te s
ac ro
ss U
SA L
ov e,
J. M
., E
.E .
K is
k er
, C
. R
os s,
H .
R ai
k es
, J.
C on
st an
ti n
e, K
. B
ol le
r, J.
B ro
ok s-
G u
n n
, R
. C
h az
an -C
oh en
, L .B
. T
ar u ll
o, C
. B
ra d y-
Sm it
h ,
A .S
. F u li
g n i,
P. Z
. Sc
h oc
h et
, 3
7 b
. E
ar ly
H ea
d St
ar t,
m ix
ed (h
om e-
an d
ce n
te r-
b as
ed ),
1 7
si te
s ac
ro ss
U SA
D .P
au ls
el l,
an d
C .V
og el
.2 0
0 5
.T h
e E
ff ec
ti ve
n es
s of
E ar
ly H
ea d
St ar
t fo
r 3
-Y ea
r- O
ld C
h il
d re
n an
d T
h ei
r P
ar en
ts :L
es so
n s
fo r
P ol
ic y
an d
P ro
g ra
m s.
D ev
el op
m en
ta l
P sy
ch ol
og y
4 1
(6 ):
8 8 5 – 9 0 1 .
3 8 .
H ea
lt h y
St ep
s fo
r Y
ou n g
C h
il d
re n
P ro
g ra
m (H
S) ,
P ac
if ic
N or
th w
es t,
U SA
, an
d C
an ad
a
Jo h n st
on ,
B .D
., C
.E .
H u eb
n er
, M
.L . A
n d er
so n ,
L .T
. T
yl l,
an d
R .S
. T
h om
p so
n .
2 0 0 6 .
H ea
lt h
y St
ep s
in an
In te
g ra
te d
D el
iv er
y Sy
st em
— C
h il
d an
d P
ar en
t O
u tc
om es
at 3 0
M on
th s.
A rc
hi ve
s of
P ed
ia tr
ic s
& A
do le
sc en
t M
ed ic
in e
1 6 0
(8 ):
7 9 3 – 8 0 0 .
C on
ti nu
ed
106 L. Segal, R.S. Opie, and K. Dalziel A
P P
E N
D IX
B —
C on
ti nu
ed
P ro
g ra
m N
u m
b er
,N am
e, an
d L
oc at
io n
R ef
er en
ce
3 9 .
H om
e vi
si ti
n g , D
am as
cu s,
Sy ri
a B
as h
ou r,
H .N
., M
.H . K
h ar
ou f,
A .A
. A
b d
u ls
al am
, K
. E
l A
sm ar
, M
.A . T
ab b
aa ,
an d
S. A
.C h
ei k
h a.
2 0
0 8
.E ff
ec t
of P
os tn
at al
H om
e V
is it
s on
M at
er n
al /I
n fa
n t
O u
tc om
es in
Sy ri
a: A
R an
d om
iz ed
C on
tr ol
le d
T ri
al . P
ub li
c H
ea lt
h N
ur si
ng 2 5
(2 ):
1 1 5 – 2 5 .
4 0 .
C og
n it
iv e
ex te
n si
on of
th e
H ea
lt h
y St
ar t
P ro
g ra
m ,
Sa n
ta B
ar b
ar a,
C al
if or
n ia
B u
g en
ta l,
D .B
., an
d A
. Sc
h w
ar tz
. 2
0 0
9 .
A C
og n
it iv
e A
p p
ro ac
h to
C h
il d
M is
tr ea
tm en
t P
re ve
n ti
on am
on g
M ed
ic al
ly A
t- R
is k
In fa
n ts
.D ev
el op
m en
ta l
P sy
ch ol
og y
4 5
(1 ):
2 8 4 – 8 8 .
4 1 .
H om
e vi
si ti
n g , Y
am an
as h i,
Ja p
an C
h en
g ,
S. ,
N . K
on d o,
Y .
A ok
i, Y
. K
it am
u ra
, Y
. T
ak ed
a, an
d Z
. Y
am ag
at a.
2 0 0 7 .
T h e
E ff
ec ti
ve n
es s
of E
ar ly
In te
rv en
ti on
an d
th e
F ac
to rs
R el
at ed
to C
h il
d B
eh av
io ra
l P
ro b
le m
s at
A g
e 2
: A
R an
d om
iz ed
C on
tr ol
le d
T ri
al . E
ar ly
H um
an D
ev el
op m
en t
8 3
(1 0 ):
6 8 3 – 9 1 .
4 2 .
M od
if ie
d M
ot h er
-I n fa
n t
T ra
n sa
ct io
n P
ro g
ra m
(M IT
P ),
N or
w ay
K aa
re se
n , P.
I. , J.
A . R
on n in
g ,
S. E
. U
lv u n d ,
an d
L .B
. D
ah l.
2 0 0 6 .
A R
an d om
iz ed
, C
on tr
ol le
d T
ri al
of th
e E
ff ec
ti ve
n es
s of
an E
ar ly
-I n
te rv
en ti
on P
ro g
ra m
in R
ed u
ci n
g P
ar en
ti n
g St
re ss
af te
r P
re te
rm B
ir th
. P
ed ia
tr ic
s 1 1 8
(1 ):
e9 – 1 9 .
4 3 .
R E
ST ,
U ta
h K
ee fe
, M
.R .,
K .A
. K
aj rl
se n , M
.L .
L ob
o, A
.M .
K ot
ze r,
an d
W .N
. D
u d le
y. 2 0 0 6 .
R ed
u ci
n g
P ar
en ti
n g
St re
ss in
F am
il ie
s w
it h
Ir ri
ta b
le In
fa n
ts .
N ur
si ng
R es
ea rc
h 5 5
(3 ):
1 9 8 – 2 0 5 .
4 4 .
H om
e vi
si ti
n g , O
n ta
ri o,
C an
ad a
St ee
l O
’C on
n or
, K
.O .,
D .L
. M
ow at
, H
.M .
Sc ot
t, P.
A .
C ar
r, J.
L .
D or
la n
d ,
an d
K .F
.W .
Y ou
n g
T ai
. 2
0 0
3 .
A R
an d
om iz
ed T
ri al
of T w
o P
u b
li c
H ea
lt h
N u
rs e
F ol
lo w
-U p
P ro
g ra
m s
af te
r E
ar ly
O b
st et
ri ca
l D
is ch
ar g
e: A
n E
xa m
in at
io n
of B
re as
tf ee
d in
g R
at es
, M
at er
n al
C on
fi d
en ce
an d
U ti
li za
ti on
an d
C os
ts of
H ea
lt h
Se rv
ic es
. C
an ad
ia n
Jo ur
na l
of P
ub li
c H
ea lt
h 9 4
(2 ):
9 8 – 1 0 3 .
4 5
a. P
ar en
t- In
fa n
t in
te rv
en ti
on m
od el
, O
n ta
ri o,
C an
ad a
B ar
re ra
, M
.E .,
P. L . R
os en
b au
m , an
d C
.E . C
u n n in
g h am
. 1 9 8 6 . E
ar ly
H om
e In
te rv
en ti
on w
it h
L ow
-B ir
th -W
ei g
h t
In fa
n ts
an d
T h
ei r
P ar
en ts
. C
hi ld
D ev
el op
m en
t 5 7
(1 ):
2 0 – 3 3 .
4 5
b .
D ev
el op
m en
ta l
in te
rv en
ti on
(c on
tr ol
), O
n ta
ri o,
C an
ad a
N ot
e: P
ro g
ra m
n u
m b
er s
1 6
a an
d 1
6 b
; 2
5 a,
2 5
b , an
d 2
5 c;
2 6
a an
d 2
6 b
; 2
9 a
an d
2 9
b ; 3
7 a
an d
3 7
b ; an
d 4
5 a
an d
4 5
b sh
ar e
th e
sa m
e re
fe re
n ce
(s ).
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