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September 2004Vol. 5, No. 7Home Visiting Study Prompts Changes

Study findings indicating that the Hawaii Healthy Start home visiting program had little impact on the incidence of child abuse and neglect have prompted changes both to the program and to the evaluation of home visiting program outcomes. As a result of a 3-year study, researchers from the Johns Hopkins Children's Center have endorsed the value of testing different models, training programs, and implementation systems in home visiting programs, as well as utilizing experimental tests to determine the impact of home visiting on the incidence of child abuse and neglect.

The Hawaii Healthy Start Program was the focus of a large-scale study involving 643 families with infants who were identified as being at risk for child abuse and neglect. In this randomized evaluation, families were assigned to home visiting or control groups. Families in the home visiting groups received regular visits from paraprofessionals who were trained to establish a trusting relationship with parents, model parenting and problem-solving skills, and help families access needed services.

Annual assessments, including mothers' self-reports, home observations, child hospitalization and child protective services reports, and home visitors' records, showed little difference in the incidence of child abuse and neglect between families enrolled in the home visiting program and control families. In fact, high rates of abusive and neglectful parenting behaviors were found in both groups. Abusive and neglectful behavior was correlated with such maternal factors as depression, illegal substance abuse, and having no partner or having an abusive partner. These maternal risk factors for child abuse and neglect often went unrecognized by home visitors, so appropriate referrals to community services that might have prevented abuse and neglect were not made.

Researchers who studied the Healthy Start Program also noted a shift in the home visitation model that affected the content and focus of the home visits. This shift marked a change from the home visiting model of the late 1980s, in which the home visitor and supervisor developed a case plan based on family risk for abuse, to a more recent model in which parents designed their own goals within a strengths-based perspective. The latter model relied on families to propose their own risk-reduction goals, but staff were not trained to help families recognize and address their risk for abuse and neglect.

The results of this study have prompted Hawaii's Healthy Start Program to consider a number of changes, which will be tested for their effectiveness in preventing abuse and neglect. These include:

  • Collaboration between home visitors and families in developing family support plans
  • Partnering with families to help them address risks for abuse while building on their strengths
  • Addressing factors that discourage or block families' use of community resources

Information about this study can be found in three journal articles in the June issue of Child Abuse & Neglect, The International Journal 28(6):

  • "Randomized Trial of a Statewide Home Visiting Program: Impact in Preventing Child Abuse and Neglect"
  • "Randomized Trial of a Statewide Home Visiting Program to Prevent Child Abuse: Impact in Reducing Parental Risk Factors"
  • "Risk of Mother-Reported Child Abuse in the First 3 Years of Life"

Article abstracts and information about subscriptions to Child Abuse & Neglect, The International Journal can be found at

Related Items

Studies of other home visiting programs have yielded more positive results. Read more about evaluations of home visiting programs in previous issues of Children's Bureau Express:

  • "Time Spent in Home Visits Related to Personality Traits of Mothers and Staff" (December 2003/January 2004)
  • "Home Visiting Programs Help Reduce Child Maltreatment" (April 2003)
  • "Home Visitation Measured as a Way to Prevent Child Abuse" (November 2000)

The Nurse-Family Partnership Program is a home visiting program that has shown positive results for first-time, low-income parents who are visited by nurses. For information on that program, including scientific results tracked over 20 years, visit their website at

The Harvard Family Research Project sponsors the Home Visit Forum, comprised of representatives from national home visitation programs committed to improving outcomes, developing research that leads to better practice and training, and sharing lessons throughout the field. Information about the Home Visit Forum can be accessed at