Sept/Oct 2006Vol. 7, No. 7Population Served May Explain Home Visiting Results
A recent evaluation of the Healthy Families New York (HFNY) home visiting program offers a possible explanation for some of the discrepant findings from home visiting programs around the country. While randomized trials of programs involving home visits by nurses have demonstrated positive effects for reducing child maltreatment, randomized trials of paraprofessional home visitation programs have found little effect on child maltreatment. The HFNY study suggests that the differential impact of home visiting programs on parenting outcomes may be due to characteristics of the parent populations served by each program.
The HFNY study examined parenting behaviors for 1,173 families at risk for child abuse and neglect who were randomly assigned to the home visiting intervention or to a control group that received traditional services. The researchers analyzed the impacts of HFNY enrollment on child maltreatment at the target child's first and second birthdays for the sample as a whole as well as for two subgroups: (1) women younger than 19 years who joined the program while they were pregnant with their first child and (2) mothers classified as psychologically vulnerable.
The results to date show that HFNY's home visiting intervention had positive effects on a number of different forms of self-reported child abuse and neglect for the sample overall. These included very serious physical abuse, neglect, minor physical aggression, and psychological abuse when the child was 1 year old, and serious physical abuse at age 2. The program was particularly effective for the subgroups of young, first-time mothers enrolled while pregnant and psychologically vulnerable mothers. Specifically:
- At the target child's second birthday, the young, first-time mothers who had participated in home visiting since their pregnancy were substantially less likely to report engaging in minor physical aggression against their children and in harsh parenting, compared to their counterparts in the control group and compared to the more diverse group of mothers in both the intervention and control groups.
- Psychologically vulnerable mothers (those with limited intellectual functioning, mental health, and sense of control over their lives) in the intervention group were only about a quarter as likely to report engaging in acts of serious abuse or neglect when compared to similar mothers in the control group.
These results suggest that targeting young women who have not yet had an opportunity to abuse or neglect a child by providing them with home visiting services early in their first pregnancy may help prevent abuse and neglect. Likewise, targeting psychologically vulnerable women may buffer these women against committing child abuse or neglect.
The HFNY study also reports on a possible surveillance bias that may explain why no reduction in CPS reports was found. At their child's first birthday, intervention families who self-reported serious abuse and neglect were more likely to have CPS reports (43 percent) than control group families who self-reported similar rates of serious abuse or neglect (18 percent had CPS reports). Thus, enrollment in the HFNY program and the increased scrutiny by home visitors and other providers may artificially inflate the rate of CPS reports for intervention families.
The HFNY program and evaluation are ongoing. Researchers recommend prioritizing the populations that benefit the most, as well as exploring ways to enhance the model to better serve families with multiple needs.
The evaluation of HFNY is supported in part by grants from the Children's Bureau in the U.S. Department of Health and Human Services. To read the full report, Healthy Families New York (HFNY) Randomized Trial: Impacts on Parenting After the First Two Years, by K. A. DuMont, S. Mitchell-Herzfeld, R. Greene, E. Lee, A. Lowenfels, and M. Rodriguez, view the PDF:
www.ocfs.state.ny.us/main/prevention/assets/HFNYRandomizedTrialWorkingPaper.pdf (PDF - 625 KB)
Related Item
Children's Bureau Express last reported on the HFNY program in "Recognition for Healthy Families New York" (April 2006).
