Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S.S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31(8), 801-827.
Caldera, D., Burrell, L., Rodriguez, K., Crowne, S.S., Rohde, C., & Duggan, A. (2007). Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse & Neglect, 31(8), 829-852.
These two related studies examined the impact of the Healthy Families Alaska (HFAK) program model on: 1) child abuse, and 2) parenting and child health and development. HFAK is a home visiting program, targeting high-risk families; the program has explicit performance indicators; program staff must complete basic training by Healthy Families America (HFA) certified trainers; these authors had conducted an earlier evaluation of the model in Hawaii. The study sample, drawn from 6 of the 7 HFAK programs in 2000/01, comprised 325 families who agreed to be interviewed at baseline; these were randomized to experimental (n = 162) and control (n = 163) groups; the latter were referred to other community services. Data were collected from a number of different sources—family interviews, observed parenting behaviors, child protective services reports, and hospital records—using a number of standard instruments. The findings were disappointing: 1) there was no overall program effect on maltreatment reports, or on most measures of potential maltreatment; 2) there was no overall impact on child health, or on parenting outcomes; however HFAK children did have more favorable developmental and behavioral outcomes, and HFAK mothers reported greater parenting self-efficacy.
The methodology was generally strong; these studies were meticulously planned; the design involved randomized experimental and control groups; the sample was representative, having been drawn from 6 of the 7 state HAFK programs; the data collection was elaborate, involving different sources and methods, with research staff blind to group membership. The statistical analysis was thorough, involving multivariate procedures with appropriate control variables; and when it appeared that all children in the experimental group were not receiving services as specified, subgroups of experimental children who did receive the specified services were analyzed separately.
However, no corrections to significance levels were applied to account for multiple tests, which increased the possibility of Type I errors; the authors defended this decision because it allowed them “to report findings that might be worthy of further research.” The very limited program impact may be explained by failures of both program implementation and program theory. First, actual services often adhered poorly to the model, and varied among HFAK program sites—attrition rates were high, home visit rates were lower than intended, and only 4% of families had a “high dose” of service. Second, the authors had some criticisms of the HFAK model—though these were highrisk families, the model had little information on strategies to address parenting risks. This represents a change from previous practice; in the mid-1990s the training materials used in Alaska included a “problem-solving risk reduction tool”; later training materials omitted this section. The authors suggest the need for “precise specification of a model’s theory.”
It appears that this home visiting program for high-risk families may have been both too little and too late. In contrast, an earlier randomized study (Olds et al., 1997) of another home visiting program reported favorable outcomes in a 15-year follow-up—including a highly significant long-term reduction in cases of child abuse and neglect. In this earlier study, the clients were young single mothers, visited during pregnancy and infancy; the home visitors were nurses; and the service was more consistent and more intensive (M = 32 visits). This difference between the results of the HFAK and Olds et al. studies confirms the importance of providing services that are both early and adequate.
Reference
Olds, D.L., Eckenrode, J., Henderson, C.R., Jr., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278(8), 637-643.