More evidence in support of home visitation prevention programs

Date Published

Fergusson, D. M., J. M. Boden, et al. (2013). Nine-Year Follow-up of a Home-Visitation Program: A Randomized Trial. Pediatrics, 131(2): 297-303.

Reviewed by
Nico Trocmé

Provided with sufficient intensity over a sustained period of time, home visitation parent support programs for high risk families have been shown in a growing number of studies to have positive effects on parenting and on child outcomes. This nine year follow-up study of an Early Start program in New Zealand adds compelling evidence that the effects of these programs are maintained over time.  Four hundred and forty three high risk families screened at the birth of a child were randomly assigned to treatment and control conditions.  The 220 families in the treatment condition received home visitation services delivered by public health nurses or social workers for an average of two years.  

Positive changes in parenting and child outcomes that had been found at 36 months were maintained in the nine year follow-up.  Compared to the controls, the Early Start parents reported less use of harsh punishment, higher self-rated parenting competence, and more positive ratings of child behaviors.  In addition, Children in the Early Start program had significantly fewer hospital visits for unintentional injuries compared to the control group children. There were, however, no significant differences maternal depression, parental substance use, intimate partner violence, and stressful life events, and no difference in teacher ratings of child behaviour.  Nevertheless, the evidence of sustained gains in parenting provide further support for the deployment of appropriately targeted and intensive home visitation programs. 

Methodological notes

This experimental evaluation employed rigorous randomization procedures, and controlled for refusals (6%) and families lost to follow-up (22% at the nine year point).  While a fairly broad range of measures were used, it is noteworthy that other than the lower hospital reported injury rates, statistically significant differences were only noted for parent reported measures.  It should also be noted that the study did not track reports to child protection authorities.