The Role of Home-Visiting Programs in Preventing Child Abuse and Neglect

Article excerpt

Home visiting is an increasingly popular method for delivering services for families. Particularly for high-risk families with infants and young children, providing services within the context of the family's home appears to be a useful and effective strategy. In general, the goals are to provide parents with information, emotional support, access to other services, and direct instruction on parenting practices (although programs vary in how they achieve these goals and in the relative importance of the goals). (1) Many programs have been implemented, and quite a few have been evaluated rigorously, using random assignment to an intervention or a control group. Indeed, two earlier issues of The Future of Children, one in 1993 and the other in 1999, have focused on home-visiting programs for families with young children, (2) and several articles in other issues of the journal have also touched on the topic. (3) A number of good meta-analyses have been published in other journals as well, although some include only randomized experiments while others include both experimental and non-experimental evidence. (4)

The 1999 article in The Future of Children evaluated home visiting as a general intervention strategy, without specific regard to preventing child abuse and neglect. Of the six programs that were evaluated, four provided services to families with infants. The fifth program enrolled children beginning around age three, and the sixth enrolled children anytime from birth through age three and continued through age five. (5) In this article, we focus on early interventions because infants are at the greatest risk for child abuse and neglect. (6) In addition to the four programs examined in the 1999 issue--the Nurse-Family Partnership, Hawaii Healthy Start, Healthy Families America, and the Comprehensive Child Development Program--we also examine Early Head Start, the Infant Health and Development Program, the Early Start Program in New Zealand, a demonstration program in Queensland, Australia, and a program in the Netherlands for depressed mothers of infants. All have used randomized trials of home-visiting services aimed at improving parenting and preventing child abuse and neglect. (7)

What Is Home Visiting?

Home-visiting programs come in many shapes and sizes. Because home visiting is a method of service delivery and not necessarily a theoretical approach, individual programs can differ dramatically. They vary with respect to the age of the child, the risk status of the family, the range of services offered, the intensity of the home visits, and the content of the curriculum that is used in the program. Furthermore, programs vary in terms of who provides services (typically nurses vs. paraprofessionals), how effectively the program is implemented, and the range of outcomes observed. What all share is the belief that services delivered in the home will have some sort of positive impact on families and that altering parenting practices can have measurable and long-term benefits for children's development.

The results of several meta-analyses suggest that home-visiting programs do have positive effects for participants, though those effects are often modest. Some studies, such as those testing the efficacy of the Nurse-Family Partnership program across several sites, have shown positive outcomes in multiple domains for both mothers and children, with some of these effects continuing into the adolescent years. Other studies, however, such as the Hawaii Healthy Start Program and similar Healthy Families America programs have had much more limited success. Still others, like Early Head Start, have shown modest effects at the end of the intervention, although follow-up data are not available. The wide variability in programs makes it difficult to draw solid conclusions about the conditions under which home visiting is most effective.

The specific roles that home visitors play also vary quite a bit--and often fall in several different domains. …