This article presents an evaluation of an in-home support program for at-risk mothers and their children. The program was multidisciplinary and was focused on development of parenting capacity and child-development competencies. The authors examine issues and problems that resulted from the blending of two models of practice-stabilization/crisis intervention and early intervention/health promotion-and describe the outcome-based evaluation that was used to assess initial and ongoing child development, parent-child interaction, family environment, and social support. When documentation and evaluation of practice and its effect on outcomes proved a considerable challenge, the authors developed a classification system to describe practice in three areas: situations addressed, interventions used, and referrals made. The article describes challenges surrounding program development, implementation, and evaluation.

A single blind, pre-test, post-test design was used to test the effectiveness of the Keys to Caregiving Program in enhancing adolescent mother-infant interactions. Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.

Background: This systematic literature review is stimulated by the perceived need of investigator, practice and policy stakeholders for a complete but parsimonious summary of key elements of programs that use home visitation for at-risk young families as the major delivery method. Objectives: To describe the program components, practices, outcomes, and reliability of the evaluation approaches. Methods: Computer and hand searches of literature were carried out. Reports of established programs, from the last five years, that describe home visitation services to atrisk families were included. A comprehensive data collection tool was used in the analysis of the findings. Findings: Improvements over the previous five years were seen in the following areas: use of early intervention model, inclusion of comparison groups and adequate sampling. Discussion: Challenges remain in development, targeting and reporting of home visitation practice, overall lack of impact, differential effects by program site, retention of participants and appropriate measurement. METHODS Computerized searches of CINAHL, ERIC and MEDLINE were carried out. Key search terms included home visitation, healthy families, nurse visitor, paraprofessionals, and child abuse. Reports to funders and journal manuscripts published between 1995 and 2000 were included. 1-7, 9,10,12-15,17-19,21-33 Descriptions of programs and home visitation practices, not included in the recent publications, 8,11,16,20 were sought in past literature. Government documents, program reports, published bibliographies, and reference lists from six previously published literature reviews on aspects of home visitation were hand searched. 1-7 Conferences and workshops focusing on home visitation were attended and relevant abstracts and papers reviewed. Key informants were contacted to locate both published and unpublished papers. These sampling methods yielded 33 published program evaluations and 3 evaluation reports to government and/or funding agencies. Of the 36 program evaluations, 10 articles describe aspects of the Nurse Home Visitation Program. Of those 10, 3 were selected since they include: the most complete description of the program and original evaluation; 8 the most recent