A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs

Abstract

Objectives In this large scale, mixed methods evaluation, we determined the impact and context of early childhood home visiting on rates of child abuse-related injury. Methods Entropy-balanced and propensity score matched retrospective cohort analysis comparing children of Pennsylvania Nurse–Family Partnership (NFP), Parents As Teachers (PAT), and Early Head Start (EHS) enrollees and children of Pennsylvania Medicaid eligible women from 2008 to 2014. Abuse-related injury episodes were identified in medical assistance claims with ICD-9 codes. Weighted frequencies and logistic regression odds of injury within 24 months are presented. In-depth interviews with staff and clients (n = 150) from 11 programs were analyzed using a modified grounded theory approach. Results The odds of a healthcare encounter for early childhood abuse among clients were significantly greater than comparison children (NFP: 1.32, 95% CI [1.08, 1.62]; PAT: 4.11, 95% CI [1.60, 10.55]; EHS: 3.15, 95% CI [1.41, 7.06]). Qualitative data illustrated the circumstances of and program response to client issues related to child maltreatment, highlighting the role of non-client caregivers. All stakeholders described curricular content aimed at prevention (e.g. positive parenting) with little time dedicated to addressing current or past abuse. Clients who reported a lack of abuse-related content supposed their home visitor’s assumption of an absence of risk in their home, but were supportive of the introduction of abuse-related content. Approach, acceptance, and available resources were mediators of successfully addressing abuse. Conclusions for Practice Home visiting aims to prevent child abuse among high-risk families. Adequate home visitor capacity to proactively assess abuse risk, deliver effective preventive curriculum with fidelity to caregivers, and access appropriate resources is necessary.Electronic supplementary materialThe online version of this article (10.1007/s10995-018-2530-1) contains supplementary material, which is available to authorized users.

Contributions of Preventive Social Services in Early Childhood Home Visiting in a Disadvantaged Area of Sweden: The Practice of the Parental Advisor

“…The parental advisors, however, do not generally perceive any difficulty in establishing good contact once the initial acceptance is achieved. Neither is the mandatory reporting duty perceived as a hindrance, contrary to what was found in a study of child abuse prevention in home visiting ( Matone et al, 2018 ). The high levels of participation as well as very high levels of satisfaction shown in surveys with parents from the program ( Burstrom et al, 2017 ) seem to reinforce the perceptions that a positive relationship is created.…”

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

“…A 2018 evaluation of the NFP in Pennsylvania, USA, used propensity score matching to compare NFP and control families in rates of use of hospital-based health care for injuries. 81 Although a higher rate of attendance was found among NFP families, these were mostly due to differences in minor injuries; no difference between groups for more serious injuries was observed. Matone et al 81 point to the need for high-quality implementation to replicate beneficial trial findings.…”

“…81 Although a higher rate of attendance was found among NFP families, these were mostly due to differences in minor injuries; no difference between groups for more serious injuries was observed. Matone et al 81 point to the need for high-quality implementation to replicate beneficial trial findings. Olds' original trial 9 provides the most rigorous long-term evidence of programme impact when implemented as intended by the developer and when combining data sources to understand maltreatment outcomes.…”

Using probabilistic record linkage and propensity‐score matching to identify a community‐based comparison population

“…In this case, propensity score matching was necessary because we needed each comparison family to have a specific matched program family so that we could identify which CPS events occurred when the comparison child was in the same age range as the program child was during program involvement. A similar strategy was used by Matone et al (2018) to examine child abuse‐related injuries in three HV programs, which matched children in HV program data to similarly aged children in birth certificate data; the resulting dataset was linked with Medicaid data. Because unique identifiers were available, deterministic linkage was performed.…”