Components Associated With Home Visiting Program Outcomes: A Meta-analysis

Abstract

Introduction Although several systematic reviews have concluded that home visiting has strong evidence of effectiveness, individual evaluations have produced inconsistent results across and within programs. We used a component-based, domain-specific approach to determine which program characteristics most strongly predict outcomes across a range of programs and models. Methods Medline and PsycINFO searches identified evaluations of universal and selected home visiting programs implemented in the United States. Coders trained to criterion coded characteristics of research design, program content, and service delivery. We conducted random-effects, inverse-variance-weighted linear regressions using program characteristics to predict effect sizes (ESs) on six outcome domains (birth outcomes, parenting behavior, maternal life course, child cognitive outcomes, child physical health, and child maltreatment). Results Aggregated to a single ES per study (k=51), the mean ES was 0.20 (95% CI = 0.14, 0.27), with a range of – 0.68 to 3.95. Mean ESs were significant and positive for three of the six outcome domains (maternal life course outcomes, child cognitive outcomes, and parent behaviors and skills), with marked heterogeneity of ESs in all six outcome domains. Research design characteristics generally did not predict ESs across the six outcome domains. No consistent pattern of effective components emerged across all outcome domains. Conclusions Home visiting programs evidenced small but significant overall effects, with wide variability in the size of domain-specific effects and in the components that significantly predicted domain-specific effects. Communities may need complementary or alternative strategies to home visiting programs to ensure widespread impact on these six important public health outcomes.

Effects of Home-Based Intervention Program to Prevent Child Abuse for Parents: A Meta Analysis

“…We found a curvilinear association with program duration and number of program sessions. Programs with a moderate duration (6-12 months) or a moderate number of sessions (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) yielded significantly higher effect sizes compared to shorter or longer programs and programs with fewer or more sessions. This indicates that for at-risk or maltreating parents who are targeted in these interventions somewhat more comprehensive programs with longer duration may be needed in order to effectively change parenting behavior.…”

“…However, some meta-analyses did not specifically include papers that measured the actual occurrence of child maltreatment [21,22], focused solely on non-maltreating families [23][24][25], included only home-visiting programs [23,25,26], and/or included studies with less rigorous designs than RCTs [21,23,24]. For instance, Layzer and colleagues [21] combined abuse and neglect outcomes with child injuries, accidents, and removal from the home into a single category 'child safety', which makes it impossible to estimate the actual ability of programs to prevent or reduce child maltreatment.…”

“…A significant but small overall effect on reported child maltreatment was found, but moderator analyses were not conducted. Similarly, Filene and colleagues [23] examined the effect of home visiting programs on child maltreatment, but they also included nonrandomized designs, and did not include maltreating families, thereby only examining the preventive effect of interventions. In contrast to Geeraert and colleagues, these authors did not find a significant effect on child maltreatment.…”

Design matters in home visiting improvement

“…36 As a recent meta-analysis concluded, certain aspects of home visiting are more likely to be associated with specific outcomes, and selecting one programmatic approach to home visiting may not be as effective as redesigning and tailoring existing programs to address significant components. 37 …”

Creating a National Home Visiting Research Network

“…Reports of home visiting impacts are often silent on program characteristics, service delivery, fidelity, and threats to fidelity. 3,4 For example, of the 25 studies in the Centers for Disease Control and Prevention Task Force systematic review of home visiting, 5 only 3 compared actual services to service model standards. [6][7][8] Sweet and Appelbaum' s meta-analysis 9 could compare models only by broadly defined program attributes and could not assess study heterogeneity or the appropriateness of aggregating results across studies.…”