Supplement to The Effectiveness of Home

Visitation Interventions similar to KidsFirst,

Saskatchewan: A Focused Literature Review

Robert Gates, Early Childhood Development

Unit, Early Learning and Child Care Branch,
Saskatchewan Ministry of Education

Darren Nickel, Nazeem Muhajarine and the

Evaluation Research Team, Saskatchewan
Population Health and Evaluation Research Unit

2010
 Supplement to

The Effectiveness of Home Visitation Interventions Similar to

KidsFirst, Saskatchewan:
A Focused Literature Review

Containing

Appendix D: Summary of Selected Home Visitation Literature

Reviews: United States (1990 – 2007)

and

Appendix E: Summary of Selected Primary Literature on Home

Visitation Programs: United States and Canada (2005 – Most Recent)

By

Robert Gates
Early Childhood Development Unit, Early Learning and Child Care Branch,
Saskatchewan Ministry of Education

In collaboration with

Darren Nickel, Nazeem Muhajarine and the

Evaluation Research Team of the
Saskatchewan Population Health and
Evaluation Research Unit

2009
Appendix D: Summary of Selected Home Visitation Literature Reviews: United States (1990 – 2007)
Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
Gomby, D.S. To examine - primary prevention 13 meta-analyses; Parent outcomes:
(2005) research support for home visits to families 11 literature reviews; 1) knowledge, attitudes, and behaviour 1) HV may influence attitudes and sometimes
home visiting with pregnant women, 13 primary studies behaviours related to abuse/neglect, child
International programs improving newborns, or children development, and school readiness – effect sizes
Review of lives of children by up to age 5 typically <.20
reviews encouraging change - ongoing visits - families that seek services may benefit most
in attitudes, - goal to improve lives 2)
1996-2004 knowledge, and/or of children by seeking 2) maternal life course a) one project (UCLA FDP), employing a highly
behaviours of to change attitudes, a) stress, social support, and mental clinical approach, has shown positive effects
parents knowledge, and/or health - Most programs are not as clinical and have not
behaviours of parents shown benefits in mothers’ social support, stress,
- also includes HVs in or their use of community resources
combination with early - (Perhaps) very small benefits in maternal
childhood education mental health
and/or enhanced child b) mothers’ self-sufficiency b) best evidence from NFP -- deferral of
health care subsequent pregnancies – 67% reduction in
Elmira; 23% in Memphis
- studies of other large programs: no benefits,
although there might be an effect on educational
outcomes

Child outcomes:
1) health & safety
a) nutrition: breastfeeding & diet
b) preventive health services and a
medical home
c) child health status
d) child safety: unintentional injuries
and child maltreatment
1)
a) few studies have assessed – one meta-analysis
suggests not enough studies to conclude anything
- two other meta-analyses suggest HV
encourages breastfeeding
b) most research suggests no difference between
HV and comparison groups
c)little benefit on birth outcomes, mothers’
reports of children’s health, or height and weight
d) may help decrease injuries and change
parenting attitudes
- home safety hazards: may have some influence
on easy and cheap fixes
- unintentional injuries: NFP evidence suggests
HV may help lower

1 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
- child abuse and neglect: rare event – hard to
measure
- rates of abuse and neglect: best research
shows mixed results
- other measures of child maltreatment: HV
may influence maternal attitudes toward
abuse/neglect, mothers’ self-reported harsh
discipline, or mothers’ scores on measures
associated with risk for abuse/neglect
- in general: strongest evidence from NFP
research – effects depend upon family
characteristics and ability of program to modify
underlying risk factors
2) development, achievement, and 2) mixed evidence
behaviour: a) cognitive and language a) centre-based (with or without HV) yield more
development and academic benefits than HV alone
achievement - large cognitive benefits are not shown in best
research
- benefits more likely when services are directed
at the child rather than through parents
3) social and emotional development 3) most effect sizes .10-.15
and children’s behaviour - largest effects associated with targeting
children with developmental risks and/or
behavioural problems, having a goal of
developing parent competencies, and
professional staff

Additional parent education: - parents likely to participate in later schooling

Long-term outcomes: - because attribution as high as 50% in a year,

limiting results to those in program for longer
duration may result in a group that differs
substantially from the population that enrols
- ‘most compelling’ longitudinal studies involve
NFP – effects on AFDC, Food Stamps, number
of subsequent pregnancies, spacing between
pregnancies, substance use, and criminal justice
system involvement among poorest, unmarried
women in sample
- Elmira sample: less substantiated abuse (among

2 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
those who did not experience considerable
domestic violence), fewer arrests, convictions,
and probation violations among children – i.e.,
prevention of only the more serious forms of
antisocial behaviour

Fade-out and sleeper effects: - IQ differences appear to fade out

- NFP: significant differences in abuse and
neglect rates 15 years later – whereas there was
only a trend noted earlier

Effects on siblings and grandchildren - when HV combined with other services (e.g.,
early childhood education), may have effects on
siblings and may be longer lasting

Conclusions about longitudinal studies - NFP studies best, although results still vary
of HV across measures, sites, and families
- replication is necessary

Home visiting and centre-based - parent involvement combined with good

childhood education:
HV and medical system:
Cost-benefit analysis:
quality early childhood education – best results
- parents may welcome pairing of health services
with developmental services
-Aos et al. (2004), Karoly et al. (2005), work of
Olds and colleagues:
- NFP shows highest payoff
- results vary across sites
- HV in combination with other services may
offer better return
- more research needed

Importance of quality services: a) 4 elements:

a) family engagement: 1. enrolment of families
2. delivery of services at intended intensity
3. retention of families
4. maintenance of active and enthusiastic
family involvement during HV and in
recommended activities (i.e., homework)
- up to 40% refuse invitation to program
- around 50% attrition rate

3 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
- families receive about 50% of intended visits
- families often do not complete homework
- families who drop out early may be most in
need of program
b) skills and abilities of home visitors: b) success depends upon them
- research no conclusive on what training is
optimal
- paraprofessionals may produce results half the
magnitude of results of nurses (or no results at
all)
- paraprofessionals may be most appropriate in
programs with limited goals and clear and
detailed curriculum
- retention is important – difficult with low
wages
c) content and focus of visits c) important to select curriculum that directly
addresses the goals of the program and deliver
the curriculum as intended
d) cultural consonance d) parenting styles may differ by culture
- interventions that are dismissive of or
derogatory to cultural differences may lead to
problems
e) developing services appropriate for e) 3 issues to address: 1) domestic violence; 2)
high-risk families maternal mental health (especially depression);
f) malleability of quality 3) parental substance abuse
f) programs can be monitored, shaped, and
improved
- send program performance data to program
managers regularly

CONCLUSIONS:
- home visiting can produce small benefits
(effect size .0-.20) – but does not always
- Parenting outcomes most consistent
- No consistency in child development or
maternal life course outcomes
- Children with risk factors (biological,
developmental delay, already-noted behaviour
problems) benefit most
- Some research suggests highest-risk mothers

4 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
(low-income teen mothers...) may benefit most
- Fragile intervention: <100 hours contact; often
20-40 hours over a few years – tall task to
address complex issues
- Expectations should be modest
- HV should be part of a system employing
multiple service strategies, aimed at serving both
parents and children
- Quality is key – only the best programs will
benefit children and parents
- Focus on goals
- Ensure curricula match goals
- Make sure staff are ‘in sync’ with goals
- Families must receive information and
assistance related to goals
- Enrol, engage and retain families with
services delivered at intended intensity
- Hire the best, most qualified staff possible,
and pay wages that will retain them
- Check with families to make sure program
is serving their needs and wants
- Quality is malleable: set performance
standards, monitor progress, and make
corrections
Bilukha et al. To assess the - evaluated home 21primary studies -violence by child (4 studies): self- -violence by child: mixed results – insufficient
(2005) effectiveness of visiting programs reported delinquency; probation evidence to determine effectiveness of HV
home visitation - published before July processing; externalizing behaviour
US(20) & programs in 2001
Canada(1) preventing violence. - assessed at least one -violence by parent (1 study): maternal - violence by parent: non-sig results –
of: violence by child, arrests and convictions insufficient evidence – promising results
Systematic violence by parent
literature (other than child -intimate partner violence (1study): -intimate partner violence: non-sig results –
review maltreatment), domestic violence insufficient evidence
intimate partner
1969-1998? violence, violence -child maltreatment (abuse & neglect) - child maltreatment: strong evidence for
Published against child (child (21 studies in 21 reports with 26 reduction in maltreatment (around 39%) –
1979-2001 maltreatment) intervention arms): abuse/neglect stronger results with professional HVs – results
- conducted in reported by CPS/HVs; rates of injury, with paraprofessionals are mixed – benefits
established market trauma, or poison ingestion; out-of- generally found only in longer duration programs
economy home child placement (i.e., 2 years or longer)

5 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
- primary study (not
review) - professional produced stronger results
- included comparison - longer program more beneficial, esp. with
group paraprofessionals
- Elmira study suggested need to address partner
violence before HV effective in reducing child
abuse
- other benefits listed based on results of one
study

Authors outline a number of key research

issues/questions to consider.
Harding et al. 1) Provide synthesis Cover HFA 33 evaluations of A) Child health and development
2007; of Healthy Families evaluations subsequent Healthy Family a1) Birth outcomes a1) Birth outcomes -
American (HFA) to review of 17 HFA American sites • Four studies (2 RCTs) report on birth Positive findings on decreases in birth
U.S.; evaluation results to evaluations covered in outcomes with positive findings. complication and LBW call for in-depth study in
date; 1999 (Future of RCT (8) - One RCT found significantly light of generally poor outcomes across multiple
Literature 2) In-depth review Children report) with Comparison grp (7), (indicates probability of less than 5% home visiting models in this area (eg. Gomby,
review; of two large-scale emphasis on studies Single group (17) (p<.05 in this review) fewer birth 2005).
evaluations with that include a “Mixed method” (1) complications (18% vs.40% for
1998-2005 regard to science comparison group. controls).
and policy-making. - Second RCT found sig. lower rate of
LBW infants (3.3% vs. 8.3%). Two
Objectives of HFA: studies reported reductions in LBW
1) promote positive relative to community rates.
parenting, • No differences in 3rd trimester
2) enhance child prenatal care, premature births or need
health and for neonatal intensive care.
development, and
3) prevent child a2) Breastfeeding a2) Breastfeeding
abuse and neglect • Four studies reviewed, and all report Fairly consistent positive impact on
positive impacts, including two RCTs breastfeeding, although examined by relatively
which found greater likelihood of few studies.
breastfeeding mothers who enrolled
prenatally (50% vs 40%).
• Other studies found greater
likelihood of exclusive breastfeeding
(29% vs 15%) and breastfeed
significantly longer (6.5 mos vs 3.6).
• Groups did not differ on number of

6 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
mos of breastfeeding.

a3) Medical home a3) Medical home

• Sixteen studies (4 RCTs) report Results to date suggest that while families in
outcomes on the % of families linked HFA are consistently linked with medical
to a medical care provider. Rates are providers, there is no rigorous evidence of
consistently high (averaging 94% program impacts on this outcome.
across studies), yet none of the 4
RCTs reporting found a sig.
difference.

a4) Immunizations/well-baby visits a4) Immunizations/well-baby visits

•Twenty-eight evaluations report on These results provide no rigorous evidence for
one or both of these outcomes. None impacts on immunizations, and mixed findings
of the 6 RCTs examining on well-child visits.
immunization rates found program
benefits.
• Two RCTs report significant positive
impacts on number of well-child
visits, while two others found no
program impact.

a5) Developmental screening a5) Developmental screening

Thirteen evaluations report ASQ These findings reflect some challenges in
screening rates. The % of children completing screenings in many sites, most likely
screened average 75% across studies. related to the challenge of engaging families.

a6) Cognitive development a6) Cognitive development

Five RCTs included dev. assessments.
Two studies found sig. higher
performance among HV children.
One found positive impacts at 1 and 2
years on the Bayley Scales of Infant
Development, however, there was no
difference at 3 years using the
Stanford-Binet Intelligence Test. The
other RCTs found no group
differences at 1 or 2 years.
A few studies find modest evidence of program
benefits on cognitive development. There is
increasing evidence that cognitive impacts
require intensive, direct intervention with
children, such as enriched day care (Gomby,
2005).

B) Maternal life course

7 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
b1) Subsequent births b1) Subsequent births
Six studies have compared HV Few positive results and mixed findings.
families to others on subsequent
births, with few positive results. Only
one of four RCTs found a positive
effect, and this was limited to Anglo
mothers (28% vs. 55% repeat birthrate
over 3yrs). Two RCTs found no
significant group differences at 1 year
or 2 years. A fourth RCT found a
higher rate of repeat pregnancy among
HV mothers than controls at 1 yr.

b2) Economic self-sufficiency b2) Economic self-sufficiency

• One RCT found significant impacts Support for these maternal life course outcomes
on maternal education, with HV is minimal.
mothers more likely to increase their
educational level by 24 months post-
partum (18% vs. 7%).
• In contrast, four RCTs report no
positive impacts on several indicators
of maternal education and
employment. Also, one negative
impact was found on maternal
employment (41% vs. 48% at one 1
year).
• Two studies in this review (both
RCTs) reported on receipt of public
assistance, finding no program
impacts.

b3) Depression b3) Depression

• Maternal depression or general
mental health was measured in five
RCTs, of which three report limited
evidence of program impacts.
• In one (NY2), significantly
fewer home-visited mothers met the
cutoff for clinical depression at 1 year
(23% vs. 38% of controls), although
Modest but consistent impacts across 3 RCTs
and 2 comparison group studies. Although
limited, these results suggest some potential for
benefits and need for further study. Shortening
the duration of maternal depression in a child’s
earliest years could reduce child maltreatment
risk. Further examination is needed to identify
practice differences related to this outcome that

8 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
this impact was limited to one of the may guide future program development.
three sites evaluated.
• In another RCT, HVed mothers
showed a significantly greater
decrease in depression than control
mothers from intake to 2 years, but
groups did not differ at year 3.

b4) Domestic violence b4) Domestic violence

Three RCTs examined rates of No evidence of impacts unless “high dose.”
domestic violence; two studies found
no group differences at 2 and 3 years.
A third RCT found a reduction in
physical assault only for “high dose”
families (still active at 3 years and
received 75% of expected visits).

b5) Substance abuse b5) Substance abuse

Of 4 RCTs examining changes in Results provide confirmation of the challenges of
substance use, 2 report no impacts, 1 addressing substance abuse issues.
found sig. reduction in maternal
problem alcohol use but with a high
dose of services (defined above).
Number of cigarettes smoked per day
was sig. lower among home-visited
mothers under 18, and illicit drug use
was lower among HV mothers in 1 of
3 study sites. No differences were
found on the number of smokers or
alcohol abuse scores.

b6) Social Support b6) Social Support

Ten studies (including seven RCTs)
found no program impacts using the
Maternal Social Support Index which
measures support from family, friends
and neighbours. In contrast, 3 studies
using measures that assess formal (i.e.,
organized support services) as well as
informal support report positive
Findings overall suggest that few programs
impact social support, but measurement
differences may have contributed to the pattern
of results.
More information needed to determine the
comparability of maternal risk factors across
evaluations and site practices.

9 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
impacts.

C) Parenting
c1) Attitudes c1) Attitudes
Ten studies assessed parenting These results suggest that HFA may hasten
attitudes. Three RCTs report that HV positive changes in parenting attitudes.
parents improved at a greater rate on
one or both of measures used. One
found sig. improvements for teen and
least depressed parents.

c2) Stress c2) Stress

Eight evaluations examined this Overall there is very little evidence of program
outcome; 1 of 5 RCTs found HVed impacts on parenting stress
parents were sig. less likely to score at
or above the 90th %tile on the
Parenting Stress Index (PSI ) than
were control parents at 2 yrs (22% vs.
30%). Four RCTs found no sig.
program impacts.

c3) Home environment c3) Home environment

The HOME inventory results from Despite somewhat mixed results of RCTs, there
six RCTs are mixed. Two RCTs found is considerable evidence of HFA’s impact in this
no program impacts at 1-, 2-, or 3-year area.
assessments, while 4 yielded positive
program impacts at 6 mos, 1 yr, 2 yrs,
or both 1 and 2 yrs. Studies using
other designs consistently report
positive impacts on home environment

c4) Parent-child interaction (PCI) c4) Parent-child interaction

Two of the six RCTs found positive
program impacts on one or both
NCAST measures (Feeding and
Teaching). In contrast, four RCTs
found no group differences on the
NCAST scales. A pre-post study saw
sig. increases on the Teaching Scale at
1 year
Findings are mixed PCI. Overall, parenting
outcomes are positive, with greatest impacts on
parenting attitudes and home environment,
including PCI. PCI outcomes are important as
research suggests developmentally responsive
caregiving results in more attached mothers less
likely to injure, abuse, or neglect their children
(Olds, Kitzman, Cole, & Robinson, 1997).

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Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
D) Child maltreatment d1) Official statistics
d1) Official statistics/Substantiated Reduction in official rates of maltreatment
cases occurred
Six RCTs and four quasi-experimental in only 1 of 6 RCTs. .However, 3 large quasi-
studies examined this outcome. experimental studies suggest substantial benefits
- First RCT (Hawaii’s Healthy Start) a of HFA in reducing child maltreatment.
trend
(p < .10) was found indicating fewer
incidents of confirmed maltreatment
among home-visited families (3.3% vs
6.8%, where 62% were a type of
neglect).
- The remaining 5 RCTs report no
significant group differences on
substantiated child maltreatment. In
contrast, three of four quasi-
experimental studies report positive
impacts on child maltreatment rates.

d2) Parent self-report d2) Parent self-report

Four RCTs measured self-reported Parent self-report measures of child maltreatment
child maltreatment for 2 or 3 yrs. yielded modest program benefits, particularly for
- Earliest reports only 2 impacts across reductions in psychological aggression (3 of 4
3 yrs. RCTs) and neglect (2 of 4 RCTs).
- In the 2nd RCT, HV reported fewer
incidents of psych aggression and less
use of corporal punishment at 2 and 3
yrs.
- 3rd RCT found sig. lower rates of
psychological aggression and mild
physical assault across the 2 yr study,
but no difference in neglect or severe
physical assault.
- 4th RTC (Mitchelll-Herzfeld, 2005)
positive impacts on psych aggression,
neglect, minor physical aggression,
and severe/very severe physical abuse.
HV mothers used less psych
aggression overall, with sig. impacts

11 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Author,
Location,
Number and
Type, Objective Selection criteria Topics and outcomes Conclusions
type of studies
Study
period
for the least depressed mothers and
those free of domestic violence,
consistent with other research (e.g.,
Eckenrode et al., 2000).

12 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

Appendix E: Summary of Selected Primary Literature on Home Visitation Programs: United States and
Canada (2005 – Most Recent)
Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
United States
Caldera et al. “To assess the Healthy Voluntary: yes Aims: - to promote Baseline demographic and risk Parenting: HFAK associated with
(2007) impact of a Families 2-gen: yes positive parenting, variables - maternal mental improvements in...
voluntary, Alaska Targeted: yes child health, and child health, CES-D (depression - maternal self-efficacy
Alaska paraprofessional (HFAK) Onset: yes development scale), Mental Heath Index - quality of home environment for
Enrolled 1/00 to home visiting Duration: yes (MHI-5) ; substance use; and learning
7/01 and program on 6 sites Freq: yes (weekly for 6-9 partner violence (Conflict - use of centre-based parenting
followed until promoting child N=325 mo and diminish) Tactics Scale – CTS2) services
age 2 health and n=162HFAK
RCT developmental n=163control Child outcomes: injuries Child dev:
and maternal requiring medical care, - BMDI scores lower than norms
parenting hospitalizations, and ED visits; for both HFAK and control
knowledge, Baily child development groups
attitudes, and (BSID); child behaviour - child cog dev ES=.29
behaviours.” checklist (CBCL) - no (somewhat larger than mean
differences on health outcomes reported in Sweet & Appelbaum,
- HFAK better developmental 2004)
(Bayley MDI) and behavioural - improvements due to enriched
(CBCL internalizing & HOME scores?
externalizing)
Child behaviour:
Parent outcomes: parent -reduced problem behaviours
knowledge(KIDI), attitudes according to maternal reports
(AAPI), and self-ratings (Teti
Maternal Self-efficacy Scale, Home Visitors:
Guidubaldi Parent Satisfaction - felt adequately trained to
Scale); Observational measures promote positive parenting
of parenting (HOME; NCAST); through positive reinforcement
Disciplinary strategies (PC- - few felt prepared and effective
CTS); maternal recognition of in addressing risks
child developmental delay;
family linkage with a medical High attrition and lack of fidelity
home and other community to model

13 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
services
- no differences on most Implications:
- HFAK sig higher maternal - lower impact in families at
self-efficacy highest baseline risk – program
- fewer HFAK families had less appropriate for severe risk?
extremely poor HOME scores - actual services differed from
(20% vs. 31%) model and varied among sites –
- no sig differences on HOME strengthen training and
subscales monitoring
- HFAK more likely to have - program efficacy no greater than
health care coverage for target effectiveness – need to precisely
child (95% vs. 90%) specify model of change and use
- no diff in well child care and quant and qual measures of dose
immunizations that fit model
- very few receiving all of
recommended AAP well child “...evaluation of staff skills and
visits (4%) service quality need to be integral
to training and program
Actual home visiting services: operations”(p.848)
family engagement, “This experimental study found
individualized family plan, & that a home visiting program
visit content; child targeted to families at-risk of
developmental screening; home child maltreatment improved
visitor response to concerns some aspects of parenting, child
about child dev; adequate development and child behavior,
services but not child health. Outcomes
were consistent with the program
model and implementation
system. The program was
less effective in families at
greatest risk, suggesting that it
might not be appropriate for such
families. Unintended variations
in service content and quality
underscore the need for stronger
implementation systems when
taking a model to scale.” (p. 848)

Duggan et al. “To assess the Healthy Voluntary: yes Aims: - to prevent Baseline attributes: maternal - little evidence of prevention of

14 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
(2007) impact of a Families 2-gen: yes child maltreatment by mental health, substance use, child abuse – even though high
Alaska voluntary, Alaska Targeted: yes promoting positive and partner violence base rate (16%), and HVs made
Enrolled 1/00 to paraprofessional (HFAK) Onset: ? ( ½ identified parenting, child health, few child protection reports
7/01 and home visiting prenatally; ½ at birth) and child development Child maltreatment:
followed until program in 6 sites Duration: yes - CPS reports - 2 of 50 tests for moderation sig
age 2 preventing child N=325 Freq: yes (weekly for 6-9 HVs provide info, - maternal relinquishment of (level of chance)
RCT maltreatment n=162HFAK mo and diminish) make referrals to primary caregiver role - HFAK was no more efficacious
and reducing n=163control community services, - hospitalizations and ER visits for families with higher levels of
the multiple, 34 HVs help parents prepare - maternal report of disciplinary program service
malleable child dev; screen and tactics and neglectful parenting - “This suggests that the model
psychosocial refer for dev delay; behaviours (CTS-PC) might not be a good match for the
risks for promote home envir - observed parenting behaviours targeted high-risk families, for it
maltreatment safety. (HOME – HFAK families less did not achieve intended benefits
for which - use modelling & likely to provide poor quality even for families receiving a
families had reinforcement home environment) higher dose of service” (p. 819)
been targeted” - curricula encouraged
(abstract). but not required Family risk factors for child HFAK HVs are not to bring up
- encourage maltreatment at 2 years: risks (wait for parents) – move
establishment of - poor maternal mental health towards reducing risks?
medical home (CES-D; MHI-5), maternal
- support parents in substance use, and partner
crisis violence (CTS-2); and
- Individual Family Parenting Stress Index (PSI)
Support Plan for - maternal parenting attitudes
teaching problem (AAPI; Disciplining
solving around Questionnaire)
family’s goals
- HVs to complete Use of community services for
training within 6mo parenting risks

Actual home visiting services:

- family engagement, general
content, IFSP development,
ratings of home visitor
- home visitor response to
parent risks for maltreatment
- home visitor response to
concerns about child
maltreatment
- adequate services

15 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
Green et al. To present data Oregon Voluntary: yes From website: Rates of maltreatment - Program families had lower
(2008) on reported Healthy Start 2-gen: yes “Healthy Start is a rates (around 11/1000) than
US: Oregon child 32 sites Targeted: yes voluntary family comparison group (around
Fiscal year 2006- maltreatment Onset: yes support and parent 28/1000)
2007 among those Children aged Duration: yes education home - rates of maltreatment higher
participating in 0-3 in 2006-7 Freq: yes visiting program. among Healthy Start Intensive
Oregon’s who had been Healthy Start offers all Services families (17/1000)
Healthy Start served by Intensive home visiting first-birth families, compared with those who only
program, as Healthy Start services for less than 1/3 around the time their received screening, info, and
well as those n=13,853 of families. baby is born, free referral services (10/1000);
not enrolled in (11,591 basic; screening and however still lower than
the program. 2,262 information. Parents comparison group
intensive) receive information on - 96.9% of Healthy Start
Comparison: topics like child Intensive Service (home visited)
children up to development, infant families had no maltreatment –
3 yrs not care and keeping their similar to rates in NFP study
served by baby healthy, and (96%) and Hawaii Healthy Start
Healthy Start learn about what’s study (96.6%)
(general going on in their - rates of maltreatment increase
pop’n, but communities to with level of stress assessed on
screened) support new families. Kempe
n=124,363 Many families are - odds of maltreatment increases
eligible for home visits with number of risks: odds of
with a trained parent child victimization vs. no risks:
coach, or Family 1risk (2.86); 2risks (6.06);
Support Worker, who 3(10.37); 4(20.71); 5(14.55);
coaches them as they 6(30.28)
build their skills as
parents and help their
baby be safe and
healthy, grow and
learn.”

Love et al. Summarize Early Head Voluntary: yes Services provided 1)Child cognitive and language 1)
(2005) impacts of Early Start 2-gen: yes through home visits, development:
July 1995 – Head Start on 17 research Targeted: yes child care, case a) Mental Dev. Index (Bayley) a) program scored higher than
September 1998 child and parent sites located Onset: yes management, controls, although both groups
RCT outcomes when in all regions Duration: yes (mean 20- parenting education, were lower than national norms

16 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
children were of US (4 23mo) health care and b) Peabody Picture Vocab. Test b) program higher than controls,
three years old, centre-based; Freq: yes (weekly in referrals, and family (PPVT-III) and were less likely to score
and near the end 7 home- home-based programs) support below 85
of participation based; 6 - programs are home-
in the program mixed) based, centre-based, or 2)Child social-emotional 2)
3 questions: N=3,001 a combination development:
1-Did the Early (n=1,513 a) Child Behavior Checklist a) lower aggressive behaviour
Head Start program; (CBCL) (rated by parents)
programs have n=1,488 b) observation (coded using b) higher engagement with parent
significant
control) Three Box coding scales from and sustained attention to objects
impacts on child
and parenting NICHD Study of Early Child
outcomes at age Care)
3, when the
program ended? 3) Child health: 3)
2-Does adherence a) parent’s global rating of a) both groups tended to rate
to the Head Start health status over past year (5- health ‘very good’
Program point scale, poor to excellent)
Performance
b) child received b) EHS group marginally higher
Standards matter?
3-Are impacts immunizations since last (1.2%) than control
more likely to be interview? (question
found, or likely to administered 28mo after
be greater in enrolment)
magnitude, in 4) Parenting: 4)
Early Head Start a) total score from Home a) EHS group averaged 0.5 pts
programs that Observation for Measurement higher than control. Program
offer both center-
of the Environment (HOME) group in home-based program
and home-based
services (a mixed had an ES = .04 (very small).
approach) than in
programs that b) parent supportiveness based b) EHS parents rated as more
offer only, or on observation of videotape supportive than control parents
primarily, home- (composite of sensitivity, (by 0.1 pts)
or center-based positive regard, and cog.
services? stimulation – on 7-pt scale)

c) parent detachment based on c) EHS parents’ detachment

observation of videotape (7-pt marginally different from control
scale) (0.1pts)

d) reads to child daily or more d) 56.8% of EHS parents reported

than once a day versus 3 reading to child every day, versus

17 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
categories of less 52.0% of controls

e) spanked child last week e) 46.7% of EHS parents reported

spanking child in previous week,
versus 53.8% of controls.

-Full implementation of program

standards associated with better
outcomes for children

-children and parents in mixed

approach programs appeared to
fare particularly well compared to
controls (8 of 13 effect sizes were
above .2 and two of these were at
.3 or .31); especially when fully
implemented early on
-home-based programs produced
fewer impacts than did mixed
programs (only engagement of
parent and parent’s
supportiveness in play had effect
sizes above 0.15 – and none were
above 0.2)
- no sig impacts in centre-based
program families, although
smaller group – less power
- no sig differences between
approaches on many outcomes

SUMMARY:
“...we found that (a) overall, Early
Head Start programs had significant
impacts on a range of child and parent
outcomes when the child were 3 years
old; (b) programs that were well
implemented in relation to the federal
program performance standards
(whether early or later) produced a
greater range of impacts for both
children and their parents; (c) impacts

18 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
were greater for children and parents
attending the mixed-approach
programs, which combined home- and
center-based services, and being fully
implemented during the early period
increased the number and magnitude
of impacts found in mixed-approach
programs” (p. 896).
DuMont et al. Compare a Healthy Voluntary: yes Current intervention HFNY mothers reported Program effects were more
(2008) subset of HFA Families New 2-gen, comprehensive: yes focused only on child committing one-quarter as pronounced among those mothers
families that York Targeted: yes abuse/neglect many acts of serious abuse at who resembled the type of clients
U.S. resemble the Onset: prior to birth or prevention, though age 2 as control mothers (.01 traditionally served by NFP
pop. targeted by Total shortly after HFNY is a versus .04, p < .05). Two sets programs (i.e., young mothers
Data from 2005 the NFP n=1,173, Duration: yes comprehensive and of interactions were tested and enrolled prior to the birth of their
study, 2 yr program to test down to 1060 Freq: yes (at least 2/mo) intensive home found to have significant first child) and among the
follow-up the theory that it by year one, visitation program effects (p < .05). At age 2, psychologically vulnerable.
is not nurse and 992 by based on the HFA young, first-time mothers in the These findings suggest that who
RTC versus year two. model. Consistent HFNY group who were is offered home visitation may be
paraprofessional HFNY = 478 with the model, randomly assigned at 30 weeks an important factor in explaining
that accounts Control = 493 “specially trained of pregnancy or less were less the differential effectiveness of
for the different paraprofessionals likely than counterparts in the home visitation programs.
success rates, The provide home visiting control group to engage in Improved effects may be realized
but rather who “prevention services to new or minor physical aggression in by prioritizing the populations
is targeted (i.e., subgroup” expectant parents who the past year (51% vrs 70%) served or by enhancing the model
(young, first (like NFP) = are deemed to be at and harsh parenting in the past to meet program objectives for
child, recruited 15% of total risk of abusing or week (41% versus 62%). hard-to-serve families.
pre-natally) sample. neglecting their Among women who were
children. The goals of “psychologically vulnerable,”
HFNY are to: (1) HFNY mothers were one-
promote positive quarter as likely to report
parenting skills and engaging in serious abuse and
parent-child neglect as control mothers (5%
interaction; (2) prevent versus 19%) at age 2.
child abuse and
neglect; (3) support
optimal prenatal care,
and child health and
development; and (4)
improve parent’s self-
sufficiency.”
Olds et al. (2007) “...to test the Nurse Family Voluntary: yes - Prenatal visits 1) intervals between births of 1) visited women had longer

19 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
Memphis, TN effect of prenatal Partnership 2-gen: yes (mean=7) and first and second; sequelae of intervals (ES=0.29); fewer
1999-2001 and infancy home 1 site Targeted: yes postpartum visits subsequent pregnancies cumulative subsequent births per
RCT visits by nurses on N=743 Onset: yes (mean=26; birth to age year among those visited who
mothers’ fertility
<29wks Duration: yes 2) also had high initial
and children’s
functioning 7 gestation; Freq: yes - Detailed visiting psychological resources (ES=-
years after the primiparous; guidelines 0.14)
program ended at at least 2 risk Goals:
child age 2” characteristics - improve outcomes of 2) mother’s stability of 2) visited had longer relationships
(abstract). pregnancy by relationships; relationship with with current partners (ES=0.28)
From promoting healthy bio father of child
June1990 to behaviour 3) mother’s use of welfare, 3) visited used welfare (ES=-
Aug 1991, - improve health and food stamps, and Medicaid 0.14) and food stamps (ES=-0.17)
participants development of child for fewer months. No effect on
were by promoting use of Medicaid
randomized competent care 4) mother’s use of substances 4) ns
into control - improve parents’ life- 5) mother’s arrests and 5) ns
(n=515) or course development by incarcerations
nurse home promoting planned 6) child’s academic 6) visited children who were also
visited pregnancies, achievement; school conduct; born to mothers with low
through education, and finding mental disorders psychological resources had
child’s second work better grade-point averages
birthday (ES=0.22) and achievement test
(n=228) - help families use scores (ES=0.33) in math and
health and human reading (grades 1-3)
services 7) reduce child mortality 7) reduced mortality from
- attempt to involve preventable causes (control group
relatives and friends in 4.5 times more likely to die).
pregnancy, birth, and 8) subsequent marriages,
early care abortions, still-births, 8) ns
employment; domestic
violence; depression.

Gessner et al. “ ...to determine if Healthy Voluntary: yes See Duggan et al. I. mean number per child
(2008) all children Families 2-gen: yes above 1) any Child Protective 1) significantly higher than not
Alaska enrolled in Alaska Targeted: yes Services referral enrolled (4x); somewhat higher
Healthy Families
1996-2002 6 sites in 21 Onset: than high-risk group2 (born to
Alaska throughout
the state communities Duration: yes unmarried mothers with
Comparison of (including those Freq: yes documented prenatal alcohol use
population rates in the intervention – p=.07)
of abuse arm of the study) 2) referral for neglect 2) significantly higher than not

20 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
experienced a enrolled
greater decrease 3) referral for abuse 3) sig higher than not enrolled
in child abuse 4) referral for substantiated 4) sig higher than not enrolled
over time than
neglect
that documented
among all and 5) referral for substantiated 5) sig higher than not enrolled
high-risk un- abuse
enrolled children II. changes over time
living in Healthy - no changes for neglect and
Family Alaska substantiated neglect
communities (the - referrals for physical abuse
majority of whom decreased over time for enrolled
had received no
children (p=.005) and for risk
change in services
during the group 2.
evaluation - substantiated abuse did not
period)” (p. 319). change for enrolled but declined
for risk group2.

III. changes over time by number

of home visits
- highest referral rate for physical
abuse at baseline and the only
group to show change over time
was the group who had had 20 or
more home visits

IV. rates by number of home

visits
- no trend for substantiated abuse
- approaching sig trend for
physical abuse with higher rates
for those with more visits (p=.08)

Compared to two non-enrolled at-

risk groups, HF Alaska children
tended to experience lower rates
of abuse and neglect during first
month of life. After that, nearly
identical.

CONCLUSIONS:

21 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
- little evidence that home
visitation reduced rates of abuse
and neglect
- 42% decrease in referral rates
over time among enrolled
families may suggest
effectiveness, given increased
scrutiny
- on the other hand, 38% decrease
in physical abuse referral rates
among non-enrolled families with
unmarried mother who reported
prenatal alcohol use.
- possible population trend, not
associated with HF Alaska
CANADIAN STUDIES
Brownell et al. 1) determine the BabyFirst/ Voluntary: yes -“universal” in- hospital 1) - 75% of babies born 1) Missing ¼ of all births, and
(2007) utility of the Families First 2-gen: yes screening between 2000 and 2002 were missed most vulnerable families
Manitoba screening tool Targeted: yes - Paraprofessional HV screened. and infants
for identifying
Program is Onset: yes supervised by public - families not screen tended to
children at risk
Regression & of maltreatment; offered to all Duration: yes health nurses be more vulnerable, and infants
regression 2) evaluate the families in Freq: yes - Visitation begins not screened were at higher risk
discontinuity impact of the Manitoba, off- weekly for the first 1- for maltreatment
design BabyFirst home reserve 2yrs
visiting program - Targeted to families 2a) Rate of children in care 2a) 16 program children in care,
on selected N=184 to 242 with newborns living in (proxy for maltreatment) no comparison children
outcomes (program n=133 conditions of risk -
associated with
to 179; prenatal to 3 yrs of age 2b) children receiving services 2b) program families more likely
child
maltreatment; comparison from CFS to be involved than comparisons
3) examine n=51 to 62); - HVs seek to facilitate – improved connection or over-
trends in injuries depending upon problem solving, identification? (RDD could be
in the child outcome parent-child interaction used with this outcome only)
population of and community 3) maltreatment-related deaths
Manitoba before referrals. and hospitalizations 3) no deaths or hospitalizations
and after
program
4) continuity of care 4) no differences
implementation.
5) immunization rates 5) no differences, but relatively
high rates

22 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
Population-level data suggests
that the implementation of Continued analysis of population
BabyFirst is associated with a level trends in child maltreatment
reduction in rates of rates would help provide
maltreatment for children <3 confirmation as to whether these
yrs, independent of declining rates have truly declined, and if
time trends, but not for children BabyFirst implementation is
0–18 yrs. associated.
Gomes et al. “To present an Variety of Voluntary: yes Goals: Family functioning (Family Family Functioning:
(2005) analysis of programs based 2-gen: • Families are safe, Assessment Device): small Some improvements associated
Alberta descriptive on Healthy Targeted: yes healthy and able to numbers with repeated with HV – those in the program
(Edmonton information Families/Best Onset: <3mos (a little promote children’s measures; some improvements longer appeared to improve more
region) about the Start Model later) development. noted. Most benefit for (small numbers -- caution)
2001-2004 clients...” Duration: yes • Parents are more families not functioning well at
“To present an 11 sites, 2 Freq: knowledgeable about program entry.
Multi- analysis of Aboriginal parenting.
observation program programs At most sites, priority is • Children demonstrate Parent knowledge of child Parent Knowledge:
tracking study outcomes...” given to first time improved development (Child Improvements associated with
Non-client parents with children developmental Development Inventory): those HV among those with limited
(screened as under 3 months of age. functioning. expected to improve (limited initial knowledge – drop
eligible, but • Parents know how to initial knowledge) appeared to coincides with decrease in
chose to not access professional do so until yr 3 – then small relevance of the CDI instrument.
join) community resources decline
& General when required or
Edmonton for additional supports. Maternal Social Support Index: Maternal Social Support:
population (p.93) improvement expected groups HVs may have been successful in
comparison (felt they lacked support most helping parents develop and
groups on Model has developed at intake) appeared to improve maintain relationships.
selected over time, using over time; increased feelings of
analyses knowledge and research support were maintained for 2-
for best practice – 3 years. Improvement not
Program programs are “an ideal expected group appeared to
families N = model of collaborative decrease over time (?)
500. (60% community capacity
young single building” (p.92) Carey Infant Temperament Infant Temperament and Parent
parents) Questionnaire: % parents who Perception:
inaccurately characterized their HVs may model good parenting
infants’ temperaments perception and skills – may help
decreased from time 1 to time 2 parents deal with challenging
(rhythmicity: 32.3% improved; child

23 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics
Study period, Description measures
Number of (similarity to KF)
study type
sites
approachability: 76.9%;
adaptability: 25.7%; intensity:
25.7%; mood: 43.8%)
Parent interviews: 60
respondents, all felt the
program provided valuable and
needed services. Some parents
said they passed on information
learned from the HV to other
people.
Child Welfare Involvement
(child protection):
% of children with
involvement: 31.1 (clients);
20.4 (non-clients);
2.7 (population)
% of screens requiring further
investigation:
81.9 (clients);
77.8 (non-clients);
81.5 (population)
% of investigations requiring
further action:
49.1 (clients);
63.3 (non-clients);
56.8 (population)
% of investigations with
‘concerns not substantiated’:
22.0 (clients);
14.3 (non-clients);
21.2 (population)
% of placements involving
parental care:
49.6% (clients);
24 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)
Conclusions
Emphasizes the importance of the
relationships between parents and
their HVs in improving the lives
of their children and themselves.
Child Protection: clients are well
observed by well-trained home
visitors – suspicions are reported,
screened, and investigated, but
less likely to need further action –
evidence of program
effectiveness(?)
home visitation programs provide
less intrusive, cost-effective
alternative (adjunct?) to Child
Welfare services
Health Care:
Findings interpreted as supporting
the need for HV for client
population – parents younger,
more at-risk, more likely to
smoke, drink take drugs during
pregnancy, children more likely
to be premature and low birth
weight.
Findings seen to support the
effectiveness of HV – early on,
clients use healthcare services
more; however, use less services
later on (“appears to be due” to
involvement with HVs?)
 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
57.1% (non-clients);
39.3% (population Overall Conclusion:
HV programs “are effective in
% of placements involving achieving their objectives and at
agency foster care or foster the same time are generating cost
care: 25.0 & 7.8 (clients); savings for the Child Welfare
18.4 & 8.2 (non-clients); system.”
29.1 & 12.9 (population)
*Recommendations included in
% born early (< 37wks): report*
21.4 (clients)
18.5 (population)
% low birth weight:
10.0 (clients)
7.0 (population)

Rates of ER visits:
Birth – 1yr:
76.9/100 children (clients)
44.2/100 (population)
1-2yrs:
124.9/100 (clients)
97.0/100 (population)
2-3yrs:
86.7/100 (clients)
76.7/100 (population)

Rates of hospitalizations:
Birth to 1yr:
42.4/100 children (clients)
34.7 (population)
1-2yrs:
8.6/100 (clients)
7.4/100 (population)
2-3yrs:
2.9/100 (clients)
4.3/100 (population)
Ryan et al. The Short Healthy Babies, Voluntary: yes Goals: Short-term outcomes:
(2006) Term Healthy 2-gen: yes - to promote optimal 1) Child outcomes: 1)
Ontario Evaluation of Children Targeted: yes physical, cognitive, - infant development - higher infant dev scores

25 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
Data collected the HBHC (HBHC) Onset: shortly after communicative and - overall child health - lower scores on health
2004-2005 (2002) was an baby is born psychosocial - hospital admissions - more hospital admissions
Children born extensive 37 health units (At time of short-term development in children 2) Parent outcomes: 2)
July 2000 – June process 1,733 families evaluation) - to act as a catalyst for - parenting confidence - higher parenting confidence
2001 evaluation in Teachers Duration: families a co-ordinated, - social support - lower levels of informal social
37 health units completed Early received on average 13 effective, integrated - parental distress support
and outcome Development home visits with system of services and - parenting competence - higher levels of parental distress
evaluation of Instrument average duration of 1.2 supports for healthy - positive parenting - no effect
two cohorts of (EDI) forms on hours (2hrs for high child development and - families’ use of professionals - no effect
families. The 874 children risk) family well being - use of public health nurses - greater use of all professionals
Follow-on Freq: every 18 calendar through the - greater use of public health
Evaluation days on average development of a nurses
assesses network of service Follow-on Evaluation: children
outcomes for Blended home visitation providers and in kindergarten (1) home visited children showed
the family and for most (73%) participation in (1) outcomes for children: better scores on language and
the child when families, which includes community planning - Early Development cognitive development,
the child is in visits by public health activities (p. 1) Instrument (EDI) communication and general
kindergarten nurses and lay home knowledge and total development
(2005). It also visitors
extends the (2) outcomes for parents: (2) younger and older visited
work on Guidelines for the - additional parental education parents tended to complete
service program are consistent additional schooling
integration and with the Invest in Kids - social support - increased perception of social
carrying out home visiting training - parental competence isolation
additional material. - positive parenting - trend toward increases
instrument - trend toward increases
validation (3) service use: (3) less frequent contact
work - contact with GP or family
doctor CONCLUSIONS:
- HV strengthened children’s
readiness for school
- HV may lead parents to seek
additional schooling opportunities
- visited parents’ higher levels of
isolation suggest need for
program improvements

Santos (2005) 1) Does BabyFirst/ Voluntary: yes See program description 1) Family outcomes 1)
Manitoba participation in Families First 2-gen: yes BabyFirst/ Family First a) social support a) no sig.
the program Targeted: yes in Brownell et al. 2) Parent outcomes 2)

26 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

 Name of
Author,
Program Intervention
Location, Intervention Outcomes and Effect
Objective and Characteristics Conclusions
Study period, Description measures
Number of (similarity to KF)
study type
sites
RDD/ multiple for one year N=250; 187 Onset: (2007) a) depression a) no sig.
regression after the birth BabyFirst Duration: yes b) psychological well-being b) HV associated with improved
of a child families; 63 Freq: yes PWB; also associated with
improve comparison alliances with HV
family, parent, families 3) Parent-child outcomes: 3)
and parent- a) positive parenting a) HV associated with improved
child outcomes positive parenting; also with
at one year? b) hostile/ineffective parenting alliances with HV
2) Do more b) HV associated with increased
positive parent hostile/ineffective parenting
ratings of c) reading with children (???); also with alliances with HV
relationships c) no sig. – about 90% of parents
with others in both groups reported reading to
predict more children
positive parent
ratings of the
early alliance
in home
visiting?
3) Do stronger
alliances
between
parents and
HVs predict
better family,
parent, and
parent-child
outcomes at 1
year?
4) Do
improvements
in home
visiting
alliance predict
better family,
parent, and
parent-child
outcomes at 1
year?

27 Supplement to Effectiveness of Home Visitation Interventions Similar to KidsFirst (literature review)

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 For general information regarding SPHERU’s research
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SPHERU is a bi-university, interdisciplinary research unit committed to critical

population health research. The SPHERU team consists of researchers from
University of Saskatchewan and University of Regina who conduct research in
three main areas - northern and aboriginal health, rural health, and healthy children.

www.spheru.ca