New Statewide Study Shows Home Visiting Services Need Additional Supports to Prevent Child Abuse Injuries

Large Pennsylvania Study Finds No Evidence of Child Abuse Injury Prevention Among Three Evidence-Based Home Visiting Models

Philadelphia, Pa. – June 14, 2018 – Children of mothers engaged in evidence-based home visiting programs are more likely than children who don’t receive home visiting services to visit the emergency department or receive inpatient care for abuse or injury, according to a new study by PolicyLab at Children’s Hospital of Philadelphia. The large, mixed-methods study, published online ahead of a special issue of Maternal and Child Health Journal for state-led evaluations of the federal home visiting program, found no evidence that programing in three of Pennsylvania’s federally funded home visiting models prevents child abuse, which suggests a need for interventions to strengthen child abuse prevention services.

When the researchers looked carefully at occurrences of abuse, they found that while abuse was not common, children in home-visited families were at higher risk of experiencing it than children who lived in their community and shared very similar characteristics, but who didn’t receive home visiting services. The researchers did not find that home visiting services caused abuse, but rather they had no discernible impact on child abuse prevention. The majority of injuries to home-visited children observed in the study were minor and not abuse related, including bruises, abrasions and lacerations.

“As evidence-based home visiting programs have expanded in recent years to serve more families with varying health and social challenges, such as domestic violence and mental illness, the research has been mixed on whether or not these services successfully prevent child abuse and injury,” said Meredith Matone, DrPH, MHS, deputy director of PolicyLab and lead author on the study. “In collaboration with the Commonwealth of Pennsylvania, we were able to conduct a rigorous, large-scale study across several home visiting models that unfortunately showed these programs, as currently implemented, are not meeting the child abuse prevention needs of families, reflecting the same difficulty many health professionals and programs have faced in tackling what is a very complex issue.”

In the study, the researchers presented information from interviews with families and home visitors that provide insight into the challenges surrounding abuse prevention among home visiting programs in the Commonwealth. Three important themes emerged, including 1) a commendable job by the Pennsylvania programs in enrolling families most in need of supportive parenting services – those with mental health challenges, social adversities and compounding health issues that are also known to contribute to risk for child abuse and injury; 2) a trend of injuries happening not under the mother’s supervision, but when children are left with other caregivers who may not receive home visiting services; and 3) differing opinions among families on the quality and consistency of resources they received from home visitors related to child abuse prevention and injury.

“It would be easy to take these findings as a threat to home visiting programs, but that would ignore the tremendous support these programs provide to families and the significant opportunity the evidence-based Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) legislation created for quality improvement of these services for families in need,” said Dr. Matone. “We look forward to working with policymakers and program administrators to use these evaluation findings to ensure home visiting services, which have become a critical component of public health infrastructure in many states, are best meeting the needs of families in Pennsylvania and across the country.”

In Pennsylvania, the Office of Child Development and Early Learning (OCDEL) receives funding through MIECHV to implement and expand four evidence-based home visiting programs: Early Head Start, Healthy Families America, Parents as Teachers and Nurse-Family Partnership. PolicyLab has partnered with OCDEL on the evaluation of the state’s MIECHV-funded programs since 2011, an evaluation that is mandated by federal law.

PolicyLab relied on a rigorous, mixed-methods evaluation – using large administrative datasets and more than 150 qualitative interviews with home visiting administrators, staff, and clients – to understand the real world impact of these programs on the lives of the more than 14,000 Pennsylvania families they serve. The findings in the Maternal and Child Health Journal paper are only one piece of PolicyLab’s full evaluation report, which also showed positive impacts of home visiting programs including helping pregnant mothers quit smoking and receive adequate prenatal care, and leading to more children receiving recommended well-child visits. Learn more about PolicyLab’s evaluation here: http://policylab.chop.edu/project/evaluating-home-visiting-programs-pennsylvania-how-are-they-faring.

Limitations: The use of the gold-standard controlled experiment was not feasible in the conduct of this research study given the scope; therefore, the study used robust and widely-accepted methodology for estimating program effects with an observational design. Additionally, the study was not able to identify the perpetrators of abusive injuries to children.

Citation: Matone M, Kellom K, Griffis H, Quarshie W, Faerber J, Gierlach P, Whittaker J, Rubin D, Cronholm P. A mixed methods evaluation of early childhood abuse prevention within evidence-based home visiting programs [published online ahead of print (May 31, 2018)]. Maternal and Child Health Journal. 2018. doi: 10.1007/s10995-018-2530-1

Funding: Commonwealth of Pennsylvania Office of Child Development and Early Learning

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About PolicyLab at Children’s Hospital of Philadelphia: PolicyLab at Children’s Hospital of Philadelphia (CHOP) is dedicated to achieving optimal child health and well-being by informing program and policy changes through interdisciplinary research. Founded in 2008, PolicyLab is a Center of Emphasis within the CHOP Research Institute, one of the largest pediatric research institutes in the country. With more than 28 highly-regarded faculty and 55 passionate staff who bring expertise from myriad of fields covering health, research and health policy, our work focuses on improving public systems, improving health care delivery and improving child health outcomes. For more information, visit http://www.policylab.chop.edu.