The effects of home visiting on child maltreatment: A matched comparison group study

• In Event: Engagement and Outcomes of Home Visiting or Small Group Programs in the Transition to Parenthood

Abstract

Federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds support the implementation of three evidence-based home visiting programs in Texas: Parents as Teachers (PAT), Nurse Family Partnership (NFP), and Home Instruction for Parents of Preschool Youngsters (HIPPY). Limited causal evidence exists that these program models reduce child maltreatment. Early randomized control trials of NFP include some favorable effects on medical visits for injuries and ingestions but no effects on substantiated abuse or neglect in early childhood (Kitzman et al., 1997; Olds et al., 1986; Olds et al., 1994). Although early studies of PAT show no impact on maltreatment, PAT names child safety as a program goal (Drazen et al., 1993; Wagner et al., 1999; Wagner et al., 2001). In contrast, HIPPY neither targets child maltreatment nor has evidence for the outcome. Most child maltreatment studies on NFP and PAT occurred over twenty years ago, and as early as the 1970s. The populations, priorities, and policies today differ from that time, casting doubt that the program models will produce the same impacts today. However, more recent evidence of these programs’ effects on maltreatment remains mixed. For example, Chaiyachati et al. (2018) found that PAT participants were less likely than a matched comparison group to experience substantiated maltreatment, whereas Matone et al. (2018) found that NFP and PAT children were more likely than matched comparison groups to experience serious injuries often associated with abuse.
To broaden the evidence base, this quasi-experimental matched comparison group study will compare child maltreatment outcomes from families that participate in Texas PAT, NFP, and HIPPY from 2009 to 2018 to similar non-participating families. We identified participant families in Texas birth records using exact and fuzzy-matching techniques, successfully identifying 86% of NFP, 85% of PAT, and 78% of HIPPY families. Next, we will use Coarsened Exact Matching (CEM) to select samples of non-participating families who are similar to the participating families at birth. We will use multivariate logistic regression to compare the prevalence of investigations and substantiated investigations of maltreatment recorded in Texas’s child welfare database following the start of home visiting for participating families and over a comparable timeframe for non-participating families, controlling for additional covariates and any remaining imbalance between the groups. Programs rarely know families’ prior child welfare involvement beyond direct referrals or self-report, and many past studies either do not report prior child maltreatment or intentionally exclude families with prior child welfare involvement (Reynolds et al., 2009). For the three programs in this study, prior child welfare involvement is one of the strongest predictors of subsequent involvement after starting home visiting ([Blinded], 2021); therefore, we will examine differences between participating and non-participating families accounting for prior investigations with statistical controls and subgroup analyses. We will discuss the results of the multivariate analyses for HIPPY, PAT, and NFP, any notable results for subgroup analyses within race/ethnicity groups, and the implications for federally funded home visiting programs for the prevention and reduction of child maltreatment.

Authors

• Hilary Ann Doe, Vanderbilt University
  Presenting Author

• Cynthia A Osborne, Vanderbilt University

• Jennifer Huffman, Vanderbilt University

• Mason Shero, Vanderbilt University