Building healthy children: evidence-based home visitation integrated with pediatric medical homes

Area of Science:

• Pediatric Health
• Maternal Health
• Social Work in Healthcare

Background:

• Young, low-income mothers and their infants face significant risks, including child maltreatment, trauma, and maternal depression.
• The Building Healthy Children (BHC) collaborative integrates home visitation into primary medical care to address these challenges.
• Existing services often rely on screening and referral, which may not adequately support at-risk families.

Purpose of the Study:

• To evaluate the effectiveness of integrating three evidence-based home visiting services into primary care for at-risk families.
• To compare this integrated model against standard screening and referral to community services.
• To assess the impact on child maltreatment, parent-child relationships, maternal mental health, and overall family functioning.

Main Methods:

• A randomized trial involving 497 eligible families from three primary care practices.
• Intervention group received Parents as Teachers, child-parent psychotherapy, and interpersonal psychotherapy, with outreach support.
• Control group received screening and referral to community services.
• Data collected through participant evaluations and pediatric medical chart reviews, with integrated electronic medical record communication.

Main Results:

• High enrollment (75%) and retention (85% at age 3) rates in the BHC program.
• Baseline data revealed high prevalence of child abuse/neglect (37%), maternal depression (22%), and domestic violence exposure (59%).
• Preliminary findings indicate avoidance of Child Protective Services reports and foster placement, alongside high rates of preventive care for enrolled children.

Conclusions:

• The Building Healthy Children program provides a unique, effective model of evidence-based home visiting integrated within primary care.
• The program demonstrates high participant retention and successfully addresses the complex needs of young, at-risk families.
• This integrated approach shows promise for improving health outcomes and family functioning in vulnerable populations.