A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs

Area of Science:

• Public Health
• Pediatrics
• Social Work

Background:

• Early childhood home visiting programs aim to prevent child abuse in high-risk families.
• The effectiveness of these programs in reducing child abuse-related injuries requires further investigation.

Purpose of the Study:

• To evaluate the impact of early childhood home visiting programs on child abuse-related injury rates.
• To explore the context and program responses to child maltreatment within these interventions.

Main Methods:

• A mixed-methods evaluation using retrospective cohort analysis of Pennsylvania Medicaid data (2008-2014).
• Compared children enrolled in Nurse-Family Partnership (NFP), Parents As Teachers (PAT), and Early Head Start (EHS) with Medicaid-eligible controls.
• Analyzed in-depth interviews with 150 program staff and clients using modified grounded theory.

Main Results:

• Home visiting program clients had significantly higher odds of healthcare encounters for child abuse compared to control children (NFP: 1.32, PAT: 4.11, EHS: 3.15).
• Qualitative data revealed program focus on prevention (e.g., positive parenting) with limited content on addressing existing abuse.
• Clients desired more abuse-related content, and program capacity, acceptance, and resources mediated effective intervention.

Conclusions:

• Current home visiting models may not adequately reduce child abuse-related injuries.
• Programs require enhanced capacity for proactive abuse risk assessment and effective curriculum delivery.
• Adequate resources and trained home visitors are crucial for addressing child maltreatment in high-risk families.