Home visiting, one of the most acclaimed child welfare strategies in recent decades, just got another gold star from researchers, who found new evidence that the program could help prevent child neglect.
The study of Connecticut’s statewide home visiting program, which uses the Parents as Teachers model, found that participation in the program reduced the likelihood of a substantiated neglect report by 22 percent.
“These results from a scaled-up statewide program highlight the potential of home visiting as an important approach to preventing child abuse and neglect,” said the authors of “Preventing Child Maltreatment,” which was published in the most recent edition of Child Abuse & Neglect.
Home visits for at-risk parents involve sending a trained professional (a nurse, a social worker or a trained community member) to the home of young families (often single or teen moms, or low-income parents) a few times per month to go over basic parenting skills. These might include safe sleep practices, nutrition, basic child psychology and communication training.
Such programs have previously been shown to improve health, education and cognitive outcomes for their young children. The reach of home visiting received a major boost when the Affordable Care Act passed, and included a massive increase in federal spending on certain home visitation models.
But researchers had found little to suggest that most home visiting models prevent child abuse and neglect. The Nurse-Family Partnership model is a notable exception, identified in 2016 by a federal commission as the only program known to reduce the risk of a maltreatment-related fatality.
This study adds more evidence that home visiting can lower the likelihood of maltreatment. A team led by Barbara Chaiyachati of Yale School of Medicine’s Department of Pediatrics searched Connecticut’s state child protection investigation database for records matching those of over 2,600 mothers who signed up for a home visit from a trained parent and social worker team.
The team also collected data on any investigations of child maltreatment, substantiated cases of maltreatment, and child removal due to a confirmed maltreatment allegation. The study used a process called propensity score matching to compare the home visiting clients to a “cohort of families who were eligible for the home-visiting program but did not participate.”
The two groups were investigated for maltreatment at about the same rate. But, confirmed maltreatment reports were significantly lower for those mothers who received home visits twice a month from Connecticut’s Nurturing Families Network.
The authors conclude: “Home visiting was associated with a 22 percent decrease in the likelihood of substantiated reports, with specific impact on the occurrence of neglect but not physical abuse.”
There were other positive findings, but the connection between home visiting and lower substantiated neglect looms largest. While physical and sexual abuse generate a more visceral public reaction, the vast majority of substantiated maltreatment is neglect.
Neglect accounted for 80 percent of the estimated 676,000 maltreatment cases in 2016, according to recent federal data. Neglect cases have declined overall in the United States since 2014, though that drop has been concentrated in about 20 states.
The study noted its own shortcomings. It was not a randomized control trial design — the most rigorous, conclusive study design. The study also noted that if home visiting involvement is known to a child protective services worker, “it is possible” that the family “may have experienced a positive bias in decision making by CPS case workers resulting in fewer substantiated reports.”
These findings come on the heels of a five-year reauthorization of Maternal, Infant and Early Childhood Home Visiting (MIECHV), the federal program that was expanded through the Affordable Care Act. MIECHV will distribute $400 million per year to states for home visiting through the year 2022.
Parents as Teachers is a national model of home visiting that uses trained and certified parent educators to build protective factors in new families. The national organization is based in St. Louis. The model is rated as a “promising practice” by the California Evidence-Based Clearinghouse for Child Welfare.
“Our families are dealing with a lot of stressors, including high rates of poverty, maternal depression, opioid abuse and teen parenting,” said Constance Gully, CEO of Parents as Teachers National Center. “We are truly humbled that this new research confirms that our home visiting model has such a significant impact on supporting families and children being healthy, safe and ready to learn.”