Home Visiting Program

About the program

The Home Visiting program is a home-based prevention and early intervention program. It aims to mediate the risk for child abuse and neglect by enhancing family adjustment to the parenting role.

The home visiting program is designed to:

• establish a relationship of trust between the professional home visitors and the family
• promote maternal-infant attachment
• improve parental adoption of health promoting behaviors
• promote positive parenting practices
• reduce parental stress and improve maternal mood
• reduce child abuse potential
• promote the use of community and neighborhood support systems to assist families.

Who does it work for?

The program is designed for families of newly born infants who reported one or more of the following risk factors:

• sole parenthood
• ambivalence to the pregnancy (e.g. sought termination, no antenatal care)
• physical forms of domestic violence
• child abuse of either parent
• mother less than 18 years old
• unstable housing
• financial stress
• low levels of education for the mother
• low family income
• social isolation
• history of mental health disorders
• alcohol or drug abuse.

The Home Visiting program has been evaluated in Australia (Fraser et al. 2000).

A randomised control trial was conducted with 138 people (68 people were in the intervention group and 70 people were in the control group). On average, mothers were 26 years old. Most participants were Australian born, and around 9% identified as Aboriginal and/or Torres Strait Islander. CALD populations were also included in the study (about 25% were not born in Australia). Most participants were from low-income households.

What outcomes does it contribute to?

Positive outcomes:

• Child abuse potential: parents who participated in the Home Visiting program were less likely to be at risk of perpetrating child abuse, compared to parents who did not participate in the program. There was a significant reduction in the Child Abuse Prevention Inventory (CAPI) abuse scale scores, a screening tool used to identify individual risk for child abuse potential.

No effect:

• General parenting behaviours: the program has no effect on improved parenting behaviours, such as improvements in responsivity, acceptance, organisation, play materials, and involvement.
• Parenting stress: the program has no effect on parenting stress scores.
• Parent’s mental health: the program has no effect on the amount of a mother’s depressive symptoms.

Negative outcomes:

• No negative outcomes were found.

How effective is it?

Overall, the Home Visiting program has a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality randomised controlled trial (RCT) or quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT or QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT or QED studies show statistically significant adverse effects.

How is it implemented?

The Home Visiting program is implemented through home visits of 20-60mins in length.

Child health nurses undertook the home visits. Visits were weekly until infants are 6 weeks old, fortnightly until infants are 3 months old, then monthly until the age of 12 months. The minimum number of home-visits expected per family is 18 and can be exceeded where negotiated between families and nurses. 

A social worker also provided social work intervention in the home for families where parental conflict or maternal ambivalence was reported and where parents requested counselling for issues related to their own abusive childhood. The social worker provided an extension of the nurses’ home visiting by using a family therapy approach.

Six parent aides also provided weekly assistance on a short-term basis to families requiring intensive assistance with parenting.

Program services are adapted according to individual needs. However, one of the key aims of the program is to improve utilisation of community and neighborhood support systems. Both nurses and social workers are engaged in promoting social support systems, informal resources, and enhancing skills and confidence to access these resources.

Weekly case conferencing also occurs. This aims to encourage discourse, reflection, and mutual information sharing. Interdisciplinary assessment, planning, and evaluation of program strategies takes place at these weekly meetings. This interdisciplinary model of home visitation allows home visiting nurses to coordinate available community services to which families could be referred.

How much does it cost?

Not reported

What else should I consider?

Another community child health nurse was available for staff relief when required.

The visiting nurses (including the relief nurse) were selected on the basis of their experience of working with high-risk families in a community context. Each nurse held general nursing, midwifery and child health nurse qualifications.

A community paediatrician with expertise in child protection coordinated the intervention program team. The community paediatrician assessed families referred to an outpatient clinic, home visited in acute situations, provided medical attention where required, and facilitated access to child protection services when necessary.

Where does the evidence come from?

One RCT conducted in Australia, with 138 participants (Fraser et al. 2000).

Further resources

Fraser et al. (2000), Home visiting intervention for vulnerable families with newborns: Follow-up results of a randomized controlled trial. Child Abuse & Neglect, Vol. 24, No. 11, pp. 1399-1429.