A comparison of three evidence based home visiting programs aimed at the prevention of childhood maltreatment

Abstract

Childhood maltreatment has lifetime consequences to a child's mental and physical health. For decades childhood maltreatment has been recognized as a public health crisis. In 2010, The Patient Protection and Affordable Care Act (ACA) of 2010 created the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) to promote and improve the health, development and well-being of at risk children and families through evidence based home visiting programs. This initiative has recognized home visiting programs as an early intervention preventative step in reducing incidence of childhood maltreatment. Urie Bronfenbrenner's Ecological Systems Theory of Development was used as the theoretical framework. This paper outlines and compares the effectiveness of the Nurse-Family Partnership, Parents as Teachers, and Early Head Start Home Visiting programs. The objectives of the paper are to provide a literature review exploring the ecological effects of childhood maltreatment, compare three home visiting programs delivery, efficacy, staffing, and costs. The Nurse Family Partnership is implemented in two cities in Montana. The fidelity of the program requires baccalaureate nurses. Appropriately trained personnel and funds must be available to implement. Parents as Teachers is the most widely used program in Montana accounting for sixteen programs. It costs the least of the three programs and is implemented by paraprofessionals. Early Headstart Home Visiting is offered in ten Head Start facilities throughout Montana. This is an option offered to families, but not utilized by all. Nurse Family Partnership showed favorable results in both reduction of childhood maltreatment and positive parenting practices. Parents as Teachers and Early Headstart Home Visiting findings enhanced positive parenting practices, but had mixed results in the prevention of childhood maltreatment. Much of the research of home visiting programs did not identify childhood maltreatment as a main intervention, which was evidenced by mixed results of effectiveness among the programs. Evidenced based home visiting programs are new to Montana. It may take years of implementation before effectiveness is assured. Home visiting programs need further study and a clear focus of program goals and measurements in order to correlate interventions with the reduction of childhood maltreatment.