Reducing maternal intimate partner violence after the birth of a child: a randomized controlled trial of the Hawaii Healthy Start Home Visitation Program

Abstract

Objectives: To estimate whether home visitation beginning after childbirth was associated with changes in average rates of mothers' intimate partner violence (IPV) victimization and perpetration as well as rates of specific IPV types (physical assault, verbal abuse, sexual assault, and injury) during the 3 years of program implementation and during 3 years of long-term follow-up.

Design: Randomized controlled trial.

Setting: Oahu, Hawaii.

Participants: Six hundred forty-three families with an infant at high risk for child maltreatment born between November 1994 and December 1995. Intervention Home visitors provided direct services and linked families to community resources. Home visits were to initially occur weekly and to continue for at least 3 years.

Main outcome measures: Women's self-reports of past-year IPV victimization and perpetration using the Conflict Tactics Scale. Blinded research staff conducted maternal interviews following the child's birth and annually when children were aged 1 to 3 years and then 7 to 9 years.

Results: During program implementation, intervention mothers as compared with control mothers reported lower rates of IPV victimization (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.73-1.01) and significantly lower rates of perpetration (IRR, 0.83; 95% CI, 0.72-0.96). Considering specific IPV types, intervention women reported significantly lower rates of physical assault victimization (IRR, 0.85; 95% CI, 0.71-1.00) and perpetration (IRR, 0.82; 95% CI, 0.70-0.96). During long-term follow-up, rates of overall IPV victimization and perpetration decreased, with nonsignificant between-group differences. Verbal abuse victimization rates (IRR, 1.14, 95% CI, 0.97-1.34) may have increased among intervention mothers.

Conclusion: Early-childhood home visitation may be a promising strategy for reducing IPV.

Trial registration: ClinicalTrials.gov NCT00218751.

Figure 1. Participant flow through recruitment, intervention and follow-up

*Multiple imputation used to decrease bias from lost-to follow-up

Figure 2. Mean rates (number of acts per one person-year) of maternal intimate partner violence (IPV) victimization by treatment group at each point of follow-up

*Follow-up occurred annually from child age 1–3 years, and then annually when the child was 7–9 years old. The x-axis shows the average child age at each follow-up time point. Baseline IPV is not included because the instrument used (CTS1) at this point differed the instrument used (CTS2) at all other time points.

Figure 3. Mean rates (number of acts per one person-year) of maternal intimate partner violence (IPV) perpetration by treatment group at each point of follow-up

*Follow-up occurred annually from child age 1–3 years, and then annually when the child was 7–9 years old. The x-axis shows the average child age at each follow-up time point. Baseline IPV is not included because the instrument used (CTS1) at this point differed the instrument used (CTS2) at all other time points.