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Observational Study
. 2018 May:79:476-484.
doi: 10.1016/j.chiabu.2018.02.019. Epub 2018 Mar 20.

Preventing child maltreatment: Examination of an established statewide home-visiting program

Barbara H Chaiyachati  1 , Julie R Gaither  2 , Marcia Hughes  3 , Karen Foley-Schain  4 , John M Leventhal  2
Affiliations
Observational Study

Preventing child maltreatment: Examination of an established statewide home-visiting program

Barbara H Chaiyachati et al. Child Abuse Negl. 2018 May.

Abstract

Although home visiting has been used in many populations in prevention efforts, the impact of scaled-up home-visiting programs on abuse and neglect remains unclear. The objective of this study was to assess the impact of voluntary participation in an established statewide home-visiting program for socially high-risk families on child maltreatment as identified by Child Protective Services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008 and December 31, 2011 who participated in Connecticut's home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. The main outcomes were child maltreatment investigations, substantiations, and out-of-home placements by CPS between January 1, 2008 and December 31, 2013. In the unmatched sample, families who participated in home-visiting had significantly higher median risk scores (P < .001). After matching families on measured confounders, the percentages of families with CPS investigations (21.1% vs. 20.9%, P = .86) were similar between the two groups. However, there was a 22% decreased likelihood of CPS substantiations (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.64-0.95) for families receiving home visiting. First substantiations also occurred later in the child's life among home-visited families. There was a trend toward decreased out-of-home placement (HR 0.73, 95% CI 0.53-1.02, P = .06). These results from a scaled-up statewide program highlight the potential of home visiting as an important approach to preventing child abuse and neglect.

Keywords: Child maltreatment prevention; Home-visiting.

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Figures

Figure 1
Figure 1
Consort Diagram
Figure 2
Figure 2
Propensity-Matched Kaplan-Meier Survival Plots (with number of families at risk at each time point) for Time to First Substantiation by Home-Visiting Status
Figure 3
Figure 3
Propensity-Matched Kaplan-Meier Survival Plots (with number of families at risk at each time point) for Time to First Out-of-Home Placement by Home-Visiting Status
See this image and copyright information in PMC

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