Duggan Anne, McFarlane Elizabeth, Fuddy Loretta, Burrell Lori, Higman Susan M, Windham Amy, Sia Calvin
Department of General Pediatrics, Johns Hopkins University School of Medicine, 1620 McElderry Street, Baltimore, MD 21205-1903, USA.
Child Abuse Negl. 2004 Jun;28(6):597-622. doi: 10.1016/j.chiabu.2003.08.007.
To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth.
This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records.
HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency.
The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.
通过对出生时经人群筛查确定为有虐待儿童风险的家庭进行家访，评估家访对预防儿童出生后头3年遭受虐待和忽视的影响。
本实验研究聚焦于由三个社区机构运营的夏威夷健康起步计划（HSP）站点。从1994年11月至1995年12月，643个家庭被纳入研究并随机分为干预组和对照组。虐待和忽视儿童的情况通过观察到的和自我报告的养育行为、所有因创伤以及若有足够预防护理本可避免住院的疾病而住院的情况、母亲放弃其主要照顾者角色以及儿童保护服务（CPS）机构证实的报告来衡量。数据通过每年对母亲的访谈（对所有接受基线访谈的家庭每年随访率达88%）、对家庭环境的观察以及对CPS、HSP和儿科医疗记录的审查来收集。
HSP记录很少提及家访人员对可能存在虐待行为的担忧。在大多数虐待衡量指标上，HSP组和对照组相似。HSP组的母亲较少使用常见的体罚/言语惩罚（调整后优势比[AOR]=0.59，p=0.01），但这归因于一个机构减少了威胁打孩子的行为。HSP组的母亲报告的忽视行为较少（AOR=0.72，p=0.02），这与一个机构中干预家庭的母亲对问题的关注减少趋势以及获得医疗护理的改善有关。
该计划未能预防虐待儿童或促进非暴力管教方式的使用；它在预防忽视方面有一定程度的影响。提高成效的可能目标包括该计划的实施系统和模式。
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