Duggan Anne, Caldera Debra, Rodriguez Kira, Burrell Lori, Rohde Charles, Crowne Sarah Shea
General Pediatrics Research Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1903, USA.
Child Abuse Negl. 2007 Aug;31(8):801-27. doi: 10.1016/j.chiabu.2006.06.011. Epub 2007 Sep 5.
To assess the impact of a voluntary, paraprofessional home visiting program in preventing child maltreatment and reducing the multiple, malleable psychosocial risks for maltreatment for which families had been targeted.
This collaborative, experimental study focused on 6 Healthy Families Alaska (HFAK) programs; 325 families were enrolled in 2000-2001, randomized to intervention and control groups, and interviewed to measure baseline attributes. Follow-up data were collected when children were 2 years old (85% follow-up rate). Outcomes included maltreatment reports, measures of potential maltreatment and parental risks, for example, poor mental health, substance use, and partner violence. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure perceived effectiveness and training adequacy.
Parental risks were common at baseline, and one-sixth of families had a substantiated child protective services report in the child's first 2 years of life. There was no overall program effect on maltreatment reports, and most measures of potential maltreatment. Home visited mothers reported using mild forms of physical discipline less often than control mothers. The groups were similar in their use of more severe forms of physical discipline. There was no program impact on parental risks. There was no impact on outcomes for families with a 'high dose' of home visiting. Home visitors often failed to address parental risks and seldom linked families with community resources. Contradictions in the model compromised effectiveness.
The program did not prevent child maltreatment, nor reduce the parental risks that had made families eligible for service. Research is needed to develop and test strategies to improve the effectiveness of home visiting.
评估一项由准专业人员自愿进行的家访项目在预防儿童虐待以及降低家庭面临的多种可改变的虐待相关社会心理风险方面的影响，该项目的目标群体即为这些家庭。
这项合作性实验研究聚焦于阿拉斯加6个“健康家庭”（HFAK）项目；2000年至2001年期间，325个家庭参与其中，被随机分为干预组和对照组，并接受访谈以测量基线特征。当孩子2岁时收集随访数据（随访率为85%）。结果包括虐待报告、潜在虐待及父母风险的测量指标，例如心理健康不佳、物质使用及伴侣暴力。查阅HFAK记录以衡量家访服务。对家访人员进行调查以衡量其感知到的有效性和培训充足性。
父母风险在基线时很常见，六分之一的家庭在孩子出生后的头两年有一份经证实的儿童保护服务报告。该项目对虐待报告及大多数潜在虐待测量指标没有总体影响。接受家访的母亲报告称，她们使用温和体罚形式的频率低于对照组母亲。两组在使用更严厉体罚形式方面相似。该项目对父母风险没有影响。对接受“高剂量”家访的家庭的结果没有影响。家访人员常常未能解决父母风险问题，很少将家庭与社区资源联系起来。该模式中的矛盾损害了有效性。
该项目未能预防儿童虐待，也未降低使家庭符合服务条件的父母风险。需要开展研究以开发和测试提高家访有效性的策略。
