Hawaii Research Offices, Johns Hopkins University School of Medicine, 677 Ala Moana Blvd., Suite 1009, Honolulu, Hawaii 96813, USA.
Prev Sci. 2013 Feb;14(1):25-39. doi: 10.1007/s11121-012-0297-y.
There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n = 643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3 years. Outcome data were collected when children were 1, 2, and 3 years old and 7, 8, and 9 years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.
家庭访视计划对高风险家庭所取得成果的影响存在差异。了解效果在家庭之间的差异对于完善服务目标和内容非常重要。本研究评估了母亲的属性（包括关系安全感）是否以及如何适度影响短期和长期家庭访视对母亲心理社会功能的影响。在这项针对基于人群的、具有多种族裔的、有虐待新生儿风险的家庭的家庭访视的多地点 RCT 中（n=643），家庭被随机分配到家庭访视（HV）和对照组。HV 家庭将接受受过培训的准专业人员从出生到 3 岁的密集服务。在儿童 1、2 和 3 岁以及 7、8 和 9 岁时收集了结果数据。总体而言，HV 和对照组母亲的短期和长期结果没有显著差异。人口统计学属性、整体母亲风险的一般衡量标准以及伴侣暴力并没有调节方案对心理社会功能结果的影响。母亲的关系安全感确实调节了项目的影响。在关系焦虑方面得分高但在关系回避方面得分不高的母亲表现出最大的益处，尤其是在长期随访中。在关系焦虑和回避方面得分都较高的母亲经历了家庭访视的一些不利后果。需要进一步研究以确定中介途径，并为家庭访视的目标人群提供信息并测试方法，以扩大当前模型无法受益的目标家庭的积极家庭访视的影响。
