Child outcomes of home visiting for families with complex and multiple problems: a systematic review and meta-analysis

Introduction Families with complex and multiple problems are faced with an accumulation of problems across multiple areas of life. Furthermore, these families are often considered to be ‘difficult to treat’. Children and... [ view full abstract ]

Introduction
Families with complex and multiple problems are faced with an accumulation of problems across multiple areas of life. Furthermore, these families are often considered to be ‘difficult to treat’. Children and teenagers growing up in these families are exposed to an accumulation of risks and are adversely affected in their cognitive, social, emotional, and health development (Ghesquière, 1993).
A prominently used type of intervention for these families is Home Visiting (HV); these programmes take into account the complex combination of problems, set a clear priority of goals and support families in attaining these goals through intensive home visiting. Whereas positive effects of HV on parental stress and family functioning have been established, child outcomes show only moderate or incoherent patterns of change. Possible explanations of this phenomenon are 1) that existing interventions are too short to realise sustainable change and 2) that children receive too little attention in family-focused interventions (Knot-Dickscheit, Thoburn & Knorth, 2016).

Objective
A systematic review of child outcomes of professional HV programmes is lacking. The aim of this study is to investigate which child outcomes are reported in evaluation studies of HV and how HV affects these outcomes. The study is part of a larger project investigating the effects of combining home-visiting with child and youth coaching.

Methods
A systematic review was conducted using the PsycInfo, ERIC, SocIndex and MedLine databases. Combinations of terms referring to families with complex and multiple problems (e.g. multi-problem families, multi-stressed families, disadvantaged families) and home-visiting programmes (e.g. home-visiting, home-based care, placement prevention programmes) were used. The focus of this study was on home visiting programmes for families with complex problems. This excludes interventions aimed at families or persons with a single problem (e.g. financial problems) and interventions that are not home-based (e.g. foster care or residential care). In focussing on child outcomes we excluded reports of parent or family-related measures and only included measures related to child development such as cognitive development, social skills and problem behaviour. Finally, studies from before 1980 were excluded. During the review process both qualitative and quantitative studies were included. However, for quantitative outcomes – where enough statistical data was available - a meta-analysis was conducted to examine the extent to which home visiting programmes are successful in influencing these outcomes.

Outcomes
In the presentation a description will be given of the systematic review of reported child outcomes of HV. Multiple child outcomes of HV programmes are reported such as decreased externalizing problem behaviour, decreased delinquency and improved language and cognitive development. Although some positive effects of HV have been found, patterns of outcomes – both within and between studies – are often incoherent. Outcome measures will be presented in more detail, as well as specific outcomes of the meta-analysis. A review of child outcomes of HV provides youth care practitioners and researchers with a systematic overview of how HV affects child development. The identification of child outcomes in HV programmes allows practitioners and researchers to establish when HV is suitable. Finally, identifying child outcomes is an important step in the process of identifying which intervention elements of HV are related to meaningful improvement in child development.

References
Ghesquière, P. (1993). Multiprobleemgezinnen: Problematische hulpverleningssituaties in perspectief. Leuven/Apeldoorn: Garant.

Knot-Dickscheit, J., Thoburn, J., & Knorth, E. J. (Eds.) (2016). Supporting children when providing services to families experiencing multiple problems: Perspectives and evidence. Antwerp: Garant Publishers (pp. 1-134) (ISBN 978-90-441-3378-3).