Early childhood home visits

Impact on crime
Evidence quality 2
Effect
How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 1
Implementation
What it costs
cost full Evidence quality 0
Economic cost

What is the focus of the intervention?

Home visits in early childhood involve trained personnel (known as health visitors in the UK) visiting the home of parents with children within the first two years of the child’s life.

Visits can begin during pregnancy or after the birth, and visitors provide information about child care, children’s health and development, and parental training.

The visitors offer support to the parents and often deliver a combination of services. While home visits are universal in the UK, they are not in the USA, where they are often targeted at specific population groups, such as parents on low incomes, ethnic minorities, young and first-time mothers, and those with lower educational achievements. Homes where children are believed to be at risk of abuse are also specifically targeted.

This narrative is based on one review of 26 studies, all conducted in the USA. The outcomes measured were child abuse and neglect, domestic violence between parents, and violence by children in later life. 

EFFECT

How effective is it?

Overall, the evidence suggests that home visits in early childhood have reduced crime.

The authors calculated an overall effect size using 20 studies which had child abuse or neglect as an outcome. They found that on average, rates/incidents of abuse and neglect were 39% lower for those children whose families received early childhood home visits compared to control groups. This is a statistically significant difference. Findings from the 4 studies which measured future levels of violence by children in later life were inconsistent, with two studies finding no significant differences between treatment and control groups, and two studies finding significantly lower levels of convictions, self-reported arrests and numbers of individuals processed through the probation system.

Only one study assessed levels of violent behaviour committed by adults in the visited home, finding a significant decrease of over 80% in the sample of single mothers with a low income who were arrested and convicted of crimes in a 15-year follow up period. The rest of the participants in this study did not see a significant decrease.

Studies measuring child abuse and neglect, and which were of higher design quality, with randomised allocation of participants, saw an average reduction of 27.5%, while those of lesser quality without randomised allocations saw a much higher average reduction of 68.3%.

How strong is the evidence?

Although the review was systematic, some forms of bias that could influence the study conclusions remain. 

The review had a well-designed search strategy and statistically analysed differences in the effect size between different study designs. However, the review did not take into account potential issues with publication bias, statistical dependency or weighting by size of the study sample.

MECHANISM

How does it work?

The review mentioned a number of ways in which home visits in early childhood may reduce crime.

Human ecology theory stresses the importance of the home environment of a child for their development, while attachment theory stresses the important of the child-parent bond. By increasing parents’ self-confidence, knowledge and skills, early childhood home visits are believed to improve the environment in which children are raised, and improve positive attachment to the parents. Giving parents knowledge and resources is believed to help improve child development, skills and health and well-being, leading to less violence being perpetrated by, or against, members of the household. The review did not collect data to test these mechanisms.

MODERATORS

In which contexts does it work best?

Within the review, a number of contextual factors were presented and tested by the authors. Home visits in early childhood appeared to be more successful for households with low socio-economic status. The type of person who visited the home to provide help and information to parents was also found to have an impact upon the effectiveness of the intervention. Programmes which used nurses (47.8% decrease) and mental health workers (44.5% decrease) saw significantly larger decreases in crime (child abuse, neglect and domestic abuse between parents) than those which used paraprofessionals (those who are trained to assist professionals but do not hold professional licenses) (17.7% decrease). It was also found that programmes of a longer duration (of two years or more) showed significantly larger decreases in crime than those which were shorter.

Multi-component programmes which involved both pre-natal and post-natal visits showed significantly higher decreases in crime (74.3% reductions) than those which were post-natal only (20.9% reductions).

IMPLEMENTATION

What can be said about implementing this initiative?

Early childhood home visits are universally offered in the UK but in the USA, where the studies from the review were conducted, visits are targeted on at risk groups.

Targeted populations included teenage parents, single mothers, families of low socio-economic status, families with very low birth-weight infants, parents previously investigated for child maltreatment, and parents with alcohol, drug, or mental health problems. In the U.S., programme components may include one or more of the following: training of parent(s) on prenatal and infant care; training on parenting to prevent child abuse and neglect; developmental interaction with infants and toddlers; family planning assistance; development of problem-solving and life skills; educational and work opportunities; and linkage with community services.

Home visit programmes may be accompanied by the provision of day care; parent group meetings for support and/or instruction; and advocacy.

The review noted that barriers to successful implementation of programmes include the recruitment, training and retention of visitors due to low pay and difficult working conditions. Paraprofessional visitors may also require more training and supervision than professionals.

ECONOMIC CONSIDERATIONS

How much might it cost?

Where information about the cost of the intervention was reported in the primary studies, this was highlighted within the review, but no cost/benefit analysis was conducted as the relevant information was not available.

For one study the direct costs of nurse visits for 2 years was $6,286 per family in 1997. Another study from the same year reported average programme costs of $958 per family. The review mentioned one cost-benefit study which found a benefit of $350.61 per low income family. However for the whole sample, which also included families of medium and high income, they found a cost of $3,081 per family rather than an overall benefit.

General considerations

  • All the primary studies were conducted in the USA, where the intervention can be more comprehensive than the universally available but more basic support offered in the UK. This needs to be kept in mind when interpreting the results.

Summary

Overall, the evidence suggests that home visits in early childhood have reduced crime when directed at high-risk groups.

For those studies which measured child abuse and neglect, on average rates/incidents of abuse and neglect were 39% lower for those children whose families received early childhood home visits compared to control groups. Significant reductions in arrests and convictions were also seen in populations of low income parents and single mothers. Visits by professionals and programmes of longer duration which started before birth were shown to have the greatest effect on reducing violence. Limited information showed the programmes to be more cost beneficial to participants on low incomes.

Ratings for Individual Reviews

Review 1

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 2
Moderator
How to do it
what full Evidence quality 1
Implementation
What it costs
cost full Evidence quality 0
Economic cost

Resources

Review: Bilukha, O., Hahn, R. A., Crosby, A., Fullilove, M. T., Liberman, A., Moscicki, E., Snyder, S., Tuma, F., Corso, P., Schofield, A. and Briss, P. A. (2005) 'The Effectiveness of Early Childhood Home Visitation in Preventing Violence: A Systematic Review', American Journal of Preventative Medicine, 2005:28(2S1), 11-39

This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC).  ESRC Grant title: 'University Consortium for Evidence-Based Crime Reduction'.  Grant Ref: ES/L007223/1.

 

Uploaded on 20/04/2016

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