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Home visit programmes

Assessing whether home visit interventions for new and pregnant mothers are a cost-effective tool to prevent child maltreatment

Headline points
  • This review investigated the cost-effectiveness of 12 different home visit programmes for new and pregnant mothers
  • Home visit programmes are most cost-effective for median to high risk families
  • Effectiveness of the intervention was measured by reductions in child maltreatment
  • There is high quality evidence that suggests that home visit programmes prevent child maltreatment
  • The body of evidence is based on home visit programmes predominantly based in the USA, only one of the reviewed home visit programmes is based in the UK
Useful contacts
Child maltreatment

Overall effectiveness: 1 (maximum 2)

Strength of evidence: 3 (maximum 3)

What is this?

This review sought to report on the cost effectiveness of home visit programmes that aimed to prevent children from entering care and reduce child maltreatment. The home visit programmes are interventions that provide support and guidance to new and pregnant mothers, where there is deemed to be risk of child maltreatment

The paper looked at 33 pieces of research evaluating home visit programmes, but detailed analysis of the cost effectiveness was explored using data from 18 studies which evaluated 12 different types of home visit programmes.

The home visit programmes varied in terms of components, length, intensity, and target population. However, the programmes followed a similar structure which consisted of information sharing, service provision and case management.

How is it meant to work?

Home-visit programmes are interventions which provide support and guidance to new and pregnant mothers. The intervention is a preventative programme which seeks to identify and address potential maltreatment of children.

Home visit programmes are broad and can include a range of interventions. The programme often includes meetings that cover topics from childhood development, physical care of children, and the parent-child-relationship and so forth.

What are the evaluated outcomes?

  • Child maltreatment

How effective is it?

Overall, home-visiting programmes had a positive effect on reducing child maltreatment. This is based on the high strength of the evidence which indicates that strong confidence can be placed on the conclusions drawn. This is because of the 18 studies reviewed, 16 used randomised control trials.

However, it is important to note that the review has potentially limitations. The studies reviewed used different definitions of child maltreatment, which will lead to differences in the number of cases of child abuse reported.

Where has it been studied?

The majority of the programmes reviewed were based in the USA, followed by Australia, Canada and New Zealand, while only one of the 18 studies took place in the UK.

Who does it work for?

There were different eligibility criteria for the home-visit programmes that were reviewed. The reviewed pieces of research were targeted at women either during pregnancy or within six months of giving birth. Eleven of the studies targeted women during pregnancy, while the rest targeted women who had given birth within the last six months.

Seven of the 18 studies targeted women who were at low to medium risk. This included adolescent mothers, those on low incomes, those who were socially isolated, in unstable housing or had negative feelings towards their pregnancy.

The remaining 11 studies included women deemed to be at a ‘high risk’ or ‘very high risk’. This included situations where there was current or suspected child abuse, domestic violence, drug use or criminal convictions.

The findings suggest that home visiting programmes are most cost effective for families who show medium to high risk of child abuse. Home visit programmes are least cost-effective for low risk families.

When, where and how does it work?

The implementation of the home visit programmes varied depending on the length of the programme, the number of visits and way measurements were reported. Some programmes had total number of visits, hours per week, or number of times per month, whilst others offered visits tailored to individual family needs.

The evidence showed that the seven most cost effective programmes lasted for a duration of six to 30 months, with an average of 19.5 months. The number of visits ranged from six to 22, although where families had six visits, these visits could last up to four hours in duration.

While, the eight least cost-effective programmes lasted for 12 months or less and only two delivered more than 20 sessions, with three using less than ten visits.

This evidence suggests that home visit programmes are most effective when the intervention is intensive and lasts over longer durations.

What are the costs and benefits?

To evaluate the cost effectiveness of home visiting programmes it was compared to the cost of usual practice. However, the authors of this review use a flawed approach to calculation when they tried to evaluate the impact to wider society, therefore no conclusion can be made on the cost-effectiveness of home visiting programmes from a societal perspective.

How is it implemented?

The review evaluated different home-visiting programmes, therefore the way in which they are delivered varies. Most of the programmes were delivered by  nurses, midwives or support workers. The interventions that targeted high to very high-risk women were delivered by professionals including social workers, psychologists or early childhood tutors.

Programmes lasted for a duration of six to 30 months, and the number of visits ranged from 6 to 22. Home-visit programmes included a combination of information sharing, service provision and case management. Parents are also taught about child health and development, childcare and education.

Home visiting programmes often involve access to other services. Nine of the studies also provided other support services such as clinic visits, transportation, and phone contact. While eight studies adopted an approach where they would do ‘whatever it takes’ to provide the correct support. This could include social work intervention, housing assistance, parenting groups and other appropriate services and support.

In summary...

  • Home visit programmes are most cost-effective for families at medium to high risk of child maltreatment.
  • The findings suggest that the programmes that provided extra support, alongside home-visit intervention, are more effective.
  • Cost-effectiveness analysis are based on the direct costs of the intervention. The review was unable to effectively calculate how the programme was cost-effective for wider society by preventing the number of cases of child maltreatment.
  • Only one of the reviewed studies evaluated a UK based home visit programme. Research investigating home visit programmes is required in a UK setting, in order to assess whether home visit programmes are cost-effective in a UK context.

Further resources

This summary comes from an original systematic review called:

Dalziel, K. and Segal, L. (2012). Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes. Archives of Disease in Childhood, 97, 787-798