Child outcomes of home-visiting for families with complex and multiple problems

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. A prominently used type of intervention for these families is Home Visiting (HV). 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 realize sustainable change and 2) that children receive too little attention in family-focused interventions (Knot-Dickscheit, Thoburn & Knorth, 2016). Objective The aim of this study is to investigate which child outcomes are reported in evaluation studies of HV and how HV affects these outcomes. Methods A systematic review was conducted using the PsycInfo, ERIC, SocIndex, MedLine and Picarta databases. The focus of this study was on home visiting programs for families with complex problems. In focusing 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 behavior. Finally, studies from before 1980 were excluded. Outcomes Multiple child outcomes of HV programs are reported such as decreased externalizing problem behavior, decreased delinquency and prevention of out-of-home placement. Although some positive effects of HV have been found, patterns of outcomes – both within and between studies – are often incoherent