Building Social Support to Enhance Home Visitation

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The problem of physical child abuse and neglect remains an intractable public health concern, with over five million children per year suspected as victims in the U.S. In addition to immediate medical sequelae, physical child abuse and neglect predicts some of society's most intractable social problems, including propensity for later life violence perpetration. In this context, early home visitation services have emerged as one promising primary prevention strategy that aims to avert physical child abuse and neglect and its later consequences. Although prior research indicates the generally positive impact of such services, growing evidence indicates that social contextual factors, and most especially qualities of parents' social networks, long identified as playing a key role in the etiology of physical child abuse and neglect, also play a substantial role in shaping the degree to which such services succeed in preventing maltreatment. Given this, in response to the CDC Request for Applications for "Violence-Related Injury Prevention Research," the present study proposes to examine the efficacy of a social networking enhancement integrated within home visitation services. Initial pilot work has yielded a manualized intervention that has showing highly promising preliminary trends on child maltreatment proxies, social network qualities, parenting stress, and related factors. The present study proposes a cross-over waitlist control group design, whereby 200 families will be randomly assigned to either a home visitation plus social network enhancement condition, or a wait-list control group of families only receiving home visitation services for 4 months, later to receive the social networking enhancement component. Data on physical child abuse and neglect risk, social networks, parents sense of control, participation in home visitation, and associated other factors will be collected at baseline and at 3 month and 9 month follow-up points. This study will be led by a team of child maltreatment prevention investigators at Columbia University, in close collaboration with two of the major home visitation programs in New York City that served as pilotsites, Best Beginnings of Alianza Dominicana, and Healthy Families Staten Island of the New York Foundling Hospital.