Home-visiting interventions for families with complex and multiple problems:A systematic review and meta-analysis of out-of-home placement and child outcomes

Children growing up in families experiencing complex and multiple problems (FECMP) are at an increased risk of developing problems in multiple areas of life. A wide array of home-visiting interventions has been developed to address the complex care needs of these families. The aim of this study is to investigate out-of-home placement rates and child outcomes of these home-visiting interventions. A systematic review and meta-analysis was conducted using five scientific databases (PsycInfo, ERIC, SocIndex, MedLine, & Picarta). The systematic search of these databases yielded 8,377 hits. Forty-two publications reporting on 50 studies were included in the review. A random-effects survival curve meta-analysis model was estimated for out-of-home placement and random-effects meta-analysis models were estimated for children's behavioral problems and stressful experiences. Out-of-home placement increased from 7.5% at case closure to 24.3% one year after case closure. On average there was a moderate decrease in emotional and behavioral problems (d = 0.50) and stressful experiences (d = 0.50) during intervention, but considerable problems remained after case closure. More research is needed to investigate family and service characteristics that may explain heterogeneity in outcomes. Furthermore, there is a need to adopt a broader perspective in evaluations of home-visiting services by including outcomes related to the skills, development, and wellbeing of children

Toward tailored care for families with multiple problems:A quasi-experimental study on effective elements of care

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions