Background: The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods: A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. <p>Results: Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.</p> <p>Conclusions: Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.</p> / http://www.biomedcentral.com/1471-2458/13/17

Research Doctorate - Doctor of Philosophy (PhD) / Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

Research Doctorate - Doctor of Philosophy (PhD) / Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.