Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening.
Date
2021-12
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Abstract
Background
The MIECHV (Maternal, Infant, and Early Childhood Home Visiting) program invests substantial federal resources to prevent child maltreatment and emergency medical costs. Eligibility is based on screening of demographic or clinical risk factors, but because screening accuracy in predicting poor outcomes is unknown, assignment to home-visiting might miss high-risk families or waste resources on low-risk families.Objectives
To guide eligibility decisions, this study tested accuracy of demographic and clinical screening in predicting child maltreatment and emergency medical care.Participants and setting
A population-representative sample of 201 birthing mothers (39.8% Black, 33.8% Latina) in Durham, NC, was enrolled between July 2009, and December 2010, and followed through December 2015.Methods
Participants were screened demographically (i.e., Medicaid, first-born, teenage, no high school diploma) and clinically (i.e., health/health care, parenting readiness, home safety, and parent mental health) at birth and followed through age 60 months, when Child Protective Services and hospital records were reviewed. Cox hazard models tested accuracy of prediction from screening variables.Results
Demographic factors did not significantly predict outcomes, except having Medicaid/uninsured predicted more emergency medical care and being first-born was a (surprising) protective factor against a child maltreatment investigation. In contrast, clinical factors strongly predicted both maltreatment investigations (Hazard Ratio = 4.01 [95% CI = 1.97, 8.15], sensitivity = 0.70, specificity = 0.64, accuracy = 0.65) and emergency medical care (Hazard Ratio = 2.14 [95% CI = 1.03, 2.14], sensitivity = 0.50, specificity = 0.69, accuracy = 0.58).Conclusions
Even with added costs for clinical screening, selecting families for home visiting based on assessed clinical risk will improve accuracy and may yield a higher return on investment. The authors recommend a universal system of screening and care to support birthing families.Type
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Dodge, Kenneth A, W Benjamin Goodman, Yu Bai, Robert A Murphy and Karen O'Donnell (2021). Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening. Child abuse & neglect, 122. p. 105339. 10.1016/j.chiabu.2021.105339 Retrieved from https://hdl.handle.net/10161/25481.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Kenneth A. Dodge
Kenneth A. Dodge is the William McDougall Distinguished Professor of Public Policy and Professor of Psychology and Neuroscience at Duke University. He is also the founding and past director of the Center for Child and Family Policy, as well as the founder of Family Connects International.
Dodge is a leading scholar in the development and prevention of aggressive and violent behaviors. His work provides a model for understanding how some young children grow up to engage in aggression and violence and provides a framework for intervening early to prevent the costly consequences of violence for children and their communities.
Dodge joined the faculty of the Sanford School of Public Policy in September 1998. He is trained as a clinical and developmental psychologist, having earned his B.A. in psychology at Northwestern University in 1975 and his Ph.D. in psychology at Duke University in 1978. Prior to joining Duke, Dodge served on the faculty at Indiana University, the University of Colorado, and Vanderbilt University.
Dodge's research has resulted in the Family Connects Program, an evidence-based, population health approach to supporting families of newborn infants. Piloted in Durham, NC, and formerly known as Durham Connects, the program attempts to reach all families giving birth in a community to assess family needs, intervene where needed, and connect families to tailored community resources. Randomized trials indicate the program's success in improving family connections to the community, reducing maternal depression and anxiety, and preventing child abuse. The model is currently expanding to many communities across the U.S.
Dodge has published more than 500 scientific articles which have been cited more than 120,000 times.
Elected into the National Academy of Medicine in 2015, Dodge has received many honors and awards, including the following:
- President (Elected), Society for Research in Child Development
- Fellow, Society for Prevention Research
- Distinguished Scientist, Child Mind Institute
- Research Scientist Award from the National Institutes of Health
- Distinguished Scientific Award for Early Career Contribution from the American Psychological Association
- J.P. Scott Award for Lifetime Contribution to Aggression Research from the International Society for Research on Aggression
- Science to Practice Award from the Society for Prevention Research
- Inaugural recipient of the “Public Service Matters” Award from the Network of Schools of Public Policy, Affairs and Administration
- Inaugural recipient of the Presidential Citation Award for Excellence in Research from the Society for Research on Adolescence
Yu Bai
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.