A community home visiting program that supports at-risk families with children from pregnancy to child age 5.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Families First Home Visiting (FFHV) is a program that provides services to families with children (from pregnancy to child age 5) living in at-risk conditions. It is a program partnership between various departments and agencies in Canada, including Manitoba Education, Manitoba Families, Manitoba Health, Seniors and Active Living, Manitoba Indigenous and Northern Relations, Manitoba Justice and Municipal Relations.
Aims
- Improve family relationships
- Support children’s healthy growth, development and learning
- Provide information about pregnancy, health, safety and nutrition
- Provide information about pregnancy
- Help families get access to health care
- Connect families to community resources.
Impact
Evidence suggests that FFHV was effective in reducing out-of-home care and hospitalisation for child maltreatment-related injuries. There was no effect or difference observed for improving child education and development between those who enrolled in the program and those who did not. The evidence is based on administrative linked data of at-risk families eligible for FFHV of some who participated and some who did not. Participants were followed from one to 5 years after initial exposure to the program.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Health service use | Yes | Not found | Not found |
| System | Out-of-home care | Yes | Not found | Not found |
| Child | Education | Not found | Yes | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
FFHV has an evidence rating of Supported+.
This means that FFHV has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on one research output of QE design. FFHV has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | Not identified or included |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from the included study.
The study was conducted in Canada and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
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The QE was conducted in Manitoba, Canada.
Sample characteristics
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9746 families (4562 intervention, 5184 control) participated in the study.
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The target population was families with children born between 2003 to 2009, defined as at-risk on the universal newborn screen and Kempe Family Stress Checklist.
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Families were experiencing a number of challenges related to the child having congenital health problems, teenage parenting, financial difficulties or the parents experiencing mental health issues.
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No information on participant ethnicity was found.
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Families with a lower level of risk were included in a control group for evaluation purposes.
Implementation
Delivery model, mode and setting
- FFHV is delivered in-person, to the parent only or parent and child together, in their home, by paraprofessional home visitors.
Target cohort
- Families experiencing at-risk circumstances from prenatal to child age 5.
Program delivery
- Families are matched with a paraprofessional home visitor who meets with the family on a regular basis.
- In the study, mothers with newborns in Manitoba were contacted by a public-health nurse to access FFHV.
- Home visitors develop a trusting relationship with 10 to 18 families and connect families with the support they need to help the family build a strong, healthy and nurturing relationship with their children. This is achieved by sharing information and suggesting activities tailored to each family’s situation.
- Public-health nurses screen and provide clinical expertise and support to families as required. They also provide training and weekly supervision to all home visitors.
Duration and intensity
- On average, families spend approximately 18 months in the program. Home visitors may meet with the family for up to 3 years.
- Depending on the family’s needs, the frequency of home visiting varies from weekly to monthly. The duration of each visit is between one to 2 hours.
Manuals and guides
- We were unable to locate any manuals or guides to implement FFHV.
Additional information
- The Manitoba Government website has more information about FFHV.
Staffing
- Home visitors have training in health, education or child development, or personal experience with parenting under difficult circumstances.
Training
- Public health nurses provide training, clinical expertise support and supervision to home visitors.
- Both home visitors and their supervisors are required to participate in a week-long core training session to learn the basic principles of FFHV. Home visitors meet weekly with their supervisors to reflect on family issues and home visiting challenges.
- Additional training sessions are available to home visitors after the core training.
To our knowledge, FFHV is not available and has not been implemented in Australia.
Cost
In Manitoba, Canada, Healthy Child Manitoba Office (HCMO) has been funding and coordinating FFHV province-wide since 1999. The program is provided to families at no cost.
References
Studies identified and included in the review
- Chartier MJ, Brownell MD, Isaac MR, Chateau D, Nickel NC, Katz A, Sarkar J, Hu M & Taylor C (2017). Is the Families First home visiting program effective in reducing child maltreatment and improving child development? Child Maltreatment, 22(2):121-131.
Studies identified but not counted towards the evidence rating due to study quality
No studies that were identified were excluded due to study quality.