Can we measure risk in home visitation? An examination of the predictive validity of the Healthy Families Parenting Inventory (HFPI)

Can We Measure Risk in Home Visitation?

Authors:

  • Cara Kelly, Craig LeCroy

  • Arizona State University, United States

Article Information

  • Keywords: Child welfare, home visitation, child abuse and neglect, assessment, measurement

Abstract

  • Objective: The study examines the predictive validity of the Healthy Families Parenting Inventory (HFPI) in predicting future risk of child abuse and neglect.

  • Method: Participants included 2,088 parents in a statewide home visitation program, mostly low-income mothers with various socio-demographic risk indicators. HFPI was administered at enrollment and followed by monitoring through administrative data for about one year.

  • Results: Pre-intervention HFPI scores showed incremental predictive validity for future maltreatment reports.

  • Conclusions: HFPI can be effectively used during home visitation to identify needs and services aimed at reducing child maltreatment likelihood.

Introduction

  • Maltreatment (including neglect, physical, sexual, and emotional abuse) persists as a significant social issue despite various intervention efforts.

  • Evidence-based early childhood home visitation programs primarily aim to prevent maltreatment by enhancing child well-being and supporting vulnerable families in the U.S. (Azzi-Lessing, 2017).

  • These programs focus on at-risk families with children under five, building supportive caregiver relationships to improve family welfare.

  • Studies indicate considerable variation in risk levels among these families (Duggan et al., 2007; Peacock et al., 2013), yet little focus has been on validating assessment protocols for accurate risk identification.

1.1. High-risk Children and Home Visitation

  • Research highlights that many families enrolled have significant maternal and child risk factors for maltreatment (Jacobs et al., 2016; Easterbrooks et al., 2019).

  • Common factors:

    • Mothers often live in poverty, are teen parents, undereducated, or suffering from mental health or substance issues (Ammerman et al., 2010).

    • Infants often experience congenital disabilities, low birth weight, or are born preterm (LeCroy & Milligan Associates, 2016).

  • Chronic stress from community violence, poor housing, and lack of resources heightens risks (Fortin et al., 2012).

  • Untreated maltreatment has long-term adverse effects on development (Barlow & Scott, 2010).

  • Home visitation, when implemented thoroughly, can alter negative parenting practices and improve child and family well-being (Caldera et al., 2007; DuMont et al., 2008).

1.2. Home Visitation Program Impact on Risk Factors

  • Home visitation models aim to promote child development, reduce maltreatment risk, and enhance parental competence (Avellar & Supplee, 2013).

  • Engaging families through preventive services helps to mitigate child maltreatment occurrences (Daro & Donnelly, 2002).

  • Flexible programs can create tailored service plans suitable for individual family needs, contrary to public welfare systems (Duggan et al., 2000).

1.3. Measuring Risk in Home Visitation

  • Assessment tools have emerged as vital in determining family risks and guiding service interventions (Shlonsky & Gambrill, 2014).

  • Tools exist for protecting children and managing service demands, but the reliability and validity of these instruments in early childhood contexts are questionable (Kirk et al., 2005).

  • Understanding the multi-dimensional nature of maltreatment risk is necessary for effective interventions (Ogles et al., 2002).

1.4. Background of the Healthy Families Parenting Inventory (HFPI)

  • HFPI is a 63-item assessment created to evaluate risks and protective factors within home visitation settings (LeCroy & Milligan Associates, 2004).

  • Administered within 30 days of program start and every six months, scores range from 63 to 315 for overall and 5 to 50 for each of the nine subscales: 1. Social Support

  1. Problem Solving/Coping

  2. Depression

  3. Personal Care

  4. Mobilizing Resources

  5. Role Satisfaction

  6. Parent/Child Interaction

  7. Home Environment

  8. Parenting Efficacy

  • Items are scored on a Likert scale indicating frequency, with designated “red flag” and “strength indicator” items guiding intervention plans.

  • Reliability for HFPI subscale and total scores is established (Krysik & LeCroy, 2012).

1.5. Purpose of the Current Study

  • Prior studies show risks for maltreatment, yet family identification in home visitation needs clarification.

  • This study aims to validate HFPI's effectiveness for predicting future maltreatment in home visitation, potentially influencing policy and practice to better serve high-risk families.

Methods

2.1. Study Context

  • The study involves 2,088 parents with young children in a voluntary statewide child abuse prevention program.

  • Families volunteered, with criteria of having at least one child under three months and meeting socio-environmental risk factors via a two-stage screening process.

2.2. Data Collection Procedures

  • Data was extracted from a maintained database for longitudinal evaluation, combining socio-demographic, HFPI scores, and public child welfare data.

  • The Institutional Review Board approved study procedures.

2.3. Sample Characteristics

  • Most participants were female, low socio-economic, with 67.8% single, and less than half graduated high school.

  • Average household size: ~4; average children prior: 1; 8% faced maltreatment reports within a year.

2.4. Measures

  • HFPI scores evaluated for predictive validity using total composite and subscale scores.

  • Maltreatment defined by official reports, allowing the study to assess risks regardless of substantiation status (Hussey et al., 2005).

2.4.1. Analytic Approach

  • Bivariate and multivariate analyses determined HFPI's predictive validity.

  • T-tests compared averages between maltreatment and non-maltreatment groups, while correlations and logistic models assessed risk relationships.

Results

3.1. Bivariate Analyses: T-Tests

  • Differences in HFPI scores between maltreated and non-maltreated families were significant across various subscales (social support, problem-solving, etc.), with effect sizes evaluated via Cohen’s d (0.17 to 0.26).

3.2. Bivariate Analyses: Correlations

  • Point-biserial correlations showed significant relationships between HFPI scores and maltreatment outcome, affirming HFPI's relevance.

3.3. Multivariate Analyses: Logistic Regression

  • HFPI's total composite score was negatively predictive of maltreatment risk (AOR = 0.99) with specific subscales showing mixed results regarding risk increase or decrease (e.g., personal care AOR = 0.92).

Discussion

4.1. Predictive Validity of HFPI

  • The study affirmed HFPI's predictive validity in assessing families for maltreatment risk based on various interacting factors.

4.2. Implications for Policy

  • Public child welfare can benefit from early identification via home visitation to divert families from engaging with the welfare system.

4.3. Implications for Practice

  • HFPI can guide practitioners in effectively serving families based on their risk scores, aiding in the development of individualized treatment plans.

Limitations

  • Limitations related to using official maltreatment reports raise questions about generalizability and actual maltreatment rates.

  • Future research should evaluate HFPI's predictive validity across diverse samples and follow-up periods.

Conclusions

  • Validating HFPI presents an opportunity for early childhood home visitation programs to monitor and improve outcomes related to family risk for maltreatment.

References

  • Over 70 references cited regarding early childhood intervention, assessment, risk factors, and program effectiveness related to home visitation and child welfare.