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A Randomized Controlled Trial of the Hawaii Healthy Start Home Visitation Program

Megan H. Bair-Merritt, MD, MSCE; Jacky M. Jennings, PhD, MPH; Rusan Chen, PhD; Lori Burrell, MA; Elizabeth McFarlane, PhD; Loretta Fuddy, ACSW, MPH; Anne K. Duggan, ScD

Arch Pediatr Adolesc Med. 2010;164(1):16-23.

Objectives  To estimate whether home visitation beginning after childbirth was associated with changes in average rates of mothers' intimate partner violence (IPV) victimization and perpetration as well as rates of specific IPV types (physical assault, verbal abuse, sexual assault, and injury) during the 3 years of program implementation and during 3 years of long-term follow-up.

Design  Randomized controlled trial.

Setting  Oahu, Hawaii.

Participants  Six hundred forty-three families with an infant at high risk for child maltreatment born between November 1994 and December 1995.

Intervention  Home visitors provided direct services and linked families to community resources. Home visits were to initially occur weekly and to continue for at least 3 years.

Main Outcome Measures  Women's self-reports of past-year IPV victimization and perpetration using the Conflict Tactics Scale. Blinded research staff conducted maternal interviews following the child's birth and annually when children were aged 1 to 3 years and then 7 to 9 years.

Results  During program implementation, intervention mothers as compared with control mothers reported lower rates of IPV victimization (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.73-1.01) and significantly lower rates of perpetration (IRR, 0.83; 95% CI, 0.72-0.96). Considering specific IPV types, intervention women reported significantly lower rates of physical assault victimization (IRR, 0.85; 95% CI, 0.71-1.00) and perpetration (IRR, 0.82; 95% CI, 0.70-0.96). During long-term follow-up, rates of overall IPV victimization and perpetration decreased, with nonsignificant between-group differences. Verbal abuse victimization rates (IRR, 1.14, 95% CI, 0.97-1.34) may have increased among intervention mothers.

Conclusion  Early-childhood home visitation may be a promising strategy for reducing IPV.

Trial Registration  clinical trials.gov Identifier: NCT00218751

Author Affiliations: Division of General Pediatrics and Adolescent Medicine, School of Medicine (Drs Bair-Merritt, Jennings, McFarlane, and Duggan and Ms Burrell), and Department of Epidemiology, Bloomberg School of Public Health (Dr Jennings), Johns Hopkins University, Baltimore, Maryland; Center for New Designs in Learning and Scholarship, Georgetown University, Washington, DC (Dr Chen); and Hawaii State Department of Health, Honolulu (Ms Fuddy).

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