Paper
Long-term effectiveness of the parenting support program Home-Start
- issue: Issue 2 / 2008
- authors: Anna H. Rutgers, Peter J. Hoffenaar, Jessica J. Asscher, Maja Deković and Jo M. A. Hermanns
- keywords: The Netherlands, Social support, Home-Start, home-visiting
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- downloaded: 0
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abstract
Background. Empirical evaluations of home-visiting programs have revealed that families can benefit from this kind of (preventive) intervention. A meta-analysis on 60 home-visiting programs concluded that participation resulted in modest positive short-term effects on both parent and child outcomes. Significant (though small) effect sizes were found for parents' attitudes and behaviours, and aspects of children's cognitive and socioemotional development (Sweet & Appelbaum, 2004). Nevertheless, there is hardly any evidence for long-term or 'sleeper' effects of home-visiting programs (Gomby, Larson, Lewitt, & Behrman, 1993).
In this study, the long-term effectiveness of the parenting support program Home-Start is examined. Home-Start is a grass-root program that is set up for families with at least one child under the age of six. The general aim of Home-Start is to prevent family crisis and breakdown through offering support, friendship and practical help by (trained) volunteers. The Home-Start model assumes that children will benefit from reduction of stress levels within families, enhancement of parental self-esteem, and improvement of parents' social relations.
Previous studies on the short-term effectiveness of Home-Start (e.g., McAuley, Knapp, Beecham, McCurry, & Sleed, 2004; Asscher, Hermanns, & Deković, in press) showed modest benefits for participating parents, but no positive effects on child outcomes were demonstrated. The absence of intervention effects on child outcomes can possibly be explained by the fact that the objective of the program is primarily to support the parents. Nevertheless, it is reasonable to expect long-term child benefits. That is to say, it can be hypothesised that the enhancement of parental self-esteem and parental self-efficacy results in better parenting behaviour (Jones & Prinz, 2005), which subsequently has positive effects on the development of child (problem) behaviour. To the best of our knowledge, no studies have explicitly evaluated the long-term effects of the program.
Research questions. In sum, our main question is: what are the long-term (parental and child) benefits of the parenting support program Home-Start? Second, can the postulated long-term child effects be explained by improvements in parental attitudes and/or parental behaviour?
Method. The current research is an elaboration of the Home-Start evaluation study by Asscher et al. (in press), which involved a quasi experimental design with two control groups and two measurements (prior and after intervention). In the analyses of the present study, we distinguished between three groups and included five measurement occasions. Additionally to the Home-Start group (n = 59) and a control group with comparable (high) stress levels (n = 57), a community sample without conspicuous levels of stress (n = 36) was examined. Only mothers were included in the study, as they represent the vast majority of the Home-Start participants.
Evaluation outcomes included three types of indicators: a) maternal well-being (life-satisfaction, depressive mood, and maternal feelings of competence), b) parenting behaviour (consistent maternal behaviour, responsiveness, and rejection), and c) negative child behaviour (oppositional behaviour). Maternal self-report questionnaires were administered prior to the intervention, during the intervention, directly after the interven¬tion, and at two follow-up occasions (respectively, 6 and 30-60 months after the end of service delivery).
Data for the five measurement occasions were modelled simultaneously by using longitudi¬nal multilevel models. Effectiveness of Home-Start was assessed by testing interactions between groups and time.
Key findings. Results indicated improvements of the Home-Start group at follow-up measurements relative to the two control groups: mothers in the Home-Start group reported diminished depressive feelings and increased life-satisfaction. Next, their ratings indicated a reduction in rejecting parenting as well as an increase in consistent discipline. In addition, benefits were found within the Home-Start group with regard to child problem behaviour.
Maternal ratings of oppositional defiant behaviour (ODD) showed significantly greater decreases in the Home-Start group than in the two comparison groups with and without pronounced levels of stress. Finally, the mechanisms were explored by which change in child behaviour could be explained. Results suggested that both maternal depression and rejecting behaviour mediated the effects of Home-Start on oppositional child behaviour.
In conclusion, the parenting support program Home-Start showed positive effects on parental well-being, positive parenting behaviour, and oppositional defiant child behaviour. Furthermore, the current data offered preliminary evidence that the program effects on children's oppositional behaviour could be attributed to a reduction of maternal depression and rejecting behaviour.
Our findings suggest that volunteers can play a role in alleviating maternal depression and help to build a more positive parent-child relationship by providing a positive, supportive relationship to mothers in need. It should be noted, however, that assignment to the study conditions was not at random. A Randomised Controlled Trial (RCT) will help to determine whether these preliminary findings hold up.
Key reference
Asscher, J. J., Hermanns, J. M. A., & Deković, M. (in press). Effectiveness of the Home-Start parenting support program: Behavioral outcomes for parents and children. Infant Mental Health Journal.
Contacts: Anna H. Rutgers, University of Amsterdam, P.O. Box 94208, 1090 GE Amsterdam, E-mail: A.H.Rutgers@uva.nl / P.J.Hoffenaar@uva.nl, Phone +31 20 525 1510 / +31 20 525 1311.