Community Prevention of Child Maltreatment

This randomized controlled trial aims to evaluate the impact and mechanisms of the Durham Connects brief universal newborn nurse home-visiting program to prevent child maltreatment and improve child well-being. It is the first-ever such trial of a home-visiting program designed to prevent child maltreatment in an entire community population.

The study follows children from 6 months to 66 months of age, and their families. Families of newborns are randomly assigned to the Durham Connects program. Administrative records are used to evaluate the impact of participation in the program on child maltreatment cases, emergency room maltreatment-related injuries, and pediatric care. In-home interviews and blinded observations are employed to assess parental functioning and child well-being in a random representative subsample of families from both the intervention and control groups.

Data analyses will test four hypotheses: 1) Random assignment to the Durham Connects program will be associated with lower rates of child maltreatment and emergency department maltreatment-related injuries, better pediatric care, better parental functioning, and better child well-being, as compared to control group rates; 2) Intervention effect sizes will be larger for higher-risk groups; 3) Community resource use and enhanced family functioning will mediate the positive impact of Durham Connects on outcomes; and 4) Developmental processes in dysfunctional parenting and child behavior among the control group will conform to the model guiding the program.

The project will contribute to public health by 1) evaluating the impact and mechanisms of a universal home-visiting program that aims to lower child maltreatment rates across a community population in a cost-effective way; and 2) testing models of the development of maltreatment, dysfunctional parenting, and child behavior and well-being.

A study on Durham Connects’ effect on emergency care appeared in a special November 1, 2013,┬áissue of Pediatrics. View the study here.