A Mixed Methods Evaluation of Early Childhood Abuse Prevention Within Evidence-Based Home Visiting Programs




Meredith Matone, Katherine Kellom, Heather Griffis, William Quarshie, Jennifer Faerber, Peter Gierlach, Jennifer Whittaker, David M. Rubin, and Peter F. Cronholm

Brief Type

Journal publication


  • Early Head Start Home-Based Option
  • Nurse-Family Partnership (NFP)
  • Parents as Teachers (PAT)


Objectives: In this large scale, mixed methods evaluation, we determined the impact and context of early childhood home visiting on rates of child abuse-related injury. Methods: Entropy-balanced and propensity score matched retrospective cohort analysis comparing children of Pennsylvania Nurse-Family Partnership (NFP), Parents As Teachers (PAT), and Early Head Start (EHS) enrollees and children of Pennsylvania Medicaid eligible women from 2008 to 2014. Abuse-related injury episodes were identified in medical assistance claims with ICD-9 codes. Weighted frequencies and logistic regression odds of injury within 24 months are presented. In-depth interviews with staff and clients (n = 150) from 11 programs were analyzed using a modified grounded theory approach. Results: The odds of a healthcare encounter for early childhood abuse among clients were significantly greater than comparison children (NFP: 1.32, 95% CI [1.08, 1.62]; PAT: 4.11, 95% CI [1.60, 10.55]; EHS: 3.15, 95% CI [1.41, 7.06]). Qualitative data illustrated the circumstances of and program response to client issues related to child maltreatment, highlighting the role of non-client caregivers. All stakeholders described curricular content aimed at prevention (e.g. positive parenting) with little time dedicated to addressing current or past abuse. Clients who reported a lack of abuse-related content supposed their home visitor’s assumption of an absence of risk in their home, but were supportive of the introduction of abuse-related content. Approach, acceptance, and available resources were mediators of successfully addressing abuse. Conclusions for Practice: Home visiting aims to prevent child abuse among high-risk families. Adequate home visitor capacity to proactively assess abuse risk, deliver effective preventive curriculum with fidelity to caregivers, and access appropriate resources is necessary. (author abstract)

Data Collection Methods

  • Program administrative record reviews



For More Information

Matone, M., Kellom, K., Griffis, H., Quarshie, W., Faerber, J., Gierlach, P., ... & Cronholm, P. F. (2018). A mixed methods evaluation of early childhood abuse prevention within evidence-based home visiting programs. Maternal and Child Health Journal, 22(1), 79-91.  https://doi.org/10.1007/s10995-018-2530-1
Author Contact Information:
Meredith Matone


  • Participant, Family, and Program Outcomes