Home-visiting interventions for families with complex and multiple problems: A systematic review and meta-analysis of out-of-home placement and child outcomes

Abstract

Children growing up in families experiencing complex and multiple problems (FECMP) are at an increased risk of developing problems in multiple areas of life. A wide array of home-visiting interventions has been developed to address the complex care needs of these families. The aim of this study is to investigate out-of-home placement rates and child outcomes of these home-visiting interventions. A systematic review and meta-analysis was conducted using five scientific databases (PsycInfo, ERIC, SocIndex, MedLine, & Picarta). The systematic search of these databases yielded 8,377 hits. Forty-two publications reporting on 50 studies were included in the review. A random-effects survival curve meta-analysis model was estimated for out-of-home placement and random-effects meta-analysis models were estimated for children’s behavioral problems and stressful experiences. Out-of-home placement increased from 7.5% at case closure to 24.3% one year after case closure. On average there was a moderate decrease in emotional and behavioral problems (d = 0.50) and stressful experiences (d = 0.50) during intervention, but considerable problems remained after case closure. More research is needed to investigate family and service characteristics that may explain heterogeneity in outcomes. Furthermore, there is a need to adopt a broader perspective in evaluations of home-visiting services by including outcomes related to the skills, development, and wellbeing of children.