Home Visiting Interventions and Their Impact on Mental Health, Psychosocial, and Parenting Practice Outcomes of Vulnerable Caregivers: A Systematic Review and Meta-Analysis

TL;DR

Home visiting programs can slightly improve mental health and parenting outcomes for vulnerable caregivers, but more research is needed to determine the most effective approaches.

Contribution

This is the first systematic review focusing specifically on the impact of home visiting interventions on caregivers with high vulnerability and complex needs.

Findings

Home visiting interventions showed small effects on improving mental health, parenting practices, and reducing family violence.

Only one parenting outcome (practical parenting skills) showed a statistically significant improvement.

Variation in interventions and limited data made it difficult to identify which components are most effective.

Abstract

Public health relevance—How does this work relate to a public health issue?
Having a caregiver with high vulnerability and complex needs can negatively impact child development, particularly during the early years of life.

Having a caregiver with high vulnerability and complex needs can negatively impact child development, particularly during the early years of life.

Public health significance—Why is this work of significance to public health?
Home visiting interventions can improve caregiver outcomes and, in turn, the caregiving environment.Improvements in the caregiving environment can positively impact child health and development.

Home visiting interventions can improve caregiver outcomes and, in turn, the caregiving environment.

Improvements in the caregiving environment can positively impact child health and development.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
While home visiting interventions were found to improve a range of caregiver outcomes no one intervention was suitable to address all the varied needs of caregivers with high vulnerability and complex needs.Given the limited number of studies on each intervention and the inclusion of primarily female caregivers in participant samples, more research with diverse samples, notably male caregivers, is required.

While home visiting interventions were found to improve a range of caregiver outcomes no one intervention was suitable to address all the varied needs of caregivers with high vulnerability and complex needs.

Given the limited number of studies on each intervention and the inclusion of primarily female caregivers in participant samples, more research with diverse samples, notably male caregivers, is required.

Past reviews have found home visiting interventions to be successful at improving caregiver outcomes. Though, no review has looked specifically at the effect of home visiting interventions on caregivers with high vulnerability and complex needs. This review aimed to examine and synthesis the literature on the impact of home visiting programs administered to caregivers with young children, high vulnerability and complex needs by professionals/paraprofessionals. Interdisciplinary databases, reference lists, and the Home Visiting Evidence of Effectiveness database were searched for articles that fit the inclusion criteria. Together searches resulted in a total of 623 articles, 34 of these articles were included in the final review, all from high-income countries. Twenty-five interventions were implemented across the 34 studies. Findings showed that these interventions were effective at improving a range of mental health, parenting, and family violence outcomes in caregivers with high vulnerability and complex needs. However, weighted mean standardized effect sizes ranged from 0.01–0.24 (small effect), with only one (i.e., practical parenting skills) of the five significantly different from 0 (standardized mean difference 0.24; 95% CI: 0.10, 0.38; z = 3.39, p = 0.00) and results favoring the control group. Missing information together with considerable variation in interventions, meant that identifying a clear pattern in treatment components that lead to effective verses non-effective interventions was not possible. Further research is therefore needed to assess the effectiveness of these interventions. Trial registration: The University of York Centre for Reviews and Dissemination (PROSPERO) registration number CRD42023460366.

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