The added value of targeting specific risk factors for child maltreatment in an evidence-based home visitation program: a repeated single-case time series study

The effects of home visiting programs to reduce child maltreatment are generally limited and warrant improvement. The present study, therefore, examined whether the effectiveness of a home visitation program in the Netherlands can be improved by adding specific intervention components targeting important risk factors for child maltreatment, namely parental stress, parental anger, and PTSD symptoms. Using a single-case experimental design, nine mothers were assessed weekly during 36 weeks of the Dutch home visiting program VoorZorg, comparing baseline, treatment (i.e., phase with added intervention components), and follow-up. Outcome effects were examined using statistical analyses on a group level and combining statistical and visual analyses on a case level for primary outcomes: perceived stress, parental anger, and PTSD symptoms, and secondary outcomes: risk of child maltreatment and parental sense of competence. As a group, mothers showed a reduction of anger in response to the additional components. No group effects were found for other outcomes. At an individual level, three mothers showed only positive effects, four mothers showed no intervention effects, and two mothers showed mixed effects (i.e., positive on some outcomes and negative on other). Consequently, the component targeting parental anger seems promising, because it can easily be implemented, but it is important to prevent any possible detrimental effects. Effects of the component targeting stress depended on the use of relaxation exercises, and therefore this component should be expanded in such a way that it is more feasible for mothers to implement it