This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (65)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Violence and Human Rights, Other  • Randomized Controlled Trial  • Pediatrics  • Child Abuse  • Alert me on articles by topic

The Limiting Effects of Domestic Violence

John Eckenrode, PhD; Barbara Ganzel, MS; Charles R. Henderson, Jr, MA; Elliott Smith, PhD; David L. Olds, PhD; Jane Powers, PhD; Robert Cole, PhD; Harriett Kitzman, RN, PhD; Kimberly Sidora, MPH

JAMA. 2000;284:1385-1391.

Context  Home visitation to families with young children has been promoted as an effective way to prevent child maltreatment, but few studies have examined the conditions under which such programs meet this goal.

Objective  To investigate whether the presence of domestic violence limits the effects of nurse home visitation interventions in reducing substantiated reports of child abuse and neglect.

Design  Fifteen-year follow-up study of a randomized trial.

Setting  Semirural community in upstate New York.

Participants  Of 400 socially disadvantaged pregnant women with no previous live births enrolled consecutively between April 1978 and September 1980, 324 mothers and their children participated in the follow-up study.

Interventions  Families were randomly assigned to receive routine perinatal care (control group; n = 184 participated in follow-up), routine care plus nurse home visits during pregnancy only (n = 100), or routine care plus nurse home visits during pregnancy and through the child's second birthday (n = 116).

Main Outcome Measures  Number of substantiated reports over the entire 15-year period involving the study child as subject regardless of the identity of the perpetrator or involving the mother as perpetrator regardless of the identity of the child abstracted from state records and analyzed by treatment group and level of domestic violence in the home as measured by the Conflict Tactics Scale.

Results  Families receiving home visitation during pregnancy and infancy had significantly fewer child maltreatment reports involving the mother as perpetrator (P = .01) or the study child as subject (P = .04) than families not receiving home visitation. The number of maltreatment reports for mothers who received home visitation during pregnancy only was not different from the control group. For mothers who received visits through the child's second birthday, the treatment effect decreased as the level of domestic violence increased. Of women who reported 28 or fewer incidents of domestic violence (79% of sample), home-visited mothers had significantly fewer child maltreatment reports during the 15-year period than mothers not receiving the longer-term intervention (P = .01). However, this intervention did not significantly reduce child maltreatment among mothers reporting more than 28 incidents of domestic violence (21% of sample).

Conclusions  The presence of domestic violence may limit the effectiveness of interventions to reduce incidence of child abuse and neglect.

Author Affiliations: Department of Human Development (Dr Eckenrode, Ms Ganzel, and Mr Henderson) and Family Life Development Center (Drs Eckenrode, Smith and Powers), Cornell University, Ithaca, NY; University of Colorado Health Sciences Center, Denver (Dr Olds); and Department of Psychiatry (Dr Cole) and School of Nursing (Drs Cole and Kitzman and Ms Sidora), University of Rochester, Rochester, NY.

RELATED ARTICLES

Promise and Limitations of Home Visitation
Deanna S. Gomby
JAMA. 2000;284(11):1430-1431.
EXTRACT | FULL TEXT  

September 20, 2000
JAMA. 2000;284(11):1451-1452.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

In-Home Cognitive Behavior Therapy for a Depressed Mother in a Home Visitation Program
Ammerman et al.
Clinical Case Studies 2007;6:161-180.
ABSTRACT  

Home-visiting intervention to improve child care among american Indian adolescent mothers: a randomized trial.
Barlow et al.
Arch Pediatr Adolesc Med 2006;160:1101-1107.
ABSTRACT | FULL TEXT  

Patterns of Health Care Use That May Identify Young Children Who Are at Risk for Maltreatment
Friedlaender et al.
Pediatrics 2005;116:1303-1308.
ABSTRACT | FULL TEXT  

Strengthening Families With First-Born Children: Exploratory Story of the Outcomes of a Home Visiting Intervention
de la Rosa et al.
Research on Social Work Practice 2005;15:323-338.
ABSTRACT  

Can the Results Be Believed?: In Reply
Olds et al.
Pediatrics 2005;115:1113-1114.
FULL TEXT  

Medical Homes for At-Risk Children: Parental Reports of Clinician-Parent Relationships, Anticipatory Guidance, and Behavior Changes
Nelson et al.
Pediatrics 2005;115:48-56.
ABSTRACT | FULL TEXT  

Theme Issue on Violence and Human Rights: Call for Papers
Cole and Flanagin
JAMA 2004;292:3030-3030.
FULL TEXT  

Effects of Home Visits by Paraprofessionals and by Nurses: Age 4 Follow-Up Results of a Randomized Trial
Olds et al.
Pediatrics 2004;114:1560-1568.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration
Paul et al.
Pediatrics 2004;114:1015-1022.
ABSTRACT | FULL TEXT  

Physical Aggression During Early Childhood: Trajectories and Predictors
Tremblay et al.
Pediatrics 2004;114:e43-e50.
ABSTRACT | FULL TEXT  

Screening for Family and Intimate Partner Violence: Recommendation Statement
U.S. Preventive Services Task Force*
ANN INTERN MED 2004;140:382-386.
ABSTRACT | FULL TEXT  

Screening for Family and Intimate Partner Violence: Recommendation Statement
U.S. Preventive Services Task Force
Ann Fam Med 2004;2:156-160.
FULL TEXT  

Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force
Nygren et al.
Ann Fam Med 2004;2:161-169.
ABSTRACT | FULL TEXT  

Evaluating a Statewide Home Visiting Program to Prevent Child Abuse in at-Risk Families of Newborns: Fathers' Participation and Outcomes
Duggan et al.
Child Maltreat 2004;9:3-17.
ABSTRACT  

Risk for Intimate Partner Violence and Child Physical Abuse: Psychosocial Characteristics of Multirisk Male and Female Navy Recruits
Merrill et al.
Child Maltreat 2004;9:18-29.
ABSTRACT  

Trends in Postneonatal Mortality Attributable to Injury, United States, 1988-1998
Tomashek et al.
Pediatrics 2003;111:1219-1225.
ABSTRACT | FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 2001;4:E1-11.
FULL TEXT  

Review: home visitation by nurses beginning prenatally and extending through infancy prevents child abuse and neglect
Pelcovitz
Evid. Based Ment. Health 2001;4:81-81.
FULL TEXT  

Falik
AAP News 2000;17:240-241.
FULL TEXT  

Promise and Limitations of Home Visitation
Gomby
JAMA 2000;284:1430-1431.
FULL TEXT