PII S0145-2134(00)00193-9 HOME VISITING INTERVENTION FOR VULNERABLE FAMILIES WITH NEWBORNS: FOLLOW-UP RESULTS OF A RANDOMIZED CONTROLLED TRIAL JENNIFER A. FRASER School of Applied Psychology, Griffith University, Queensland, Australia KENNETH L. ARMSTRONG and JEANETTE P. MORRIS Community Child Health Service, Royal Children’s Hospital and District Health Service, Fortitude Valley, Queensland, Australia MARK R. DADDS School of Applied Psychology, Griffith University, Queensland, Australia ABSTRACT Objective: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child’s environment that predict poor adjustment to the parenting role. Method: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. Results: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. Conclusions: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, the Funding bodies for this research include the Community Child Health, Royal Children’s Hospital and District Health Service, The Abused Child Trust (Queensland), The Creswick Foundation (Victoria), and the National Health and Medical Research Council (Australia). Received for publication October 18, 1999; final revision received March 21, 2000; accepted March 31, 2000. Requests for reprints should be sent to Dr. Jennifer A. Fraser, School of Nursing, Faculty of Nursing and Health, Griffith University, Nathan 4111, Queensland, Australia. Pergamon Child Abuse & Neglect, Vol. 24, No. 11, pp. 1399 –1429, 2000 Copyright © 2000 Elsevier Science Ltd. Printed in the USA. All rights reserved 0145-2134/00/$–see front matter 1399