| Popis: |
Background: A predominantly North American evidence-base suggests that domiciliary visiting can be an effective strategy for promoting the development and well-being of at-risk infants. This paper attempts to extend this evidence-base to the very different of service-context of the UK by assessing the impact on quality of the home environment of an intensive home-visiting programme (‘Starting Well’) aimed at improving the health and life-chances of pre-school children in disadvantaged communities.Methods: Quasi-experimental prospective cohort study of families with newborn in selected areas of Glasgow, Scotland. Detailed survey, observation and interview data (including the Infant/Toddler-HOME Inventory) were collected on a cohort of 406 (268 intervention; 138 comparison) families over the first eighteen months of the child’s life.Results: At 18-months, multivariate analyses revealed no significant group differences in quality of the home environment (as indexed by total HOME score), however a positive intervention effect was observed (p=.05) with a sub-sample of 295 families who completed all assessments. In the context of a generally deprived cohort, ‘full’ participation in the evaluation was associated with marginally greater affluence and fewer risk factors.Conclusion: Findings are interpreted as evidence of a possible ‘threshold’ intervention effect, with the benefits of the enhanced service (at least in terms of this outcome) accruing preferentially to families with basic pre-existing levels of material and/or personal coping resources. Implications for policy and, in particular, the need for increased targeting of vulnerable families within the context of a universal health visiting service, are discussed. |
