Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the "universal versus targeted" debate: a meta-analysis of population-based and screening-based programs.

OBJECTIVE: Seeking to discern optimal programmatic strategies and inform the "universal versus targeted" debate in early home visitation services to prevent physical child abuse and neglect, a meta-analysis was conducted examining enrollment approaches in early home visitation studies and their reported outcomes.
METHOD: Quantitative meta-analytic techniques were used to compare effect sizes from 19 controlled outcome studies across screening-based and population-based enrollment strategies. Effect sizes were calculated on protective services data and on child maltreatment related measures of parenting.
RESULTS: On protective services report data, population-based studies reported a weighted mean effect size attributable to early home visitation of +3.72%, in comparison to -.07% for screening-based studies. On child maltreatment related measures of parenting, population-based studies reported a weighted mean effect size (r) attributable to early home visitation of +.092, in comparison to +.020 for screening-based studies.
CONCLUSIONS: The findings indicate that population-based enrollment strategies appear favorable to screening-based ones in early home visitation programs seeking to prevent physical child abuse and neglect. It may be that psychosocial risk screens serve to enroll higher proportions of families for which early home visitation services are less likely to leverage change, and to exacerbate a mismatch between early home visitation service aims and family needs.