Systematic review and meta-analysis of home visiting interventions aimed at enhancing child mental health, psychosocial, and developmental outcomes in vulnerable families.

Background: Numerous systematic reviews have shown home visiting interventions to be effective at improving a variety of parent and child outcomes. No review has, however, examined the impact of home visiting programs targeting child (aged 0-5 years) mental health, socioemotional and/or developmental outcomes in the context of families with high vulnerability and complex needs.

Method: A systematic review and meta-analysis were undertaken to examine and synthesize the literature on home visiting programs administered by professionals/paraprofessionals for families with young children, high vulnerability, and complex needs. PsychInfo, Scopus, Embase, PubMed, and CINAHL were searched through August 2023. A manual review was also undertaken of the reference lists of the articles selected for the review and the Home Visiting Evidence of Effectiveness 2023 review/database. English language studies were included if they were evaluated with a group of participants (case studies were excluded), reported results of home visiting intervention targeted at improving mental health and psychosocial outcomes of caregivers and/or developmental outcomes for children (aged 0-4 years 11 months) of families with high vulnerability and complex needs. Two independent reviewers extracted data and assessed for risk of bias. Qualitative results were consolidated narratively while a meta-analysis was used to synthesize quantitative results.

Results: Initial searches identified 623 articles, of which 22 were included in the final review. Findings showed that 18 different home visiting interventions have been implemented with families with high vulnerability and complex needs, and that these interventions are effective at improving a variety of child outcomes. The meta-analysis showed that the weighted mean standardised effect sizes ranged from -0.31 to 0.20, with only one of the four outcomes (i.e., socioemotional and/or behavioural outcomes) being significantly different from 0 (standardised mean difference -0.31; 95% CI: -0.49, -0.13; z = 3.45, p = 0.00). High intervention variability and missing information meant that it was not possible to determine clear patterns regarding features that led to effective versus non-effective interventions.

Conclusion: Taken together, results indicate that there is some evidence showing that home visiting interventions targeted at families with high vulnerability and complex needs can be effective at improving some child outcomes. More research is required to solidify findings.

Trial registration: The University of York Centre for Reviews and Dissemination (PROSPERO) registration number CRD42023460366.