Johns Hopkins Children and Youth Program

About the program

The Johns Hopkins Children and Youth program is a community-based home visiting program for mothers and their infants. It aims to provide mothers with health and parenting education in the home. The program employs paediatricians, nurses, parent education specialists, social workers and support staff. Emphasis is placed on prevention by training health and parenting education specialists and by employing social workers.

Who does it work for?

One RCT study was conducted with a final sample of 263  infants and mothers in the USA (Hardy and Streett, 1989).The study included inner-city Baltimore mothers of newborns living on low incomes. Mothers’ mean age ranged from 18 to 33 years, with a mean age of 22.6 years. Infants’ age ranged from 3 to 13 months. All mothers were African American, and 78% were single mothers. 23% had no prior children, and the remainder had children who ranged in age from 1-6 years.

No evidence that the program has been evaluated in Australia or with First Nations communities was identified in the review.

What outcomes does it contribute to?

Positive outcomes:

Hospital outpatient visits: The study found a significant positive effect on the number and type of outpatient clinic visits. The control group had an overall mean of 16.6 visits to a child and youth clinic, and 4.3 visits to the emergency department, whereas the study group had a mean of 15.5 visits to a child and youth clinic and three visits to the emergency department. There was also a reduction in the likelihood of hospital admission, with 20% of children in the control group admitted to hospital, compared to 6% of children in study group.

Child abuse and neglect: Fewer instances of abuse and neglect were present in the intervention group. Inpatient care was required by eight (6.1%) of the children in the intervention group and 20 (15.2%) of the children in the control group.

Immunisations: The program was found to have a positive and significant effect on immunisations. In all, 88% of children in the intervention group had received the complete set of immunisations for their age, compared with 69% of children in the control group. Furthermore, in only 6% of  children in the intervention group were immunisations delayed for more than 2 months by illness or a missed appointment, and in only 6% were they incomplete at termination of followup, compared with 14% and 17%, respectively, among children in the control group.

No effect:

None.

Negative outcomes:

None.

Is the program effective?

Overall, the program had a positive effect on client outcomes

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

The program is implemented through fortnightly home visits, for 40-60 minutes each. The duration of the program is up to 24 months. It is a community-based service, with community-based home visitors receiving training and direct supervision from the module’s educator (Johns Hopkins University) and the social worker.

The home visitor provides education on parenting and childcare skills to mothers, covering topics appropriate for the age of the infants visited. Developmental milestones are discussed with anticipatory parenting guidance, and suggestions are made for enhancing child development. A calendar is developed and given to each parent at the first visit, and includes information on child development, seasonal safety tips, clinic hours, and program contact names and telephone numbers.

The program educator does not address psychosocial issues,  but instead refers the family to a social worker or educator, depending on the nature and severity of observed presentation. The home visitor’s role is one of a support person to the parent, rather than a therapist.

How much does it cost? In 1983-1984, the per-visit, all-inclusive cost of the child and youth program averaged US$53.

What else should I consider?

The available program evidence is based on one study from the 1980s; this study has not been replicated.

Where does the evidence come from?

One RCT study with a final sample of 263 mother and infant dyads conducted in the USA (Hardy & Streett, 1989).

Further resources

Hardy, J.B. and Streett, R., (1989). Family support and parenting education in the home: An effective extension of clinic-based preventive health care services for poor children. The Journal of pediatrics, 115(6), pp.927–931.