Given the mounting evidence for the importance of early childhood development and the short and long-term effects of childhood abuse, greater efforts are clearly required to promote environments that are nurturing for children. One of the most widespread interventions is home visiting programs, intended to reduce risk factors and promote protective factors associated with child maltreatment.  Given that substantiated child maltreatment rates are highest during infancy (1), most home visiting programs target this developmental period. Home visiting programs are generally aimed at families with multiple parenting challenges who are at risk for neglecting or abusing their children, and consist of regular home visits by nurses, other professionals or trained paraprofessionals. Program objectives differ between programs, but generally aim at attenuating risk factors associated with child maltreatment and supporting healthy child development including improving parent-child relationships, enhancing mothers’ lives (decreasing stress, increasing self-efficacy, improving education and employment) and connecting families with their communities. While home visiting programs have been evaluated in highly structured and supervised conditions (2-4), little research has shown that these programs are effective when implemented under real-world service delivery conditions. To the best of our knowledge, there are no published studies examining the effectiveness of home visiting for at-risk families in Canada.

In 1999 Healthy Child Manitoba Office (HCMO) introduced a home visiting program throughout the province (5).  Since that time, HCMO has been funding and coordinating the province-wide Families First Home Visiting Program (originally called the BabyFirst Home Visiting Program) which provides home visiting services to families with children from prenatal to five years of age who are living in conditions of risk.  Families become eligible for the program through a two-stage screening process. In the first stage, public health nurses screen all postpartum referrals in Manitoba using a brief measure of biological, social, and demographic risk factors. In the second stage, families scoring at-risk on the universal screen are assessed for parenting challenges by public health nurses with a semi-structured interview. Families scoring high on this assessment are eligible for the program and are offered Families First home visiting.  In this analysis, outcomes will be compared for children in at-risk families who participated in the program to children in at-risk families who did not participate, as well as pre/post-test analyses of siblings and families within and not within the program.