When trained in a model program of prenatal and infancy home visiting, paraprofessionals produced small effects that rarely achieved statistical or clinical significance; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects. Nurses produced significant effects on a wide range of maternal and child outcomes.

OBJECTIVES: This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low-income, first-time parents during pregnancy and the first 2 years of the child's life. METHODS: Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor. RESULTS: On average, nurses completed more visits than paraprofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P < .001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P = .04). More paraprofessional-visited families than nurse-visited families experienced staff turnover. CONCLUSIONS: Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways.

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Although recent studies have convincingly demonstrated that emotional expressions can be judged reliably from actor-posed facial displays, there exists little evidence that facial expressions in lifelike settings are similar to actor-posed displays, are reliable across situations designed to elicit the same emotion, or provide sufficient information to mediate consistent emotion judgments by raters. The present study therefore investigated these issues as they related to the emotions of happiness, surprise, and fear. 27 infants between 10 and 12 months of age (when emotion masking is not likely to confound results) were tested in 2 situations designed to elicit hapiness (peek-a-boo game and a collapsing toy), 2 to elicit surprise (a toy-switch and a vanishing-object task), and 2 to elicit fear (the visual cliff and the approach of a stranger. Dependent variables included changes in 28 facial response components taken from previous work using actor poses, as well as judgments of the presence of 6 discrete emotions. In addition, instrumental behaviors were used to verify with other than facial expression responses whether the predicted emotion was elicited. In contrast to previous conclusions on the subject, we found that judges were able to make all facial expression judgments reliably, even in the absence of contextual information. Support was also obtained for at least some degree of specificity of facial component response patterns, especially for happiness and surprise. Emotion judgments by raters were found to be a function of the presence of discrete facial components predicted to be linked to those emotions. Finally, almost all situations elicited blends, rather than discrete emotions.

Although recent studies have convincingly demonstrated that emotional expressions can be judged reliably from actor-posed facial displays, there exists little evidence that facial expressions in lifelike settings are similar to actor-posed displays, are reliable across situations designed to elicit the same emotion, or provide sufficient information to mediate consistent emotion judgments by raters. The present study therefore investigated these issues as they related to the emotions of happiness, surprise, and fear. 27 infants between 10 and 12 months of age (when emotion masking is not likely to confound results) were tested in 2 situations designed to elicit hapiness (peek-a-boo game and a collapsing toy), 2 to elicit surprise (a toy-switch and a vanishing-object task), and 2 to elicit fear (the visual cliff and the approach of a stranger. Dependent variables included changes in 28 facial response components taken from previous work using actor poses, as well as judgments of the presence of 6 discrete emotions. In addition, instrumental behaviors were used to verify with other than facial expression responses whether the predicted emotion was elicited. In contrast to previous conclusions on the subject, we found that judges were able to make all facial expression judgments reliably, even in the absence of contextual information. Support was also obtained for at least some degree of specificity of facial component response patterns, especially for happiness and surprise. Emotion judgments by raters were found to be a function of the presence of discrete facial components predicted to be linked to those emotions. Finally, almost all situations elicited blends, rather than discrete emotions.