Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial

Abstract

OBJECTIVE-Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.METHODS-We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women <29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.RESULTS-Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with controlgroup counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.CONCLUSIONS-By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.Address correspondence to David L. Olds, PhD, University of Colorado at Denver and Health Sciences Center, 1825 Marion St, Suite 200, Denver, CO 80218. olds.david@tchden.org. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 March 16. Published in final edited form as:Pediatrics. Home visiting by nurses for low-income, at-risk families has been promoted as a promising strategy for preventing child abuse and neglect, children's mental health problems, 1-3 and infant mortality. 4 Recent evidence suggests that the benefits hoped for from such programs do not hold for all types of home-visiting programs. 5 A program of home visiting by nurses known as the Nurse-Family Partnership (NFP) has produced consistent effects on several aspects of maternal and child heal...

Childhood Disruptive Behaviour Disorders: Review of Their Origin, Development, and Prevention

“…62,63 Similarly, in the other 2 trials (Memphis and Denver), the NFP program did not reduce the children's DBD symptoms during childhood. 64,65,71 …”

Health Disparities: A Life Course Health Development Perspective and Future Research Directions

“…For example, early nurse home visiting programs for lowincome families show long-term improvements for children including better intellectual functioning, fewer behavioral problems, fewer preventable injuries, and less risky health behaviors in adolescence (Olds et al 1998(Olds et al , 2004(Olds et al , 2007. Parenting interventions in pregnancy and the first year have been shown to improve parent relationships, decrease family stress, reduce biomarkers of stress, and improve executive function and school performance of children (Feinberg et al 2014(Feinberg et al , 2015.…”

The Pediatrician's Role in Child Maltreatment Prevention

“…63 The model, which uses trained nurses, has demonstrated improvements in maternal and child functioning and showed a trend toward reduced childhood mortality rates from preventable causes. 64 On the other hand, Healthy Families, a home-visitation program that uses trained paraprofessionals, has been tested in a number of states, but it has not been shown to reduce child abuse or child abuse risk factors. [65][66][67] Cincinnati's "Every Child Succeeds" program used both the Nurse-Family Partnership model and the Healthy Families model and provided home-visiting to mothers at high risk (adolescent, unmarried, low income, or suboptimal education) and first-time mothers.…”