Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial

Abstract

OBJECTIVES: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitiverelated outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS:We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership).RESULTS: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS:The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.WHAT'S KNOWN ON THIS SUBJECT: Two randomized trials of prenatal and infant home visit by nurses found effects on children' s behavioral problems, early adolescent substance use, and among children born to mothers with limited psychological resources, cognitive outcomes. One trial found fewer convictions among females.WHAT THIS STUDY ADDS: This trial extends earlier estimates of intervention impact: compared with control-group counterparts, nurse-visited 18-year-olds born to mothers with limited psychological resources exhibited better cognitive functioning; females, as a trend, had fewer convictions. There were no significant effects on behavioral health.

Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health

“…For example, the Nurse–Family Partnership programme led to an improvement in educational and cognitive outcomes in adolescents in the USA, along with a reduction in government welfare expenditure. 28 In Brazil, the Bolsa Familia Conditional Cash Transfer programme provided a safety net for childhood nutrition, food security, and education 29 that improved childhood height-for-age and school attendance especially for girls, and reduced fertility rates. Sustaining such schemes requires investment in building the capacity of community health workers in MNCH.…”

Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study

“…44 ► The Children Looked After (CLA) return-including information on all looked after children and recent care leavers in England, from 2005. 45 46 For mothers only, we will link to Key Stages 2, 4 and 5 data, which includes teacher assessments and/or test results in Years 3-6 (ages 7-11), Year 11 (age 16) and Year 12/13 (ages [17][18]. For children only, we will link to the Early Years Census and Early Years Foundation Stage Profile (EYFSP), including teacher assessments for 3 and 4 year olds (from 2008) and 2 year olds (from 2014), as well as to Key Stage 1 assessment data (ages 5-6).…”

“…13 Three randomised controlled trials in the USA found evidence of benefit on a number of maternal and child outcomes, including reductions in child maltreatment, child emergency department visits and subsequent births, as well as some improvements in child developmental outcomes and longer subsequent birth intervals. [14][15][16][17][18] Effects on hospital visits for injury or maltreatment, children's educational achievements and maternal educational qualifications were less consistent. A trial in the Netherlands found reduced child maltreatment reports by age 2, 19 and a trial of a FNP-based model in Germany reported improved child development among high-risk women only, although no difference in subsequent births within 2 years.…”

Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial

“…Other savings to government and society, such as reductions in firstborn disability 40 and rates of low birth weight in second births, 41 are not yet monetized.…”