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Study Detail

Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114(6), 1560-1568.

Program(s) Reviewed: Nurse Family Partnership (NFP)®, NFP with Nurse Home Visitors - Mothers with low psychological resources subgroup, NFP with Paraprofessional Home Visitors, NFP with Paraprofessional Home Visitors - Mothers with low psychological resources subgroup

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRandomized controlled trialDenver, Colorado SampleLowNo relevant differences for nurse home visitor group. Statistically significant different in income between paraprofessional home visitor and comparison group.NoneNone
Notes:

This study includes three groups: nurse home visits, paraprofessional home visits, and a comparison group. The high rating is based on the comparison between nurse home visits and the comparison group. The comparison between the paraprofessional and comparison groups receives a moderate rating because of a statistically significant difference in income at baseline that was not controlled.

Study Characteristics

Study Participants Women were recruited through 21 antepartum clinics that served low-income pregnant women. Recruitment focused on women who had no previous live births and either qualified for Medicaid or had no private health insurance. Between March 1994 and June 1995, 1,178 women were invited to participate and 735 consented and were randomly assigned to one of three conditions: a control group, nurse home visiting, and paraprofessional home visiting. Randomization was conducted within strata based on maternal race (Hispanic, white, black, American Indian, or Asian), maternal gestational age (less than 32 weeks, 32 weeks or more), and geographic region. This study measured the sample when the children were 4 years old. The sample of women who completed the interviews when children were 4 years old included 635 women, 204 in the nurse home visiting program group, 211 in the paraprofessional home visiting program group, and 220 in the comparison group.
Setting Denver, Colorado metropolitan area
Home Visiting Services The study included two program groups: one serviced by paraprofessionals and one serviced by nurses. Women assigned to both groups received developmental screening and referral services for their children and home visits during pregnancy and infancy (until the child was 2 years old). Both groups had the same goals: (1) to improve women’s health-related behavior, (2) to support parents in providing competent care, and (3) to encourage planning future pregnancies and promote education and employment. Paraprofessionals conducted 6.3 home visits on average during pregnancy and 16 visits during infancy. Nurses conducted 6.5 home visits on average during pregnancy and 21 visits during infancy.
Comparison Condition Women in the comparison group received developmental screening and referral services for their children at 6, 12, 15, 21, and 24 months.
Staff Characteristics and Training Nurse home visitors were required to have a BSN degree and experience in community or maternal and child health nursing. Paraprofessionals were required to have a high school education. Although those with college preparation in the “helping” professions were excluded, preference was given to paraprofessionals who had worked in human services. Both the nurse and paraprofessional home visitors received one month of training prior to working with families. Nurses and paraprofessionals had the same caseloads (approximately 25 families), but paraprofessionals had 2 supervisors for 10 visitors, compared to 1 supervisor for 10 nurse home visitors.
Funding Source The Colorado Trust (grant 99030); the Administration for Children and Families, Department of Health and Human Services (grant 90PD0232); and a Senior Research Scientist Award (grant 1-K05-MH01382-01) to D.L.O.
Author Affiliation David L. Olds, a study author, is a developer of this program model.

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