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Study Detail

Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., et al. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110(3), 486.

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 SampleHigh for some outcomes for families with nurse home visitors, low for other outcomes in the study.Established for race/ethnicity and household income.NoneNone

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. From March 1994 through 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 measures the sample when the children were 6 months to 2 years old. The study sample at the 24-month parent interview included 630 women, 194 in the nurse home visiting program group, 213 in the paraprofessional home visiting program group, and 223 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 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. Nurse home visitors were required to have a BSN degree and experience in community or maternal and child health nursing. Both the nurse and paraprofessional home visitors received one month of training prior to working with families. Nurses and paraprofessionals had caseloads of similar size (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 (93059); a contract with Abt Associates (105–94-1925) under a grant from the Administration for Children and Families (DHHS); and a Senior Research Scientist Award to David Olds from the National Institute of Mental Health (K05-MH01382).
Author Affiliation David L. Olds, a study author, is a developer of this program model.


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