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Study Detail

Zielinski, D. S., Eckenrode, J., & Olds, D. L. (2009). Nurse home visitation and the prevention of child maltreatment: Impact on the timing of official reports. Development and Psychopathology, 21(2), 441–453. doi:10.1017/S0954579409000248

Program(s) Reviewed: Nurse Family Partnership (NFP)®

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignSampleAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRandomized controlled trial Elmira, New York SampleLowEstablished on race and SES (assuming same sample characteristics as reported in previous analyses using the 15 year follow-up).NoneNone

The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.

Study Characteristics

Study Participants The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. The study actively recruited and included pregnant, first-time mothers who were less than 25 weeks pregnant, were less than 19 years old, were single parents, or had low socioeconomic status. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. This study measured the sample when the children were 15 years old. The 15-year follow-up included 324 women (others were ineligible because of child or maternal death or because they declined to participate in the follow-up). However, the study does not report the number included in the analysis, which is likely fewer than 324. Children for whom there was one year or less of maltreatment data available were excluded from the study, as were women from one of the treatment groups (described below).
Setting The study was conducted in a small, a semi-rural city in the Appalachian region of New York.
Home Visiting Services The original sample included two treatment groups, but only one treatment group was used in this analysis. That treatment group received home visits from a nurse beginning when the mother was pregnant and continuing until the child was 2 years old. The nurse visited the family every other week during pregnancy. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. The treatment group also received the screening and transportation services described below for the comparison groups. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. The treatment group that was excluded from this study received home visits during pregnancy only, and the screening and transportation services. The authors report this group was excluded because past studies had found few and inconsistent effects (pg 444).
Comparison Condition The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening.
Staff Characteristics and Training All home visitors were nurses. No other information on training is provided.
Funding Source Prevention Research Branch of the National Institute of Mental Health (R01-MH49381); the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (96ASPE278A); the Children’s Bureau, U.S. Department of Health and Human Services (90-CA-1631); a National Institute of Mental Health Senior Research Scientist Award (to D.L.O., 1-K05-MH01382-01); and the Smith–Richardson Foundation.
Author Affiliation David L. Olds, a study author, is a developer of this program model.


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