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Study Detail

Schwarz, D. F., O’Sullivan, A. L., Guinn, J., Mautone, J. A., Carlson, E. C., Zhao, H., Zhang, X., Esposito, T. L., Askew, M., & Radcliffe, J. (2012). Promoting early intervention referral through a randomized controlled home-visiting program. Journal of Early Intervention, 34(1), 20–39

Program(s) Reviewed: MOM Program

Study Screening Details

Screening DecisionScreening Conclusion
Study Passes ScreensEligible for Review

Study Design Details

RatingDesignAttritionBaseline EquivalenceReassignmentConfounding Factors
ModerateRandomized Controlled TrialLowEquivalent on race/ethnicity, information on SES not availableNoneNone
Notes:

In order to receive a high rating, randomized controlled trials (RCTs) with low attrition must control for race/ethnicity, socioeconomic status (SES), and, if applicable, baseline outcomes if statistically significant differences exist between treatment and control groups. In this case, there were no significant differences in terms of race/ethnicity, but we had insufficient information to assess baseline equivalence on SES because the only SES measure collected at baseline was maternal education. HomVEE prefers to see equivalence on income, earnings, or poverty levels according to federal thresholds, but also considers other measures of SES (that is, maternal education, employment, and Aid to Families with Dependent Children/Temporary Assistance for Needy Families or food stamps receipt), if at least two such alternative measures of SES are provided.

Study Characteristics

Study Participants

Participating mothers were recruited from the postpartum unit of a hospital in Philadelphia and randomized into treatment and control groups. Of the 650 mothers who met eligibility criteria, 618 were invited to participate (32 were not invited, largely due to being discharged early from the hospital). The 302 mothers who consented to study participation were randomized to the treatment (n = 152) and control (n = 150) groups. All mothers lived in zip codes with high rates of poverty and each had just given birth to a singleton that weighed at least 2,500 grams and did not appear to have any genetic or developmental disorders. The study notes that most of the mothers were African American but does not provide statistics on the racial composition of the sample. The mothers had completed 12 years of schooling. No additional baseline data on socioeconomic status are specified. Participants were followed from birth until 33-months of age: telephone interviews were conducted with the mothers every four months, in-person assessments of children were completed at 18 and 33 months, and mothers were assessed and interviewed at 33 months.

Setting

The study was conducted in a high-poverty area of Philadelphia.

Home Visiting Services

The intervention included, on average, eight 15-minute home visits that were scheduled to coincide with well-child pediatric appointments during the child’s first three years. During these visits, the home visitors informed each mother of the content of the upcoming well-child visit, asked the mother to identify any concerns about her child, informed the mother about the developmental milestones relevant to her child’s age, and asked if her child met each milestone. In addition, home visitors advised the mother to raise concerns about her child’s health during the visit to the health care provider and informed her about early education services that might be suitable for the child. At 18 months, home visitors conducted a more extensive visit. They described the developmental expectations for children from 18 to 24 months, paying particular attention to emerging language skills. They reinforced previous referrals to Early Head Start or early intervention services by asking about the referral process and/or providing the relevant contact information again. They discussed the importance of immunization and lead screening. They prepared the mother for the 18-month well-child visit by emphasizing to the mother the importance of checking whether the child was growing at the expected rate, reviewing any questions for the health provider, and discussing potential barriers for attending the next well-child visit and identifying potential solutions. The mother was reminded of the importance of the annual gynecological exam, provided with resources as necessary, and asked to confirm her contact information. Finally she was offered a developmental screen for her child using the Ages and Stages Questionnaire (ASQ).

Comparison Condition

The comparison group members received information booklets on child/family services on enrollment and details on transportation for the 33-month child evaluation. They also received follow-up telephone calls every four months to maintain up-to-date contact information.

Staff Characteristics and Training

Home visits were conducted by a member of the four-person intervention team, which consisted of two nurse practitioners and two trained community workers. The team members alternated responsibility for visiting each family. The nurse practitioners were Caucasian females with master’s degrees who were in their late 30s. The community workers were African American females with high school degrees (and some college coursework for one). One of the community workers was in her mid-20s and the other in her mid-50s. The nurse practitioners and the community workers alternated visits. Oversight was conducted through weekly 90-minute supervisory meetings with a board-certified pediatrician, a doctoral-level nurse practitioner and two doctoral-level psychologists. Home visitors were trained through initial supervision meetings and additional sessions that included presentations, demonstrations by a program leader, videotapes showcasing ideal home visiting conduct, and role plays. Staff were observed while implementing the ASQ assessment and provided additional training until they reached required standards.

Funding Source

The William Penn Foundation (Grant 229-08)

Author Affiliation

Not clear from the article.


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