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Study Detail

Olds, D. L., Holmberg, J. R., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. (2014). Effects of home visits by paraprofessionals and by nurses on children follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics, 168(2), 114-121.

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

RatingDesignAttritionBaseline EquivalenceReassignmentConfounding Factors
HighRandomized controlled trialLowEstablished on race; established on SES; outcome measures not assessable at baselineNoneNone
Notes:

In the full sample, the comparison of nurse home visiting to no home visiting at the 9-year follow-up rates moderate for three outcomes with high attrition: total behavioral problems, internalizing behavior, and externalizing behavior. Outcomes for the low psychological resources subgroup rate moderate because attrition information was not reported and was not available from the author.

Study Characteristics

Study Participants Pregnant women were referred to the study by staff at clinics serving low-income women in Denver, Colorado. Women were eligible to be included in the study if they were eligible for Medicaid or were uninsured, and had no previous live births. Women were randomly assigned to one of three treatment conditions: a control condition, paraprofessional home visiting, and nurse home visiting. Randomization occurred within strata defined by maternal race/ethnicity, maternal age, and maternal residence (geography). A total of 735 women were randomized: 255 into the control group, 245 into the paraprofessional home visiting group, and 235 into the nurse home visiting group. A total of 47.3 to 56 percent of children in the final analytic sample were boys (depending on treatment condition and follow-up period). A total of 12.9 to 17.6 percent of women in the final analytic sample were African American, 42.4 to 48.6 percent were Latino, and 33.7 to 40.1 percent were white. On average, at enrollment women had completed 11 years of school and were 19 or 20 years old. Average annual household incomes ranged from $12,308 to $13,561 and census tract poverty ranged from 20 to 21 percent. The percentage of women with low psychological resources ranged from 32.8 to 47.8.
Setting Denver, Colorado
Home Visiting Services This study had two treatment groups, each of which was compared to the control condition. The first group received home visits from paraprofessionals, the second group received home visits from nurses. Both groups also received free developmental screenings and referrals. Home visits began during pregnancy and lasted until the child's second birthday. Both the nurse and paraprofessional home visits had the same goals: to improve pregnancy outcomes through improved maternal health behaviors, improve child health and development through improved parental care, and assist mothers with planning future pregnancies and pursuing education and employment.
Comparison Condition The comparison group did not receive any home visits, but received free developmental screenings and referrals when the child was 6, 12, 15, 21, and 24 months old.
Staff Characteristics and Training Nurse home visitors were required to have a bachelor's of science in nursing and nursing experience with maternal and child health or in a community setting; paraprofessional home visitors were required to have a high school education with no college work in the helping professions.
Funding Source The Colorado Trust: grants 99030, 2001-049, and 99012; the Administration for Children and Families: grants 90PD0232 and 90XP0017; the Office of Juvenile Justice and Delinquency Prevention: grant 2004-52854-CO-JS; the US Department of Justice: grant 2005-MU-MU-001; the National Institute of Mental Health: grants 1R01MH069891, 1R01MH62485, and Senior Research Scientist Award 1-K05-MH01382.
Author Affiliation David L. Olds, a study author, is a founder of this program model.

Study Registration

Clinicaltrials.gov Identifier: NCT00438282, NCT00438594. Study registration was assessed by HomVEE beginning with the 2014 review.

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