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Olds, D. L., Henderson Jr., C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65–78.

Model(s) Reviewed: Nurse-Family Partnership (NFP)®
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
High Randomized controlled trial Low Established on race and SES. None None
Notes:

In 2020, HomVEE updated this review to move four findings related to "mother-reported positive mood" and crying from the Child Health domain to the Child Development and School Readiness domain because ACF determined that all measures of child behavioral health, including internalizing and externalizing behaviors belong in HomVEE's Child Development and School Readiness domain.

footnote30

Submitted by user on Fri, 03/15/2019 - 14:29

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. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. Roughly 42 percent of the sample was married. This study measured the sample at registration and at 6, 10, 12, 22, and 24 months of the infant’s life. The study sample included 354 women, 189 in the program group and 165 in the comparison group.
Setting The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents.
Intervention services The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. 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. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services.
Comparison conditions 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 sources Bureau of Community Health Services (HHS-MCR-360403-06); the Robert Wood Johnson Foundation (grant 5263); and the W. T. Grant Foundation (grant 0723-80).
Author affiliation David L. Olds, a study author, is a developer of this model.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High BSID MDI
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison 12 months 204 children Adjusted mean = 111.23 Adjusted mean = 109.94 Mean difference = 1.29 Not available Not statistically significant,
p > 0.05
High Cattell
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison 24 months 193 children Adjusted mean = 109.34 Adjusted mean = 106.49 Mean difference = 2.85 Not available Not statistically significant,
p > 0.05
High Crying (mother-reported number of episodes last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 163 children Adjusted mean = 3.44 Adjusted mean = 3.93 Mean difference = -0.49 Not available Not statistically significant,
p > 0.05
High Mother-reported positive mood
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 209 children Adjusted mean = 2.40 Adjusted mean = 2.29 Mean difference = 0.11 Not available Statistically significant,
p < 0.05
High BSID Mental Development Index (MDI)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison 12 months 199 children Adjusted mean = 105.44 Adjusted mean = 109.94 Mean difference = -4.50 Not available Statistical significance not reported
High Cattell
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison 24 months 186 children Adjusted mean = 105.73 Adjusted mean = 106.49 Mean difference = -0.76 Not available Statistical significance not reported
High Crying (mother-reported number of episodes last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 164 children Adjusted mean = 4.05 Adjusted mean = 3.93 Mean difference = 0.12 Not available Statistical significance not reported
High Mother- reported positive mood
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 199 children Adjusted mean = 2.34 Adjusted mean = 2.29 Mean difference = 0.05 Not available Statistical significance not reported
Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Night awake (mother-reported number of episodes last 2 weeks
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 163 children Adjusted mean = 2.69 Adjusted mean = 2.83 Mean difference = -0.14 Not available Not statistically significant,
p > 0.05
High Number of emergency room visits (first year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 1-year follow-up 223 children Adjusted mean = 0.74 Adjusted mean = 1.02 Mean difference = -0.28 Not available Statistically significant,
p < 0.05
High Number of emergency room visits (second year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 2-year follow-up 196 children Adjusted mean = 0.74 Adjusted mean = 1.09 Mean difference = -0.35 Not available Statistically significant,
p < 0.01
High Resist eating (mother-reported number of episodes last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 163 children Adjusted mean = 2.29 Adjusted mean = 1.72 Mean difference = 0.57 Not available Statistically significant,
p < 0.01
High Night awake (mother-reported number of episodes last 2 weeks
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 164 children Adjusted mean = 3.25 Adjusted mean = 2.83 Mean difference = 0.42 Not available Statistical significance not reported
High Number of emergency room visits (first year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 1-year follow-up 205 children Adjusted mean = 1.12 Adjusted mean = 1.02 Mean difference = 0.10 Not available Statistical significance not reported
High Number of emergency room visits (second year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 2-year follow-up 185 children Adjusted mean = 1.04 Adjusted mean = 1.09 Mean difference = -0.05 Not available Statistical significance not reported
High Resist eating (mother-reported number of episodes last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 164 children Adjusted mean = 2.01 Adjusted mean = 1.72 Mean difference = 0.29 Not available Statistical significance not reported
Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High HOME (avoidance of restriction and punishment)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 10 months 191 mothers Adjusted mean = 5.40 Adjusted mean = 5.60 Mean difference = -0.20 Not available Not statistically significant,
p ≥ 0.05
High HOME (avoidance of restriction and punishment)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months 180 mothers Adjusted mean = 5.82 Adjusted mean = 6.28 Mean difference = -0.46 Not available Not statistically significant,
p ≥ 0.05
High HOME (provision of appropriate play materials)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 22 months 198 mothers Adjusted mean = 8.68 Adjusted mean = 8.65 Mean difference = 0.03 Not available Not statistically significant,
p ≥ 0.05
High HOME (provision of appropriate play materials)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 10 months 201 mothers Adjusted mean = 7.36 Adjusted mean = 7.26 Mean difference = 0.10 Not available Not statistically significant,
p ≥ 0.05
High Conflict
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 163 mothers Adjusted mean = 0.29 Adjusted mean = 0.25 Mean difference = 0.04 Not available Not statistically significant,
p ≥ 0.05
High Spank or hit (number of times last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 159 mothers Adjusted mean = 0.19 Adjusted mean = 1.09 Mean difference = -0.90 Not available Not statistically significant,
p ≥ 0.05
High Worry or concern (Sum of positive responses for behavioral problems)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 163 mothers Adjusted mean = 0.83 Adjusted mean = 0.54 Mean difference = 0.29 Not available Statistically significant,
p < 0.05
High Yell or scold (number of times last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 6 months 159 mothers Adjusted mean = 3.99 Adjusted mean = 7.90 Mean difference = -3.91 Not available Not statistically significant,
p ≥ 0.05
High HOME (avoidance of restriction and punishment)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 10 months 184 mothers Adjusted mean = 5.77 Adjusted mean = 5.60 Mean difference = 0.17 Not available Statistical significance not reported
High HOME (avoidance of restriction and punishment)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months 171 mothers Adjusted mean = 5.53 Adjusted mean = 6.28 Mean difference = -0.75 Not available Statistical significance not reported
High HOME (provision of appropriate play materials)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 22 months 190 mothers Adjusted mean = 8.66 Adjusted mean = 8.65 Mean difference = 0.01 Not available Statistical significance not reported
High HOME (provision of appropriate play materials)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 10 months 195 mothers Adjusted mean = 7.45 Adjusted mean = 7.26 Mean difference = 0.19 Not available Statistical significance not reported
High Conflict
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 164 mothers Adjusted mean = 0.27 Adjusted mean = 0.25 Mean difference = 0.02 Not available Statistical significance not reported
High Spank or hit (number of times last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 151 mothers Adjusted mean = 1.71 Adjusted mean = 1.09 Mean difference = 0.62 Not available Statistical significance not reported
High Worry or concern (Sum of positive responses for behavioral problems)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 164 mothers Adjusted mean = 0.61 Adjusted mean = 0.54 Mean difference = 0.07 Not available Statistical significance not reported
High Yell or scold (number of times last 2 weeks)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 6 months 151 mothers Adjusted mean = 7.56 Adjusted mean = 7.90 Mean difference = -0.34 Not available Statistical significance not reported
Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Substantiated abuse or neglect
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison 2-year follow-up 256 children % (adjusted) = 5.00 Adjusted mean % = 10.00 Mean difference = -5.00 HomeVEE calculated = -0.45 Not statistically significant,
p > 0.10
High Number of emergency room visits for accidents and poisonings (first year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 1-year follow-up 223 children Adjusted mean = 0.12 Adjusted mean = 0.06 Mean difference = 0.06 Not available Not statistically significant,
p > 0.05
High Number of emergency room visits for accidents and poisonings (second year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 2-year follow-up 196 children Adjusted mean = 0.15 Adjusted mean = 0.34 Mean difference = -0.19 Not available Statistically significant,
p < 0.05
High Substantiated abuse or neglect
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison 2-year follow-up 247 children % (adjusted) = 8.00 Adjusted mean % = 10.00 Mean difference = -2.00 HomeVEE calculated = -0.15 Not statistically significant,
p > 0.10
High Number of emergency room visits for accidents and poisonings (first year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 1-year follow-up 205 children Adjusted mean = 0.12 Adjusted mean = 0.06 Mean difference = 0.06 Not available Statistical significance not reported
High Number of emergency room visits for accidents and poisonings (second year of life)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 2-year follow-up 185 children Adjusted mean = 0.32 Adjusted mean = 0.34 Mean difference = -0.02 Not available Statistical significance not reported

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

BSID Mental Development Index

The MDI of the BSID assesses the cognitive functioning of young children. Child assessment

Not reported by author

Cattell

The Cattell assesses mental ability in young children. Child assessment

Not reported by author

Crying

Number of infant crying episodes in the last 2 weeks

Parent/caregiver report

Not applicable

Mother-reported positive mood

A measure of the extent to which the child had a happy, positive, and content disposition

Parent/caregiver report

Not applicable

Child health
Outcome measure Description of measure Data collection method Properties of measure

Night awake

Number of times that most of the night was spent awake in the last 2 weeks Parent/caregiver report

Not applicable

Number of emergency room visits

Total number of times the infant was seen in the emergency room Review of medical records

Not applicable

Resist eating

Number of times the infant resisted eating in the last 2 weeks Parent/caregiver report

Not applicable

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

HOME: Avoidance of restriction and punishment, Provision of appropriate play materials

The HOME assesses parenting practices and aspects of the home environment. The assessment had six dimensions, including the avoidance of restriction and punishment and the provision of appropriate play materials. Parent/caregiver interview and observational assessment

Rates of inter-observer agreement on the individual items ranged from 82 to 100 percent.

Conflict

Sum of positive responses to behavioral problems, such as feeding difficulties and crying Parent/caregiver self-report

Not reported by author

Spank or hit

Counts of the number of times the mother spanked or hit her child during the last two weeks Parent/caregiver self-report

Not reported by author

Worry or concern

Sum of positive responses to behavioral problems, such as feeding difficulties and crying Parent/caregiver self-report

Not reported by author

Yell or scold

Counts of the number of times the mother yelled at or scolded her child during the last two weeks Parent/caregiver self-report

Not reported by author

Reductions in child maltreatment
Outcome measure Description of measure Data collection method Properties of measure

Number of ER visits for accidents and poisonings

Counts of ER visits for accidents and poisonings Review of medical records

Not applicable

Substantiated abuse or neglect

Percentage of sample members with substantiated reports of abuse or neglect Comparisons of sample members’ names and addresses with state social service records of substantiated cases of abuse or neglect

Not applicable