Manuscript Detail

View Revisions

Eckenrode, J., Zielinski, D., Smith, E., Marcynyszyn, L. A., Henderson, C. R., Kitzman, H., et al. (2001). Child maltreatment and the early onset of problem behaviors: Can a program of nurse home visitation break the link? Development and Psychopathology, 13(4), 873–890.

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 (assuming same sample characteristics as reported in previous analyses using the 15 year follow-up). None None
Notes:

In 2020, HomVEE updated this review to move one finding, number of early onset of problem behaviors, from the Reductions in Juvenile Delinquency, Family Violence, and Crime 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 fewer than 30 weeks pregnant. The study actively recruited and included pregnant, first-time mothers who were fewer than 25 weeks pregnant, were younger 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. At enrollment, on average, 47 percent were younger than 19 years old, 61 percent came from households in which the head of household was an unskilled or semiskilled worker, and 38 percent were married. This study measured the sample when the children were 15 years old. The study sample included 228 women, 91 in the program group and 137 in the comparison group. (Information on samples sizes for this study was received through communication with the authors.)
Setting The study was conducted in and around Elmira, New York, a small city of 40,000 residents in a semirural county in the Appalachian region of New York. According to other studies of the Elmira sample, the county included 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. The 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 once a week 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 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-CA1631); a Senior Research Scientist Award (1-K05-MH01382-01); and the Smith–Richardson Foundation.
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 Number of early onset of problem behaviors
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 228 adolescents Not available Not available OR = 0.28 Not available Not statistically significant,
p = 0.12

footnote5

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

Information on sample sizes for this study was received through communication with the authors. HomVEE previously rated 24-month outcomes for nurse home visitors Moderate due to high attrition. Upon further examination, HomVEE noted that the outcomes had low attrition, and therefore they rate High.

footnote16

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

The discussion of outcomes in the text of this study implies that the direction of the effect is in the opposite direction than what is reported in the study and replicated here.

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 Percentage abused
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 228 adolescents = 0.39 = 0.37 Mean difference = 2.00 Not available Statistical significance not reported

footnote5

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

Information on sample sizes for this study was received through communication with the authors. HomVEE previously rated 24-month outcomes for nurse home visitors Moderate due to high attrition. Upon further examination, HomVEE noted that the outcomes had low attrition, and therefore they rate High.

High Percentage neglected
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 228 adolescents = 0.61 = 0.63 Mean difference = -2.00 Not available Statistical significance not reported

footnote5

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

Information on sample sizes for this study was received through communication with the authors. HomVEE previously rated 24-month outcomes for nurse home visitors Moderate due to high attrition. Upon further examination, HomVEE noted that the outcomes had low attrition, and therefore they rate High.

Outcome measure summary

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

Number of early onset problem behaviors

Reports of participation in 11 problematic health and social behaviors through the 15th year of life were aggregated to obtain a count of early onset problem behaviors. Age cutoffs for “early” were established for each behavior using comparison group frequency distributions and national data where available.

Adolescent report

Not reported by author

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

Percentage abused

Percentage of children with substantiated reports of abuse Review of CPS records

Not applicable

Percentage neglected

Percentage of children with substantiated reports of neglect Review of CPS records

Not applicable