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Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93(1), 89–98.

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 the two findings on the number of child behavioral/parental coping problems in physician record 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.

footnote207

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

The cases of abuse and neglect findings had high attrition and therefore rate moderate.

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. This study measured the sample at registration and at the 34th, 36th, 46th, and 48th months of the child’s life. For the data collection ant 48 months postpartum, the study sample included 343 women, 183 in the program group and 160 in the comparison group. (Information on sample size for this follow-up was received through communication with the author.)
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. After the child’s second birthday, home visitors provided any appropriate social service referrals to families and children with special needs. Nurses worked in two-person teams (one primary and one backup home visitor).
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 registered nurses.
Funding sources Bureau of Community Health Services (MCJ-360579 and MCJ-360403); the National Center for Nursing Research (R01 NR001691-01A1); the Robert Wood Johnson Foundation (grants 5263 and 6729); the W.T. Grant Foundation (grants 800723-80); the Ford Foundation (grants 840-0545 and 840723-0559); a Biomedical Research Support Grant (National Institutes of Health) (PHSS7RR05403-25); the Commonwealth Fund (grant 10443); and a William T. Grant Faculty Scholars Award to the first author (grant 861-080-86).
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 child behavioral/parental coping problems in physician record (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 mothers Adjusted mean = 0.39 Adjusted mean = 0.71 Mean difference = -0.32 Not available Statistically significant,
p ≤ .01

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Stanford Binet
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 48 months 236 children Adjusted mean = 111.52 Adjusted mean = 108.93 Mean difference = 2.59 Not available Not statistically significant, p ≥ 0.05
High Stanford Binet
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 36 months 236 children Adjusted mean = 103.57 Adjusted mean = 101.95 Mean difference = 1.62 Not available Not statistically significant,
p > 0.05
High Number of child behavioral/parental coping problems in physician record (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 mothers Adjusted mean = 0.43 Adjusted mean = 0.71 Mean difference = -0.28 Not available Statistical significance not reported
High Stanford Binet
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 36 months 226 children Adjusted mean = 104.20 Adjusted mean = 101.95 Mean difference = 2.25 Not available Not statistically significant,
p > 0.05
High Stanford Binet
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 48 months 226 children Adjusted mean = 111.25 Adjusted mean = 108.93 Mean difference = 2.32 Not available Not statistically significant,
p > 0.05
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 Number of days hospitalized (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 0.49 Adjusted mean = 0.31 Mean difference = 0.18 Not available Statistically significant,
p ≤ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of emergency department visits (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 1.00 Adjusted mean = 1.53 Mean difference = -0.53 Not available Statistically significant,
p ≤ .01

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of hospital admissions (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 0.14 Adjusted mean = 0.11 Mean difference = 0.03 Not available Not statistically significant,
p > 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of scheduled health supervision visits (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 1.26 Adjusted mean = 1.56 Mean difference = -0.30 Not available Not statistically significant,
p > 0.05
High Number of scheduled health supervision visits with problems (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 6.24 Adjusted mean = 6.72 Mean difference = -0.48 Not available Not statistically significant,
p > 0.05
High Number of days hospitalized (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 0.43 Adjusted mean = 0.31 Mean difference = 0.12 Not available Statistical significance not reported
High Number of emergency department visits (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 1.24 Adjusted mean = 1.53 Mean difference = -0.29 Not available Statistical significance not reported
High Number of hospital admissions (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 0.11 Adjusted mean = 0.11 Mean difference = 0.00 Not available Statistical significance not reported
High Number of scheduled health supervision visits (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 1.27 Adjusted mean = 1.56 Mean difference = -0.29 Not available Statistical significance not reported
High Number of scheduled health supervision visits with problems (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 5.18 Adjusted mean = 6.72 Mean difference = -1.54 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 inventory (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 34 months 238 mothers Adjusted mean = 39.08 Adjusted mean = 39.03 Mean difference = 0.05 Not available Not statistically significant,
p ≥ 0.05
High HOME inventory (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months 238 mothers Adjusted mean = 39.66 Adjusted mean = 39.67 Mean difference = -0.01 Not available Not statistically significant,
p ≥ 0.05
High Hazardous exposures observed in home
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 46 months 209 mothers Adjusted mean = 0.21 Adjusted mean = 0.46 Mean difference = -0.25 Not available Statistically significant,
p < 0.01

footnote4

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

Statistical significance reported on authors’ calculation of incidence ratio.

High Hazardous exposures observed in home
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 34 months 209 mothers Adjusted mean = 0.22 Adjusted mean = 0.38 Mean difference = -0.16 Not available Statistically significant,
p < 0.05

footnote4

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

Statistical significance reported on authors’ calculation of incidence ratio.

High HOME inventory (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months 227 mothers Adjusted mean = 40.18 Adjusted mean = 39.67 Mean difference = 0.51 Not available Statistical significance not reported
High HOME inventory (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 34 months 227 mothers Adjusted mean = 38.45 Adjusted mean = 39.03 Mean difference = -0.58 Not available Statistical significance not reported
High Hazardous exposures observed in home
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 46 months 202 mothers Adjusted mean = 0.31 Adjusted mean = 0.46 Mean difference = -0.15 Not available Statistical significance not reported
High Hazardous exposures observed in home
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 34 months 202 mothers Adjusted mean = 0.23 Adjusted mean = 0.38 Mean difference = -0.15 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 Number of emergency department visits for injuries/ingestions (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 0.47 Adjusted mean = 0.61 Mean difference = -0.14 Not available Not statistically significant,
p > 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of injuries/ingestions in physician record (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 50 months 221 children Adjusted mean = 0.34 Adjusted mean = 0.57 Mean difference = -0.23 Not available Statistically significant,
p ≤ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High New substantiated cases of abuse/neglect from 25 to 48 months
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 48 months 253 children % (adjusted) = 8.00 Adjusted mean % = 5.00 OR = 1.80 Study reported = 0.30 Not statistically significant
p > 0.05

footnote7

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

The <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> reversed the odds ratio from the study-reported calculation to reflect the odds of the treatment versus the control group.

High New substantiated cases of abuse/neglect from 25 to 48 months
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 48 months 245 children % (adjusted) = 4.00 Adjusted mean % = 5.00 Mean difference = -1.00 HomeVEE calculated = -0.14 Statistical significance not reported
Moderate Number of emergency department visits for injuries/ingestions (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 0.46 Adjusted mean = 0.61 Mean difference = -0.15 Not available Statistical significance not reported
Moderate Number of injuries/ingestions in physician record (25 to 50 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 50 months 209 children Adjusted mean = 0.56 Adjusted mean = 0.57 Mean difference = -0.01 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

Number of child behavioral/parental coping problems in physician record

Number of child behavioral and parental coping problems noted in the physician’s record

Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

Stanford Binet

The Stanford Binet Form L-M assesses intelligence in young children. Child assessment

Not reported by author

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

Number of days hospitalized

Number of days the child was hospitalized Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

Number of emergency department visits

Total number of emergency department encounters Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

Number of hospital admissions

Number of child hospitalizations Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

Number of scheduled health supervision visits

Number of scheduled health supervision visits for the child Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

Number of scheduled health supervision visits with problems

Number of health supervision visits at which separate illnesses were detected in the child. This included initial sick visits for an illness, as well as well-child visits at which health problems were identified. Review of medical records

Inter-rater agreement for the abstraction of diagnostic codes in the medical records was 90%.

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

HOME: Total score

The HOME assesses parenting practices and aspects of the home environment. Parent/caregiver interview and observational assessment

Inter-observer reliability for the HOME total scores were greater than 95% at both the 34- (n = 28 pairs) and 46-month observations (n = 24 pairs).

Hazardous exposures observed in HOME

A checklist indicating the degree of the child’s exposure to the following categories of household hazards: (1) chipped or flaking paint, (2) sharp objects, (3) danger of burns, and (4) objects that pose a risk for falls. Interviewer observation

For each hazard category, the inter-observer reliability at 34 months exceeded 93% (n = 30 pairs) and at 46 months exceeded 86% (n = 22 pairs).

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

New substantiated cases of abuse/neglect

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

Not applicable

Number of emergency department visits for injuries/ingestions

Counts of ER visits for injuries and poison ingestions Review of hospital records

Not applicable

Number of injuries/ingestions in physician record

Counts of injuries and poison ingestions in physicians’ records

Review of medical records

Not applicable

Number of emergency department visits for injuries/ingestions

Counts of ER visits for injuries and poison ingestions Review of hospital records

Not applicable

Number of injuries/ingestions in physician record

Counts of injuries and poison ingestions in physicians’ records

Review of medical records

Not applicable