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Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA: The Journal of the American Medical Association, 278(8), 637–643.

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:

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. The study actively recruited and included pregnant, first-time mothers who were less than 25 weeks pregnant, were less 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. This study is a longitudinal follow-up at 15 years for the women originally enrolled in the study and their children. At this follow-up, the study included data on 324 of the original mothers (176 in the program group and 148 in the comparison group) and 315 children of the original mothers (171 in the program group and 144 in the comparison group). At enrollment, on average, the women included in this study were about 19 years old and had approximately 11 years of education. Roughly 40 percent of the sample was married.
Setting The study was conducted in and around Elmira, NY, a small city of 40,000 residents in a semi-rural county in the Appalachian region of New York.
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 registered nurses.
Funding sources Senior Research Scientist Award (1-K05-MH01382-01) (Dr. Olds); grants from the Prevention Research and Behavioral Medicine Branch of the National Institute of Mental Health, Rockville, Md (R01-MH49381), and the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC (grant 96ASPE278A).
Author affiliation David L. Olds, a study author, is a developer of this model.

Findings details

Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Months employed
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 96.40 Adjusted mean = 89.70 Mean difference = 6.70 Not available Not statistically significant,
p ≥ 0.05
High Months receiving AFDC
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 52.80 Adjusted mean = 65.90 Mean difference = -13.10 Not available Not statistically significant,
p ≥ 0.05
High Months receiving Medicaid
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 61.80 Adjusted mean = 70.00 Mean difference = -8.20 Not available Not statistically significant,
p ≥ 0.05
High Months receiving food stamps
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy, and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 47.90 Adjusted mean = 56.40 Mean difference = -8.50 Not available Not statistically significant,
p ≥ 0.05
High Months employed
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 87.50 Adjusted mean = 89.70 Mean difference = -2.20 Not available Statistical significance not reported
High Months receiving AFDC
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 70.20 Adjusted mean = 65.90 Mean difference = 4.30 Not available Statistical significance not reported
High Months receiving food stamps
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 62.00 Adjusted mean = 56.40 Mean difference = 5.60 Not available Statistical significance not reported
High Months receiving Medicaid
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 71.10 Adjusted mean = 70.00 Mean difference = 1.10 Not available Statistical significance not reported
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Incidence of substance use impairments
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.34 Adjusted mean = 0.43 Mean difference = -0.09 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 Months between birth of first and second child
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 41.70 Adjusted mean = 37.30 Mean difference = 4.40 Not available Not statistically significant,
p ≥ 0.05
High Subsequent births
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 1.30 Adjusted mean = 1.60 Mean difference = -0.30 Not available Not statistically significant,
p ≥ 0.05
High Subsequent pregnancies
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 1.70 Adjusted mean = 2.10 Mean difference = -0.40 Not available Not statistically significant,
p ≥ 0.05
High Months between birth of first and second child
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 39.80 Adjusted mean = 37.30 Mean difference = 2.50 Not available Statistical significance not reported
High Subsequent births
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 1.40 Adjusted mean = 1.60 Mean difference = -0.20 Not available Statistical significance not reported
High Subsequent pregnancies
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 1.90 Adjusted mean = 2.10 Mean difference = -0.20 Not available Statistical significance not reported
High Substance use impairments since birth of first child
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.45 Adjusted mean = 0.43 Mean difference = 0.02 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 reports of child abuse and neglect (incidence)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.29 Adjusted mean = 0.54 Mean difference = -0.25 Not available Statistically significant,
p < 0.01

footnote1

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

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

High Substantiated reports of child abuse and neglect (incidence)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.35 Adjusted mean = 0.54 Mean difference = -0.19 Not available Statistical significance not reported
Reductions in juvenile delinquency, family violence, and crime
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High NYS arrests (incidence; administrative records)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.12 Adjusted mean = 0.38 Mean difference = -0.26 Not available Not statistically significant,
p > 0.05
High NYS convictions (incidence; administrative records)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.12 Adjusted mean = 0.27 Mean difference = -0.15 Not available Not statistically significant,
p > 0.05
High Arrests (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 244 mothers Adjusted mean = 0.09 Adjusted mean = 0.22 Mean difference = -0.13 Not available Not statistically significant,
p > 0.05

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 Convictions (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.03 Adjusted mean = 0.13 Mean difference = -0.10 Not available Not statistically significant,
p > 0.05
High Days in jail (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and comparison (Elmira) 15-year follow-up 245 mothers Adjusted mean = 0.01 Adjusted mean = 0.65 Mean difference = -0.64 Not available Not statistically significant,
p > 0.05
High NYS arrests (incidence; administrative records)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.34 Adjusted mean = 0.38 Mean difference = -0.04 Not available Statistical significance not reported
High NYS convictions (incidence; administrative records)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.28 Adjusted mean = 0.27 Mean difference = 0.01 Not available Statistical significance not reported
High Arrests (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 226 mothers Adjusted mean = 0.16 Adjusted mean = 0.22 Mean difference = -0.06 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 Convictions (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.05 Adjusted mean = 0.13 Mean difference = -0.08 Not available Statistical significance not reported
High Days in jail (incidence; self-report)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy and comparison (Elmira) 15-year follow-up 227 mothers Adjusted mean = 0.13 Adjusted mean = 0.65 Mean difference = -0.52 Not available Statistical significance not reported

Outcome measure summary

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Months employed

Counts of the number of months the mother was employed between the child’s birth and 15th year of life Parent/caregiver report

Not applicable

Months receiving AFDC

Counts of the number of months the mother received AFDC between the child’s birth and 15th year of life Parent/caregiver report

Not applicable

Months receiving food stamps

Counts of the number of months the mother received food stamps between the child’s birth and 15th year of life Parent/caregiver report

Not applicable

Months receiving Medicaid

Counts of the number of months the mother received Medicaid between the child’s birth and 15th year of life Parent/caregiver report

Not applicable

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

Incidence of substance use impairments

A scale summarizing the counts of behavioral impairments (e.g., missing work, motor vehicle crash) reported by women resulting from their use of alcohol and illegal drugs. The researchers examined both the total score from the scale and the incidence of impairments in the sample. Parent/caregiver report

Not reported by author

Months between birth of first and second child

Number of months that passed between the birth of the mother’s first and second child Parent/caregiver report

Not applicable

Subsequent births

The number of subsequent births experienced by the mother Parent/caregiver report

Not applicable

Subsequent pregnancies

The number of subsequent pregnancies experienced by the mother Parent/caregiver report

Not applicable

Substance use impairments since birth of first child

A scale summarizing the counts of behavioral impairments (e.g., missing work, motor vehicle crash) reported by women resulting from their use of alcohol and illegal drugs. The researchers examined both the total score from the scale and the incidence of impairments in the sample. Parent/caregiver report

Not reported by author

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

Substantiated reports of child abuse and neglect (incidence)

Incidence of substantiated reports of child abuse or neglect Review of CPS records

Not applicable

Reductions in juvenile delinquency, family violence, and crime
Outcome measure Description of measure Data collection method Properties of measure

NYS arrests

Counts of the number of times that mothers were arrested from the time of the birth of their first child to that child’s 15th birthday Review of criminal justice records

Not applicable

NYS convictions

Counts of the number of times that mothers were convicted from the time of the birth of their first child to that child’s 15th birthday Review of criminal justice records

Not applicable

Arrests

Counts of the number of times that mothers were arrested from the time of the birth of their first child to that child’s 15th birthday Parent/caregiver report

Not applicable

Convictions

Counts of the number of times that mothers were convicted from the time of the birth of their first child to that child’s 15th birthday Parent/caregiver report

Not applicable

Days in jail

Counts of the number of days that mothers were in jail from the time of the birth of their first child to that child’s 15th birthday Parent/caregiver report

Not applicable