Manuscript Detail
Model(s) Reviewed: Resources, Education, and Care in the Home (REACH)
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| Moderate | Non-experimental comparison group design | NA | Established on race/ethnicity and SES. Baseline equivalence on outcomes not feasible. | NA | For morbidity outcomes (neonatal and at 12 months), the REACH group was assessed by a nurse at home and the comparison group was assessed by a nurse in a clinic. Because a nurse collected the data in both settings, this was judged as not being a threat to the study’s internal validity. |
| Study participants | Researchers recruited 1,269 infants who were healthy at birth and had high socioeconomic risk factors from target communities. At intake, 79 percent of the infants were African American and 18 percent were Hispanic. More than one-third of infants had mothers aged 19 or younger, and more than one-third had mothers with less than a high school education. |
|---|---|
| Setting | Chicago, Illinois |
| Intervention services | Services included at least five home visits in the first year of life (at 2 weeks, 6-8 weeks, and 4, 8, and 12 months), and more as necessary. Timing of the home visits was designed to coincide with the child’s developmental changes and a greater likelihood of illness. Home visitors were registered nurses who coordinated the family’s care with participating agencies, made referrals, and provided individual counseling. The focus of the visits was health education and screening. Retention in the program (through 12 months) was 57.5 percent. |
| Comparison conditions | The study included three comparison groups, which were used for different outcomes. The comparison group for the infant mortality outcome included infants residing in REACH target communities (but not participating in REACH) over a four-year span. The comparison group for the neonatal morbidity outcomes was 334 mothers and infants evaluated at 7-15 days postpartum for a study of early discharge conducted just before the REACH study began. For morbidity at 12 months, the comparison group was recruited from a pediatric clinic and was made up of 83 infants who lived either in REACH target communities or in other neighborhoods with high infant mortality rates. |
| Staff characteristics and training | Registered nurses |
| Funding sources | Special Project of Regional and National Significance Grant by the Office of Maternal and Child Health of the Department of Health and Human Services (MCJ 173851) and the University of Illinois Hospital. |
| Author affiliation | The authors are developers of this model. |
Findings details
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Pass rate on Denver Developmental Screening Test | FavorableUnfavorable or ambiguousNo Effect |
REACH and Comparison Group III | 12 months | 372 infants | Passed = 1.00 | Passed = 0.00 | Not Reported | Not available | Not available |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Moderate | Postneonatal Mortality Rate | FavorableUnfavorable or ambiguousNo Effect |
REACH and Comparison Group I | 12 months | 1,775 infants | per 1,000 = 4.70 | 5.2 to 10.9 per 1,000 = 8.05 | Not Reported | Not available | Not available | |
| Moderate | Incidence of preventable health problems | FavorableUnfavorable or ambiguousNo Effect |
REACH and Comparison Group II | 7 to 15 days after birth | 531 infants | % had no problems = 75.00 | % had no problems = 55.00 | = 25.00 | Not available | Not statistically significant, p ≥ 0.05 | |
| Moderate | Number of illnesses in first year of life | FavorableUnfavorable or ambiguousNo Effect |
REACH and Comparison Group III | 12 months | 372 infants | % had no illnesses = 46.00 | % had no illnesses = 6.00 | = 40.00 | Not available | Statistically significant, p < 0.05 | |
| Moderate | One or more physical problems at 12-month visit | FavorableUnfavorable or ambiguousNo Effect |
REACH and Comparison Group III | 12 months | 327 infants | % = 25.00 | % = 29.00 | = -4.00 | HomeVEE calculated = -0.12 | Not statistically significant, p ≥ 0.05 |
Outcome measure summary
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Pass rate on Denver Developmental Screening Test |
The Denver Developmental Screening Test assesses cognitive and behavioral problems in children. The authors report the percentage of children that passed the assessment. | Direct child assessment | Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Incidence of preventable health problems |
Measures the incidence of preventable health problems, including upper and lower respiratory infections, eye infections, thrush, diarrhea, cord infections, skin rashes or infections, and injuries. | Child physical examination 7-15 days after birth | Not applicable |
Number of illnesses in first year of life |
Provides a count of the total illnesses recalled by the mother during the child’s first year of life | Parent/caregiver report | Not applicable |
One or more physical problems at 12-month visit |
Measures the percentage of children with one or more physical problems at the 12–month visit. Common problems included skin infections or rashes and upper respiratory infections. | Child physical examination | Not applicable |
Postneonatal Mortality Rate |
Percentage of newborns dying between 28 and 364 days of age. | Review of medical records | Not applicable |