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Dodge, K. A., Goodman, W. B., Murphy, R. A., O’Donnell, K., Sato, J., & Guptill, S. (2013). Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. American Journal of Public Health, published online ahead of print.

Model(s) Reviewed: Family Connects
Additional sources:

WWHV038501

Dodge, K. A., Goodman, W. B., Murphy, R., O’Donnell, K. T., & Sato, J. M. (2013). Toward population impact from home visiting. Zero to Three, 33(3), 17-23.
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
Moderate Randomized controlled trial Low Established on race; not established on SES; not established on outcome measures assessable at baseline No None
Study characteristics
Study participants Among 4,777 residential births from July 1, 2009, through December 31, 2010, the authors randomly selected one family with a birth on each even day to receive Durham Connects, and one family with a birth on each odd day to be followed as the control group. If those selected did not consent to be studied, the authors replaced them with a randomly selected family from the same birth date with the same race/ethnicity. Among the 664 families enrolled in the study, 531 participated in follow-up data collection. Participating families were approximately one-quarter non-Hispanic white, 40 percent black, one-quarter Hispanic, and 9 percent were another race or ethnicity. Mothers were about 28 years old on average. Control group babies had slightly worse birth outcomes (on average) than control group babies. Eight percent of control group babies had a birth complication, whereas only 4 percent of Durham Connects babies had a birth complication (a statistically significant difference, p less than 0.05).
Setting Durham, North Carolina
Intervention services Durham Connects services consist of a total of four to seven contacts: a contact at the birthing hospital, one to three nurse home visits when infants are age 3 to 12 weeks, one or two nurse contacts with a community service provider, and a telephone or in-person follow-up contact one month later.
Comparison conditions Families in the comparison condition could receive other services in their community, but were not eligible to receive Durham Connects services.
Staff characteristics and training Nurses deliver Durham Connects according to manualized procedures. An independent expert accompanied the nurses to observe adherence to the intervention protocol at a random selection of 7 percent of home visits.
Funding sources The Duke Endowment, the Pew Center on the States, NIH Grants K05DA15226 and P30DA023026.
Author affiliation The authors are affiliated with the Center for Child and Family Policy at Duke University, which sponsors Durham Connects.
Study Registration:
Clinicaltrials.gov Identifier: NCT01406184

Findings details

Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Did not have emergency medical care episodes (hospital records), proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.74 Unadjusted proportion = 0.72 Mean difference = 0.02 HomeVEE calculated = 0.06 Not statistically significant, p=0.50
Moderate Did not have emergency medical care episodes (parent report) proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.50 Unadjusted proportion = 0.51 Mean difference = -0.01 HomeVEE calculated = -0.03 Not statistically significant, p=0.70
Moderate Most recent well-baby visit within past month
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.70 Unadjusted proportion = 0.67 OR = 1.12 HomeVEE calculated = 0.07 Not statistically significant,
p = 0.54
Moderate No. of emergency department visits (hospital records)
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.32 Unadjusted mean = 0.39 Mean difference = 0.14 HomeVEE calculated = -0.09 Not statistically significant,
p = 0.36
Moderate No. of emergency medical visits (parent report)
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.82 Unadjusted mean = 0.98 Mean difference = 0.17 HomeVEE calculated = -0.12 Not statistically significant,
p = 0.07
Moderate No. of overnights in hospital (parent report)
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.08 Unadjusted mean = 0.40 Mean difference = 1.60 Study reported = 0.20 Statistically significant, p<0.001
Moderate No. of total emergency medical care episodes (hospital records)
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.43 Unadjusted mean = 1.05 Mean difference = 0.91 Study reported = 0.26 Statistically significant, p<0.001
Moderate No. of total emergency medical care episodes (parent report)
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.89 Unadjusted mean = 1.37 Mean difference = 0.40 Study reported = 0.21 Statistically significant, p<0.001
Moderate Three or more emergency medical care episodes (hospital records), proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.03 Unadjusted proportion = 0.09 Mean difference = -0.05 HomeVEE calculated = -0.65 Statistically significant, p<0.01
Moderate Three or more emergency medical care episodes (parent report), proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.09 Unadjusted proportion = 0.13 Mean difference = -0.04 HomeVEE calculated = -0.26 Statistically significant, p<0.01
Moderate Two or more emergency medical care episodes (hospital records), proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.10 Unadjusted proportion = 0.15 Mean difference = -0.06 HomeVEE calculated = -0.31 Statistically significant, p<0.01
Moderate Two or more emergency medical care episodes (parent report), proportion
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.21 Unadjusted proportion = 0.25 Mean difference = -0.04 HomeVEE calculated = -0.13 Not statistically significant, p=0.13
Linkages and referrals
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate No. of community connections
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 5.02 Unadjusted mean = 4.31 Mean difference = 0.86 Study reported = 0.28 Statistically significant, p<0.001
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
Moderate Mother possible anxiety disorder
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.21 Unadjusted proportion = 0.30 OR = 0.65 HomeVEE calculated = -0.27 Statistically significant, p<0.05
Moderate Mother possible clinical depression disorder
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted proportion = 0.08 Unadjusted proportion = 0.12 OR = 0.69 HomeVEE calculated = -0.29 Not statistically significant,
p = 0.25
Moderate Mother possible substance use problems
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 530 families Unadjusted proportion = 0.05 Unadjusted proportion = 0.06 OR = 0.80 HomeVEE calculated = -0.19 Not statistically significant,
p = 0.58
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
Moderate Father–infant relationship quality
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 524 families Unadjusted mean = 2.09 Unadjusted mean = 1.92 Mean difference = 0.11 HomeVEE calculated = 0.21 Not statistically significant,
p = 0.08
Moderate Mother knowledge of infant development
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.75 Unadjusted mean = 0.77 Mean difference = 0.02 HomeVEE calculated = -0.11 Not statistically significant,
p = 0.10
Moderate Mother negative parenting behaviors
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 0.32 Unadjusted mean = 0.33 Mean difference = 0.02 HomeVEE calculated = -0.03 Not statistically significant,
p = 0.59
Moderate Mother positive parenting behaviors
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 4.12 Unadjusted mean = 4.01 Mean difference = 0.10 Study reported = 0.25 Statistically significant, p<0.01
Moderate Mother sense of parenting competence
FavorableUnfavorable or ambiguousNo Effect
Interviewed subsample, 7/2009-12/2010 births Infant Age 6 months 531 families Unadjusted mean = 4.62 Unadjusted mean = 4.63 Mean difference = 0.01 HomeVEE calculated = -0.02 Not statistically significant,
p = 0.83

Outcome measure summary

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

Did not have emergency medical care episodes (hospital records), proportion

Proportion of families with no emergency medical care episodes (emergency department visits plus hospital overnights) by age 6 months Administrative records

Not applicable

Did not have emergency medical care episodes (parent report) proportion

Proportion of families with no emergency medical care episodes (emergency pediatric visits plus emergency department visits plus hospital overnights) by age 6 months Parent report

Not applicable

Most recent well-baby visit within past month

Date of the most recent well-baby primary care visit. Responses were recoded as 0 (more than one month ago) or 1 (within the past month) Parent report

Not applicable

No. of emergency department visits (hospital records)

Average number of emergency department visits per family by age 6 months Administrative records

Not applicable

No. of emergency medical visits (parent report)

Infant's number of emergency medical visits to any hospital for non-birth related medical care in the past 3 months Parent report

Not applicable

No. of overnights in hospital (parent report)

Infant's number of overnights in any hospital for non-birth related medical care in the past three months Parent report

Not applicable

No. of total emergency medical care episodes (hospital records)

Average number of emergency medical care episodes (emergency department visits plus hospital overnights) per family by age 6 months Administrative records

Not applicable

No. of total emergency medical care episodes (parent report)

Average number of emergency medical care episodes (emergency pediatric visits plus emergency department visits plus hospital overnights) per family by age 6 months Parent report

Not applicable

Three or more emergency medical care episodes (hospital records), proportion

Proportion of families with three or more emergency medical care episodes (emergency department visits plus hospital overnights) by age 6 months Administrative records

Not applicable

Three or more emergency medical care episodes (parent report), proportion

Proportion of families with three or more emergency medical care episodes (emergency pediatric visits plus emergency department visits plus hospital overnights) by age 6 months Parent report

Not applicable

Two or more emergency medical care episodes (hospital records), proportion

Proportion of families with two or more emergency medical care episodes (emergency department visits plus hospital overnights) by age 6 months Administrative records

Not applicable

Two or more emergency medical care episodes (parent report), proportion

Proportion of families with two or more emergency medical care episodes (emergency pediatric visits plus emergency department visits plus hospital overnights) by age 6 months Parent report

Not applicable

Linkages and referrals
Outcome measure Description of measure Data collection method Properties of measure

No. of community connections

Community resources used in the past 3 months, including professional, paraprofessional, and informal resources Parent report

Not applicable

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

Mother possible anxiety disorder

7-item brief Generalized Anxiety Disorder 7-Questionnare, indicating possible clinical anxiety (cutpoint=5) Parent report

Not applicable

Mother possible clinical depression disorder

10-item Edinburgh Postnatal Depression Scale, indicating possible clinical depression (cutpoint=10) Parent report

Not applicable

Mother possible substance use problems

8-item CAGE and CAGE -AID questionnaires indicating possible substance use problems (cutpoint=1) Parent report

Not applicable

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

Father–infant relationship quality

Father-infant relationship quality (whether the biological father was involved with the infant 10 items e.g., "hugs or shows physical affection toward child") Parent report

Not applicable

Mother knowledge of infant development

Knowledge of infant development (10 items e.g., "shouted at infant") Parent report

Not applicable

Mother negative parenting behaviors

Negative parenting behaviors (10 items, e.g., "shouted at infant") Parent report

Not applicable

Mother positive parenting behaviors

Positive parenting behaviors (7 items e.g., "comforted infant") Parent report

Not applicable

Mother sense of parenting competence

Parenting sense of competence (17 items e.g., "being a parent makes me tense and anxious") Parent report

Not applicable