Manuscript Detail

View Revisions

Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114(6), 1560-1568.

Model(s) Reviewed: Nurse-Family Partnership (NFP)® , NFP with Nurse Home Visitors - Mothers with low psychological resources subgroup , NFP with Paraprofessional Home Visitors , NFP with Paraprofessional Home Visitors - Mothers with low psychological resources subgroup
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 No relevant differences for nurse home visitor group. Statistically significant different in income between paraprofessional home visitor and comparison group. None None
Notes:

In 2020, HomVEE updated this review to remove eight mother's partnership status/family structure findings from the Family Economic Self-Sufficiency domain because ACF determined that mother's partnership status is ineligible for review by HomVEE.

footnote160

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

This study includes three groups: nurse home visits, paraprofessional home visits, and a comparison group. The high rating is based on the comparison between nurse home visits and the comparison group. The comparison between the paraprofessional and comparison groups receives a moderate rating because of a statistically significant difference in income at baseline that was not controlled.

footnote18

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

Subgroup findings have been replicated in at least two different samples. Other subgroup findings are excluded from this report. For the NFP model, the low psychological resource subgroup findings were used in the Memphis and Denver samples. The categorization for this subgroup differed somewhat across the two samples. Although both samples created a scale using intelligence, mental health, and mastery, only the Memphis sample also used a measure of self-efficacy in the scale. The authors indicated that self-efficacy was dropped in the Denver study because the measure was time-consuming to administer and did not appreciably improve the predictive power of the scale (this information was received through communication with the author).

Study characteristics
Study participants Women were recruited through 21 antepartum clinics that served low-income pregnant women. Recruitment focused on women who had no previous live births and either qualified for Medicaid or had no private health insurance. Between March 1994 and June 1995, 1,178 women were invited to participate and 735 consented and were randomly assigned to one of three conditions: a control group, nurse home visiting, and paraprofessional home visiting. Randomization was conducted within strata based on maternal race (Hispanic, white, black, American Indian, or Asian), maternal gestational age (less than 32 weeks, 32 weeks or more), and geographic region. This study measured the sample when the children were 4 years old. The sample of women who completed the interviews when children were 4 years old included 635 women, 204 in the nurse home visiting program group, 211 in the paraprofessional home visiting program group, and 220 in the comparison group.
Setting Denver, Colorado metropolitan area
Intervention services The study included two program groups: one serviced by paraprofessionals and one serviced by nurses. Women assigned to both groups received developmental screening and referral services for their children and home visits during pregnancy and infancy (until the child was 2 years old). Both groups had the same goals: (1) to improve women’s health-related behavior, (2) to support parents in providing competent care, and (3) to encourage planning future pregnancies and promote education and employment. Paraprofessionals conducted 6.3 home visits on average during pregnancy and 16 visits during infancy. Nurses conducted 6.5 home visits on average during pregnancy and 21 visits during infancy.
Comparison conditions Women in the comparison group received developmental screening and referral services for their children at 6, 12, 15, 21, and 24 months.
Staff characteristics and training Nurse home visitors were required to have a BSN degree and experience in community or maternal and child health nursing. Paraprofessionals were required to have a high school education. Although those with college preparation in the “helping” professions were excluded, preference was given to paraprofessionals who had worked in human services. Both the nurse and paraprofessional home visitors received one month of training prior to working with families. Nurses and paraprofessionals had the same caseloads (approximately 25 families), but paraprofessionals had 2 supervisors for 10 visitors, compared to 1 supervisor for 10 nurse home visitors.
Funding sources The Colorado Trust (grant 99030); the Administration for Children and Families, Department of Health and Human Services (grant 90PD0232); and a Senior Research Scientist Award (grant 1-K05-MH01382-01) to D.L.O.
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 Emotional regulation in testing
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 4-year follow-up 144 children Adjusted mean = 99.54 Adjusted mean = 98.42 Mean difference = 1.12 Study reported = 0.11 Not statistically significant,
p = 0.51

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 PLS-3 (Total language score)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 4-year follow-up 144 children Adjusted mean = 91.39 Adjusted mean = 86.73 Mean difference = 4.66 Study reported = 0.31 Statistically significant,
p = 0.04

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 Behavioral adaptation in testing
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 4-year follow-up 144 children Adjusted mean = 100.41 Adjusted mean = 96.66 Mean difference = 3.75 Study reported = 0.38 Statistically significant,
p = 0.04

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 Executive function composite
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 4-year follow-up 144 children Adjusted mean = 100.16 Adjusted mean = 95.48 Mean difference = 4.68 Study reported = 0.47 Statistically significant,
p = 0.00

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 Externalizing behavior problems
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 4-year follow-up 144 children Adjusted mean = 13.16 Adjusted mean = 12.95 Mean difference = 0.21 Study reported = 0.03 Not statistically significant,
p = 0.88

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 PLS-3 (Total language score)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 4-year follow-up 163 children Adjusted mean = 90.09 Adjusted mean = 86.73 Mean difference = 3.36 Study reported = 0.23 Not statistically significant,
p = 0.13

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 Behavioral adaptation in testing
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 4-year follow-up 163 children Adjusted mean = 99.51 Adjusted mean = 96.66 Mean difference = 2.85 Study reported = 0.28 Not statistically significant,
p = 0.10

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 Emotional regulation in testing
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 4-year follow-up 163 children Adjusted mean = 99.29 Adjusted mean = 98.42 Mean difference = 0.87 Study reported = 0.09 Not statistically significant,
p = 0.59

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 Executive function composite
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 4-year follow-up 163 children Adjusted mean = 98.40 Adjusted mean = 95.48 Mean difference = 2.92 Study reported = 0.29 Not statistically significant,
p = 0.06

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 Externalizing behavior problems
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 4-year follow-up 163 children Adjusted mean = 12.91 Adjusted mean = 12.95 Mean difference = -0.04 Study reported = 0.00 Not statistically significant,
p = 0.98

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 PLS-3 (total language score)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 children Adjusted mean = 92.65 Adjusted mean = 92.01 Mean difference = 0.64 Study reported = 0.04 Not statistically significant,
p = 0.65

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 Behavioral adaptation in testing
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 children Adjusted mean = 99.63 Adjusted mean = 99.71 Mean difference = -0.08 Study reported = -0.01 Not statistically significant,
p = 0.93

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 Child attended Head Start, preschool, center-based day care, or government-supported family care
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.54 = 0.66 OR = 0.62 HomeVEE calculated = -0.29 Statistically significant,
p = 0.03

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 Emotional regulation in testing
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 children Adjusted mean = 99.54 Adjusted mean = 99.61 Mean difference = -0.07 Study reported = -0.01 Not statistically significant,
p = 0.95

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 Executive function composite
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 children Adjusted mean = 100.64 Adjusted mean = 99.69 Mean difference = 0.95 Study reported = 0.09 Not statistically significant,
p = 0.34

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 Externalizing behavior problems
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 children Adjusted mean = 12.16 Adjusted mean = 12.20 Mean difference = -0.04 Study reported = -0.01 Not statistically significant,
p = 0.96

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.

Moderate PLS-3 (total language score)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 children Adjusted mean = 93.24 Adjusted mean = 92.01 Mean difference = 1.23 Study reported = 0.08 Not statistically significant,
p = 0.39

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.

Moderate Behavioral adaptation in testing
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 children Adjusted mean = 100.66 Adjusted mean = 99.71 Mean difference = 0.95 Study reported = 0.09 Not statistically significant,
p = 0.34

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.

Moderate Child attended Head Start, preschool, center-based day care, or government-supported family care
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 children = 0.59 = 0.66 OR = 0.76 HomeVEE calculated = -0.17 Not statistically significant,
p = 0.21

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.

Moderate Emotional regulation in testing
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 children Adjusted mean = 100.86 Adjusted mean = 99.61 Mean difference = 1.25 Study reported = 0.13 Not statistically significant,
p = 0.21

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.

Moderate Executive function composite
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 children Adjusted mean = 99.70 Adjusted mean = 99.69 Mean difference = 0.01 Study reported = 0.00 Not statistically significant,
p = 1.00

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.

Moderate Externalizing behavior problems
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 children Adjusted mean = 11.65 Adjusted mean = 12.20 Mean difference = -0.55 Study reported = -0.08 Not statistically significant,
p = 0.44

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.

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 Subsequent low birth weight newborns
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.06 = 0.08 OR = 0.75 HomeVEE calculated = -0.17 Not statistically significant,
p = 0.45
High Subsequent special care admissions
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.06 = 0.08 OR = 0.66 HomeVEE calculated = -0.26 Not statistically significant,
p = 0.27
Moderate Subsequent special care admissions
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.05 = 0.08 OR = 0.54 HomeVEE calculated = -0.38 Not statistically significant,
p = 0.13
Moderate Subsequent low birth weight newborns
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional. home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.03 = 0.08 OR = 0.34 HomeVEE calculated = -0.64 Statistically significant,
p = 0.03
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 Graduated from high school or earned GED
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.80 = 0.76 OR = 1.26 HomeVEE calculated = 0.14 Not statistically significant,
p = 0.35
High Months mother employed (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 14.42 Adjusted mean = 13.38 Mean difference = 1.04 Study reported = 0.04 Not statistically significant,
p = 0.22
High Months of AFDC (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 1.88 Adjusted mean = 2.10 Mean difference = -0.22 Study reported = 0.01 Not statistically significant,
p = 0.69
High Months of food stamps (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 4.32 Adjusted mean = 3.98 Mean difference = 0.34 Study reported = 0.07 Not statistically significant,
p = 0.67
High Months of Medicaid (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 7.34 Adjusted mean = 6.98 Mean difference = 0.36 Study reported = -0.03 Not statistically significant,
p = 0.71
Moderate Graduated from high school or earned GED
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.82 = 0.76 OR = 1.39 HomeVEE calculated = 0.20 Not statistically significant,
p = 0.18
Moderate Months mother employed (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 15.13 Adjusted mean = 13.38 Mean difference = 1.75 Study reported = 0.11 Statistically significant,
p = 0.04
Moderate Months of AFDC (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 1.95 Adjusted mean = 2.10 Mean difference = -0.15 Study reported = -0.19 Not statistically significant,
p = 0.78
Moderate Months of food stamps (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 4.56 Adjusted mean = 3.98 Mean difference = 0.58 Study reported = 0.21 Not statistically significant,
p = 0.47
Moderate Months of Medicaid (25–48 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 8.08 Adjusted mean = 6.98 Mean difference = 1.10 Study reported = 0.02 Not statistically significant,
p = 0.26
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 MHI
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 99.82 Adjusted mean = 99.16 Mean difference = 0.66 Study reported = 0.04 Not statistically significant,
p = 0.49
High Behavioral problems attributable to substance use
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.15 = 0.12 OR = 1.27 HomeVEE calculated = 0.15 Not statistically significant,
p = 0.41
High Currently using marijuana
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.08 = 0.09 OR = 0.86 HomeVEE calculated = -0.09 Not statistically significant,
p = 0.67
High Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.04 = 0.04 OR = 1.09 HomeVEE calculated = 0.06 Not statistically significant,
p = 0.84
High Months between births of first and second children
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 24.51 Adjusted mean = 20.39 Mean difference = 4.12 Study reported = 0.32 Statistically significant,
p = 0.01
High Number of subsequent live births
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 0.48 Adjusted mean = 0.57 Mean difference = -0.09 Study reported = -0.13 Not statistically significant,
p = 0.18
High Number of subsequent pregnancies
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 0.85 Adjusted mean = 0.88 Mean difference = -0.03 Study reported = -0.04 Not statistically significant,
p = 0.72
High Pearlin Mastery Scale
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers Adjusted mean = 99.41 Adjusted mean = 99.31 Mean difference = 0.10 Study reported = 0.12 Not statistically significant,
p = 0.91
High Subsequent abortion
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.05 = 0.05 OR = 0.94 HomeVEE calculated = -0.04 Not statistically significant,
p = 0.89
High Subsequent miscarriage
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.09 = 0.12 OR = 0.73 HomeVEE calculated = -0.19 Not statistically significant,
p = 0.31
Moderate MHI
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 101.20 Adjusted mean = 99.16 Mean difference = 0.66 Study reported = -0.03 Statistically significant,
p = 0.03
Moderate Behavioral problems attributable to substance use
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.10 = 0.12 OR = 0.82 HomeVEE calculated = -0.12 Not statistically significant,
p = 0.52
Moderate Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.03 = 0.04 OR = 0.74 HomeVEE calculated = -0.21 Not statistically significant,
p = 0.54
Moderate Months between births of first and second children
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 22.20 Adjusted mean = 20.39 Mean difference = 1.81 Study reported = 0.14 Not statistically significant,
p = 0.27
Moderate Number of subsequent live births
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 0.53 Adjusted mean = 0.57 Mean difference = -0.04 Study reported = -0.06 Not statistically significant,
p = 0.57
Moderate Number of subsequent pregnancies
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 0.88 Adjusted mean = 0.88 Mean difference = 0.00 Study reported = 0.00 Not statistically significant,
p = 1.00
Moderate Pearlin Mastery Scale
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers Adjusted mean = 101.20 Adjusted mean = 99.31 Mean difference = 1.94 Study reported = 0.20 Statistically significant,
p = 0.03
Moderate Subsequent abortion
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.06 = 0.05 OR = 1.19 HomeVEE calculated = 0.10 Not statistically significant,
p = 0.67
Moderate Subsequent miscarriage
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.07 = 0.12 OR = 0.50 HomeVEE calculated = -0.42 Statistically significant,
p = 0.04
Moderate Currently using marijuana
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison, (Denver) 4-year follow-up 431 mothers = 0.09 = 0.09 OR = 0.94 HomeVEE calculated = -0.04 Not statistically significant,
p = 0.87
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 total score
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 mothers Adjusted mean = 25.32 Adjusted mean = 25.09 Mean difference = 0.23 Study reported = 0.07 Not statistically significant,
p = 0.47
High Sensitive/responsive interaction
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 408 mothers Adjusted mean = 100.51 Adjusted mean = 98.66 Mean difference = 1.85 Study reported = 0.18 Not statistically significant,
p = 0.06
Moderate HOME total score
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 mothers Adjusted mean = 25.08 Adjusted mean = 25.09 Mean difference = -0.01 Study reported = 0.00 Not statistically significant,
p = 0.96
Moderate Sensitive/responsive interaction
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 412 mothers Adjusted mean = 100.92 Adjusted mean = 98.66 Mean difference = 2.26 Study reported = 0.23 Statistically significant,
p = 0.03
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 Any domestic violence (past 6 months)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.07 = 0.14 OR = 0.47 HomeVEE calculated = -0.46 Statistically significant,
p = 0.05
High Any domestic violence (since child age 2)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 4-year follow-up 424 mothers = 0.16 = 0.24 OR = 0.60 HomeVEE calculated = -0.31 Not statistically significant,
p = 0.09
Moderate Any domestic violence (past 6 months)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.14 = 0.14 OR = 1.05 HomeVEE calculated = 0.03 Not statistically significant,
p = 0.88
Moderate Any domestic violence (since child age 2)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 4-year follow-up 431 mothers = 0.22 = 0.24 OR = 0.90 HomeVEE calculated = -0.06 Not statistically significant,
p = 0.72

Outcome measure summary

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

PLS-3 (total language score)

The PLS-3 is used to assess expressive and receptive language skills in young children.

Child assessment

Not reported by author

Behavioral adaptation in testing

Assessments of children’s ability to regulate their behavior and emotions were analyzed using principal components analysis to produce two scales: (1) behavioral adaptation (attention, activity level, organization of behavior/impulse control, and sociability); and (2) emotional regulation (anxiety, energy and feelings, regulation of mood, and sensory reactivity).

In-home observational assessment

Cronbach’s α = 0.96

Child attended Head Start, preschool, center-based day care, or government-supported family care

Percentage of children who attended Head Start, preschool, center-based day care, or government-supported family care Parent/caregiver report

Not applicable

Emotional regulation in testing

Assessments of children’s ability to regulate their behavior and emotions were analyzed using principal components analysis to produce two scales: (1) behavioral adaptation (attention, activity level, organization of behavior/impulse control, and sociability); and (2) emotional regulation (anxiety, energy and feelings, regulation of mood, and sensory reactivity).

In-home observational assessment

Cronbach’s α = 0.92

Executive function composite

Assessments of a series of cognitive tasks focusing primarily on the children’s capacity for sustained attention and inhibitory control were coded and analyzed using principal components analysis to produce a single composite index labeled executive functions.

In-home observational assessment

Cronbach’s α = 0.60

Externalizing behavior problems

Instances of rule-breaking and aggressive behavior

Parent/caregiver report

Not reported by author

PLS-3

The PLS-3 is used to assess expressive and receptive language skills in young children.

Child assessment

Not reported by author

Behavioral adaptation in testing

Assessments of children’s ability to regulate their behavior and emotions were analyzed using principal components analysis to produce two scales: (1) behavioral adaptation (attention, activity level, organization of behavior/impulse control, and sociability); and (2) emotional regulation (anxiety, energy and feelings, regulation of mood, and sensory reactivity).

In-home observational assessment

Cronbach’s α = 0.96

Child attended Head Start, preschool, center-based day care, or government-supported family care

Percentage of children who attended Head Start, preschool, center-based day care, or government-supported family care

Parent/caregiver report

Not applicable

Emotional regulation in testing

Assessments of children’s ability to regulate their behavior and emotions were analyzed using principal components analysis to produce two scales: (1) behavioral adaptation (attention, activity level, organization of behavior/impulse control, and sociability); and (2) emotional regulation (anxiety, energy and feelings, regulation of mood, and sensory reactivity).

In-home observational assessment

Cronbach’s α = 0.92

Executive function composite

Assessments of a series of cognitive tasks focusing primarily on the children’s capacity for sustained attention and inhibitory control were coded and analyzed using principal components analysis to produce a single composite index labeled executive functions.

In-home observational assessment

Cronbach’s α = 0.60

Externalizing behavior problems

Instances of rule-breaking and aggressive behavior

Parent/caregiver report

Not reported by author

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

Subsequent NICU or special care admissions

Rate of subsequent NICU or special care admissions per subsequent pregnancy since the birth of the study’s focal child Parent/caregiver report

Not applicable

Subsequent low birth weight newborns

Rate of subsequent low birth weight newborns per subsequent births since the birth of the study’s focal child Parent/caregiver report

Not applicable

Subsequent NICU or special care admissions

Rate of subsequent NICU or special care admissions per subsequent pregnancy after completion of the program

Parent/caregiver report

Not applicable

Subsequent low birth weight newborns

Rate of subsequent low birth weight newborns per subsequent births after completion of the program

Parent/caregiver report

Not applicable

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

Graduated from high school or earned GED

Percentage of mothers who had earned a high school diploma or GED

Parent/caregiver report

Not applicable

Months mother employed (25–48 months postpartum)

Counts of the number of months the mother was employed Parent/caregiver report

Not applicable

Months on AFDC (25–48 months postpartum)

Counts of the number of months the mother received AFDC

Parent/caregiver report

Not applicable

Months on food stamps (25–48 months postpartum)

Counts of the number of months the mother received food stamps

Parent/caregiver report

Not applicable

Months on Medicaid (25–48 months postpartum)

Counts of the number of months the mother received Medicaid Parent/caregiver report

Not applicable

Graduated from high school or earned GED

Percentage of mothers who had earned a high school diploma or GED

Parent/caregiver report

Not applicable

Months mother employed (25–48 months postpartum)

Counts of the number of months the mother was employed. The outcome was measured for the period of 25 to 48 months postpartum

Parent/caregiver report

Not applicable

Months on AFDC (25–48 months postpartum)

Counts of the number of months the mother received AFDC. The outcome was measured for the period of 25 to 48 months postpartum

Parent/caregiver report

Not applicable

Months on food stamps (25–48 months postpartum)

Counts of the number of months the mother received food stamps. The outcome was measured for the period of 25 to 48 months postpartum

Parent/caregiver report

Not applicable

Months on Medicaid (25–48 months postpartum)

Counts of the number of months the mother received Medicaid. The outcome was measured for the period of 25 to 48 months postpartum

Parent/caregiver report

Not applicable

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

MHI

The MHI assesses mental health in the areas of anxiety, depression, behavior, positive affect, and general distress. Parent/caregiver report

Not applicable

Behavioral problems attributable to substance use

A measure of the extent to which use of alcohol and drugs interfered with the mother’s daily functioning Parent/caregiver report

Not applicable

Currently using marijuana

Percentage of mothers who were currently using marijuana Parent/caregiver report

Not applicable

Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days)

Percentage of mothers who had at least three drinks at a time at least three times in the previous 14 days Parent/caregiver report

Not applicable

Months between births of first and second children

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

Not applicable

Number of subsequent live births

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

Not applicable

Number of subsequent pregnancies

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

Not applicable

Pearlin Mastery Scale

The Pearlin Mastery Scale assesses the degree to which a person has a sense of mastery or control over their life. Parent/caregiver report

Not applicable

Subsequent abortion

Rate of abortion per subsequent pregnancy experienced by the mothers Parent/caregiver report

Not applicable

Subsequent miscarriage

Rate of miscarriage per subsequent pregnancy experienced by the mothers Parent/caregiver report

Not applicable

MHI

The MHI assesses mental health in the areas of anxiety, depression, behavior, positive affect, and general distress.

Parent/caregiver report

Not applicable

Behavioral problems attributable to substance use

A measure of the extent to which use of alcohol and drugs interfered with the mother’s daily functioning

Parent/caregiver report

Not applicable

Currently using marijuana

Percentage of mothers who were currently using marijuana

Parent/caregiver report

Not applicable

Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days)

Percentage of mothers who had at least three drinks at a time at least three times in the previous 14 days

Parent/caregiver report

Not applicable

Months between births of first and second children

Number of months that passed between the birth of the mother’s first and second child

Parent/caregiver report

Not applicable

Number of subsequent live births

The number of subsequent births experienced by the mother

Parent/caregiver report

Not applicable

Number of subsequent pregnancies

The number of subsequent pregnancies experienced by the mother

Parent/caregiver report

Not applicable

Pearlin Mastery Scale

The Pearlin Mastery Scale assesses the degree to which a person has a sense of mastery or control over their life.

Parent/caregiver report

Not applicable

Subsequent abortion

Rate of abortion per subsequent pregnancy experienced by the mothers

Parent/caregiver report

Not applicable

Subsequent miscarriage

Rate of miscarriage per subsequent pregnancy experienced by the mothers

Parent/caregiver report

Not applicable

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

Not reported by author

Sensitive/responsive interaction

Mother-child interaction during free play was coded and subsequently analyzed using principal components analysis to derive a single factor for sensitive/responsive interaction. Parent/caregiver interview and observational assessment

Cronbach’s α = 0.67

HOME: Total score

The HOME assesses parenting practices and aspects of the home environment.

Parent/caregiver interview and observational assessment

Not reported by author

Sensitive/responsive interaction

Mother-child interaction during free play was coded and subsequently analyzed using principal components analysis to derive a single factor for sensitive/responsive interaction.

Parent/caregiver interview and observational assessment

Cronbach’s α = 0.67

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

Any domestic violence (past 6 months)

Whether the mother had experienced physical violence from any of her partners during the previous 6 months Parent/caregiver report

Not applicable

Any domestic violence (since child age 2)

Whether the mother had experienced physical violence from any of her partners since the child was 2 years old Parent/caregiver report

Not applicable

Any domestic violence during the previous 6 months

Whether the mother had experienced physical violence from any of her partners during the previous 6 months

Parent/caregiver report

Not applicable

Any domestic violence since the child was 2 years old

Whether the mother had experienced physical violence from any of her partners since the child was 2 years old

Parent/caregiver report

Not applicable