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Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., et al. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110(3), 486.

Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Established for race/ethnicity and SES None None Not assessed in manuscripts reviewed before 2021
Notes:

footnote5

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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.

footnote157

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This study received a mixed rating. All of the outcomes comparing paraprofessional-visited mothers versus the control condition for the main sample rate high. Outcomes for the low resources subgroup, for both the nurse-visited and paraprofessional-visited versus control comparisons, rate high. In addition, outcomes for the main sample for the nurse-visited versus control comparison at the 21-month follow-up rate high. Due to high attrition, the nurse-visited versus control comparison for the other follow-ups rate moderate.

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. From March 1994 through 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 measures the sample when the children were 6 months to 2 years old. The study sample at the 24-month parent interview included 630 women, 194 in the nurse home visiting program group, 213 in the paraprofessional home visiting program group, and 223 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.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).

• Mother has psychological vulnerability (yes or no) • Smoking status (current smoker)

Funding sources The Colorado Trust (93059); a contract with Abt Associates (105–94-1925) under a grant from the Administration for Children and Families (HHS); and a Senior Research Scientist Award to David Olds from the National Institute of Mental Health (K05-MH01382).
Author affiliation David L. Olds, a study author, is a developer of this model.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings that rate moderate or high

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 CBCL
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 24-month follow-up 136 children Adjusted mean = 48.13 Adjusted mean = 49.25 Mean difference = -1.12 Not available Not statistically significant,
p > 0.05
High BSID (mental development delay)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 24-month follow-up 136 children = 0.10 = 0.19 OR = 0.48 HomVEE calculated = -0.12 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High BSID (mental development index)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 24-month follow-up 136 children Adjusted mean = 90.18 Adjusted mean = 86.20 Mean difference = 3.98 Not available Statistically significant,
p ≤ 0.05

footnote26

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The confidence interval includes 0, but according to the study, the result is statistically significant (α = 0.05).

High PLS-3 (language delay)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 21-month follow-up 142 children = 0.07 = 0.18 OR = 0.32 HomVEE calculated = -0.65 Statistically significant,
p ≤ 0.05
High PLS-3 (language development)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 21-month follow-up 142 children Adjusted mean = 101.52 Adjusted mean = 96.85 Mean difference = 4.67 Not available Statistically significant,
p ≤ 0.05
High Infant low vitality: anger stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 6-month follow-up 138 children = 0.13 = 0.32 OR = 0.33 HomVEE calculated = -0.31 Statistically significant,
p ≤ 0.05
High Infant low vitality: joy stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 6-month follow-up 138 children = 0.24 = 0.40 OR = 0.46 HomVEE calculated = -0.45 Statistically significant,
p ≤ 0.05
High Infant vulnerability: fear stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 6-month follow-up 138 children = 0.12 = 0.21 OR = 0.51 HomVEE calculated = -0.34 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High Irritable temperament
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Denver) 6-month follow-up 138 children Adjusted mean = 2.88 Adjusted mean = 2.92 Mean difference = -0.04 Not available Not statistically significant,
p > 0.05
High CBCL
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 24-month follow-up 163 children Adjusted mean = 48.79 Adjusted mean = 49.25 Mean difference = -0.46 Not available Not statistically significant,
p > 0.05
High BSID (Mental development delay)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 24-month follow-up 163 children = 0.19 = 0.19 OR = 0.97 HomVEE calculated = 0.00 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High BSID (Mental development index)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 24-month follow-up 163 children Adjusted mean = 88.54 Adjusted mean = 86.20 Mean difference = 2.33 Not available Not statistically significant,
p > 0.05
High PLS-3 (language delay)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 21-month follow-up 163 children = 0.13 = 0.18 OR = 0.66 HomVEE calculated = -0.23 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High PLS-3 (language development)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 21-month follow-up 163 children Adjusted mean = 97.83 Adjusted mean = 96.85 Mean difference = 0.98 Not available Not statistically significant,
p > 0.05
High Infant low vitality: anger stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 6-month follow-up 158 children = 0.22 = 0.32 OR = 0.63 HomVEE calculated = -0.31 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High Infant low vitality: joy stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 6-month follow-up 158 children = 0.30 = 0.40 OR = 0.64 HomVEE calculated = -0.27 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High Infant vulnerability: fear stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 6-month follow-up 158 children = 0.17 = 0.21 OR = 0.77 HomVEE calculated = -0.16 Not statistically significant,
p > 0.05

footnote23

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Authors report results are not statistically significant, although this appears to be inconsistent with the confidence interval.

High Irritable temperament
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Paraprofessional home visitors and comparison (Denver) 6-month follow-up 158 children Adjusted mean = 2.95 Adjusted mean = 2.92 Mean difference = 0.02 Not available HomVEE = > 0.05
High PLS-3 (language delay)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 21 months 406 children % (adjusted) = 6.00 Adjusted mean % = 12.00 OR = 0.48 HomVEE calculated = -0.45 Statistically significant,
p ≤ 0.05
High PLS-3 (language delay)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 21 months 406 children % (adjusted) = 6.00 Adjusted mean % = 12.00 OR = 0.48 HomVEE calculated = -0.45 Statistically significant,
p ≤ 0.05
High PLS-3 (language development)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 21 months 406 children Adjusted mean = 101.22 Adjusted mean = 99.49 Mean difference = 1.73 Not available Not statistically significant, p ≥ 0.05
High PLS-3 (language development)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 21 months 406 children Adjusted mean = 101.22 Adjusted mean = 99.49 Mean difference = 1.73 Not available Not statistically significant,
p > 0.05
High CBCL
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 392 children Adjusted mean = 45.49 Adjusted mean = 45.26 Mean difference = 0.23 Not available Not statistically significant,
p > 0.05
High BSID (mental development delay)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 392 children % (adjusted) = 14.00 Adjusted mean % = 13.00 OR = 1.07 Not available Not statistically significant,
p > 0.05
High BSID (Mental Developmental Index)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 392 children Adjusted mean = 89.45 Adjusted mean = 89.38 Mean difference = 0.07 Not available Not statistically significant,
p > 0.05
High PLS-3 (language delay)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 21 months 420 children % (adjusted) = 11.00 Adjusted mean % = 12.00 OR = 0.90 HomVEE calculated = -0.06 Not statistically significant,
p > 0.05
High PLS-3 (language development)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 21 months 420 children Adjusted mean = 99.89 Adjusted mean = 99.49 Mean difference = 0.40 Not available Not statistically significant,
p > 0.05
High Irritable temperament (video coding)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 6 months 377 children Adjusted mean = 2.83 Adjusted mean = 2.84 Mean difference = -0.01 Not available Not statistically significant,
p > 0.05
High Low vitality: anger stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 6 months 377 children % (adjusted) = 26.00 Adjusted mean % = 28.00 OR = 0.89 HomVEE calculated = -0.06 Not statistically significant,
p > 0.05
High Low vitality: joy stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 6 months 377 children % (adjusted) = 31.00 Adjusted mean % = 34.00 OR = 0.88 HomVEE calculated = -0.08 Not statistically significant,
p > 0.05
High Vulnerable: fear stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 6 months 377 children % (adjusted) = 18.00 Adjusted mean % = 25.00 OR = 0.67 HomVEE calculated = -0.25 Not statistically significant,
p > 0.05
Moderate CBCL (Behavior problems score)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 372 children Adjusted mean = 43.71 Adjusted mean = 45.26 Mean difference = -1.56 Not available Not statistically significant,
p > 0.05
Moderate BSID MDI
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 372 children Adjusted mean = 90.13 Adjusted mean = 89.38 Mean difference = 0.75 Not available Not statistically significant,
p > 0.05
Moderate BSID, MDI: Mental development delay
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 372 children Adjusted mean % = 11.00 Adjusted mean % = 13.00 OR = 0.83 HomVEE calculated = -0.12 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

Moderate Infant low vitality: anger stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 6 months 363 children Adjusted mean % = 19.00 Adjusted mean % = 28.00 OR = 0.62 HomVEE calculated = -0.31 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

Moderate Infant low vitality: joy stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 6 months 363 children Adjusted mean % = 26.00 Adjusted mean % = 34.00 OR = 0.68 HomVEE calculated = -0.23 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

Moderate Infant vulnerability: fear stimuli (video coding)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 6 months 363 children % (adjusted) = 16.00 Adjusted mean % = 25.00 OR = 0.57 HomVEE calculated = -0.34 Statistically significant,
p ≤ 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

Moderate Irritable temperament
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 6 months 363 children Adjusted mean = 2.80 Adjusted mean = 2.84 Mean difference = -0.04 Not available Not statistically significant,
p > 0.05
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 Educational achievement (years)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 21 months 427 mothers Adjusted mean = 11.51 Adjusted mean = 11.51 Mean difference = 0.00 Not available Not statistically significant,
p ≥ 0.05
High Educational achievement (years)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 21 months 440 mothers Adjusted mean = 11.62 Adjusted mean = 11.51 Mean difference = 0.11 Not available Not statistically significant,
p ≥ 0.05
High Months employed (1–12 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 12 months 425 mothers Adjusted mean = 4.21 Adjusted mean = 3.97 Mean difference = 0.24 Not available Not statistically significant,
p ≥ 0.05
High Months employed (13–24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 439 mothers Adjusted mean = 6.14 Adjusted mean = 5.73 Mean difference = 0.41 Not available Not statistically significant,
p ≥ 0.05
High Months on AFDC (1–12 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 12 months 425 mothers Adjusted mean = 2.60 Adjusted mean = 2.35 Mean difference = 0.25 Not available Not statistically significant,
p ≥ 0.05
High Months on AFDC (13–24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 439 mothers Adjusted mean = 2.31 Adjusted mean = 1.92 Mean difference = 0.39 Not available Not statistically significant,
p ≥ 0.05
Moderate Months employed (1–12 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 12 months 406 mothers Adjusted mean = 4.35 Adjusted mean = 3.97 Mean difference = 0.38 Not available Not statistically significant,
p ≥ 0.05
Moderate Months employed (13–24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 419 mothers Adjusted mean = 6.87 Adjusted mean = 5.73 Mean difference = 1.14 Not available Statistically significant,
p ≤ 0.05
Moderate Months on AFDC (1–12 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 12 months 406 mothers Adjusted mean = 2.31 Adjusted mean = 2.35 Mean difference = -0.04 Not available Not statistically significant,
p ≥ 0.05
Moderate Months on AFDC (13–24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 419 mothers Adjusted mean = 1.95 Adjusted mean = 1.92 Mean difference = 0.03 Not available Not statistically significant,
p ≥ 0.05
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 Subsequent birth (24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 436 mothers % (adjusted) = 12.00 Adjusted mean % = 19.00 OR = 0.58 HomVEE calculated = -0.33 Statistically significant,
p ≤ 0.05
High Subsequent pregnancy (24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 24 months 436 mothers % (adjusted) = 29.00 Adjusted mean % = 41.00 OR = 0.60 HomVEE calculated = -0.32 Statistically significant,
p ≤ 0.05
High Subsequent birth (24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 417 mothers % (adjusted) = 13.00 Adjusted mean % = 19.00 OR = 0.63 HomVEE calculated = -0.27 Not statistically significant, p > 0.05

footnote3

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Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

High Subsequent pregnancy (24 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 417 mothers % (adjusted) = 33.00 Adjusted mean % = 41.00 OR = 0.70 HomVEE calculated = -0.21 Not statistically significant, p > 0.05

footnote3

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Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

High Use of emergency services
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 36 weeks (prenatal) 344 mothers % (adjusted) = 9.00 Adjusted mean % = 9.00 OR = 1.01 HomVEE calculated = 0.00 Not statistically significant,
p > 0.05
High Use of preventative services
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 36 weeks (prenatal) 344 mothers Adjusted mean = 0.67 Adjusted mean = 0.69 Mean difference = -0.02 Not available Not statistically significant,
p > 0.05
Moderate Use of emergency services
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 36 weeks (prenatal) 353 mothers % (adjusted) = 6.00 Adjusted mean % = 9.00 OR = 0.64 HomVEE calculated = -0.27 Not statistically significant,
p > 0.05
Moderate Use of preventative services
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) 36 weeks (prenatal) 353 mothers Adjusted mean = 0.80 Adjusted mean = 0.69 Mean difference = 0.11 HomVEE calculated = 0.09 Not statistically significant,
p > 0.05
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 environment score
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 21 months 420 mothers Adjusted mean = 37.40 Adjusted mean = 37.10 Mean difference = 0.30 Not available Not statistically significant,
p > 0.05
High Mother-infant responsive interaction
FavorableUnfavorable or ambiguousNo Effect
Paraprofessional home visitor and comparison (Denver) 24 months 392 mothers Adjusted mean = 100.15 Adjusted mean = 98.99 Mean difference = 1.16 Not available Not statistically significant, p ≥ 0.05
Moderate HOME environment score
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) Unknown 406 mothers Adjusted mean = 37.79 Adjusted mean = 37.10 Mean difference = 0.69 Not available Not statistically significant,
p > 0.05

footnote3

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Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

Moderate Mother-infant responsive interaction
FavorableUnfavorable or ambiguousNo Effect
Nurse home visitor and comparison (Denver) Unknown 372 mothers Adjusted mean = 100.31 Adjusted mean = 98.99 Mean difference = 1.32 Not available Statistically significant,
p ≤ 0.05

footnote17

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The study indicates home environments were rated at 12 and 21 months, however, only one result is presented in the article and the timing is not labeled.