Study Detail

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Schwarz, D. F., O’Sullivan, A. L., Guinn, J., Mautone, J. A., Carlson, E. C., Zhao, H., Zhang, X., Esposito, T. L., Askew, M., & Radcliffe, J. (2012). Promoting early intervention referral through a randomized controlled home-visiting program. Journal of Early Intervention, 34(1), 20–39

Model(s) Reviewed: MOM Program
Study Screening Details
Screening Decision Screening Conclusion
Study passes screens Study Passes Screens
Study Design Details
Rating Design Attrition Baseline Equivalence Reassignment Confounding Factors
Moderate Randomized controlled trial Low Equivalent on race/ethnicity, information on SES not available None None
Notes:

footnote154

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

In order to receive a high rating, randomized controlled trials (RCTs) with low attrition must control for race/ethnicity, socioeconomic status (SES), and, if applicable, baseline outcomes if statistically significant differences exist between treatment and control groups. In this case, there were no significant differences in terms of race/ethnicity, but we had insufficient information to assess baseline equivalence on SES because the only SES measure collected at baseline was maternal education. HomVEE prefers to see equivalence on income, earnings, or poverty levels according to federal thresholds, but also considers other measures of SES (that is, maternal education, employment, and Aid to Families with Dependent Children/Temporary Assistance for Needy Families or food stamps receipt), if at least two such alternative measures of SES are provided.

Study Characteristics
Study Participants Participating mothers were recruited from the postpartum unit of a hospital in Philadelphia and randomized into treatment and control groups. Of the 650 mothers who met eligibility criteria, 618 were invited to participate (32 were not invited, largely due to being discharged early from the hospital). The 302 mothers who consented to study participation were randomized to the treatment (n = 152) and control (n = 150) groups. All mothers lived in zip codes with high rates of poverty and each had just given birth to a singleton that weighed at least 2,500 grams and did not appear to have any genetic or developmental disorders. The study notes that most of the mothers were African American but does not provide statistics on the racial composition of the sample. The mothers had completed 12 years of schooling. No additional baseline data on socioeconomic status are specified. Participants were followed from birth until 33-months of age: telephone interviews were conducted with the mothers every four months, in-person assessments of children were completed at 18 and 33 months, and mothers were assessed and interviewed at 33 months.
Setting The study was conducted in a high-poverty area of Philadelphia.
Home Visiting Services The intervention included, on average, eight 15-minute home visits that were scheduled to coincide with well-child pediatric appointments during the child’s first three years. During these visits, the home visitors informed each mother of the content of the upcoming well-child visit, asked the mother to identify any concerns about her child, informed the mother about the developmental milestones relevant to her child’s age, and asked if her child met each milestone. In addition, home visitors advised the mother to raise concerns about her child’s health during the visit to the health care provider and informed her about early education services that might be suitable for the child. At 18 months, home visitors conducted a more extensive visit. They described the developmental expectations for children from 18 to 24 months, paying particular attention to emerging language skills. They reinforced previous referrals to Early Head Start or early intervention services by asking about the referral process and/or providing the relevant contact information again. They discussed the importance of immunization and lead screening. They prepared the mother for the 18-month well-child visit by emphasizing to the mother the importance of checking whether the child was growing at the expected rate, reviewing any questions for the health provider, and discussing potential barriers for attending the next well-child visit and identifying potential solutions. The mother was reminded of the importance of the annual gynecological exam, provided with resources as necessary, and asked to confirm her contact information. Finally she was offered a developmental screen for her child using the Ages and Stages Questionnaire (ASQ).
Comparison Conditions The comparison group members received information booklets on child/family services on enrollment and details on transportation for the 33-month child evaluation. They also received follow-up telephone calls every four months to maintain up-to-date contact information.
Staff Characteristics and Training Home visits were conducted by a member of the four-person intervention team, which consisted of two nurse practitioners and two trained community workers. The team members alternated responsibility for visiting each family. The nurse practitioners were Caucasian females with master’s degrees who were in their late 30s. The community workers were African American females with high school degrees (and some college coursework for one). One of the community workers was in her mid-20s and the other in her mid-50s. The nurse practitioners and the community workers alternated visits. Oversight was conducted through weekly 90-minute supervisory meetings with a board-certified pediatrician, a doctoral-level nurse practitioner and two doctoral-level psychologists. Home visitors were trained through initial supervision meetings and additional sessions that included presentations, demonstrations by a program leader, videotapes showcasing ideal home visiting conduct, and role plays. Staff were observed while implementing the ASQ assessment and provided additional training until they reached required standards.
Funding Sources The William Penn Foundation (Grant 229-08)
Author Affiliation Not clear from the article.

Study Effects Details

Outcome domain: Maternal Health Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Moderate BDI-II total scale
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 269 mothers Mean = 12.20 Mean = 11.00 Mean difference = 1.20 HomeVEE calculated = 0.13 Not statistically significant, p > 0.05 Secondary
Moderate Number of other children
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 1.40 Mean = 1.40 Mean difference = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p > 0.05 Secondary
Moderate Number of other children
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 0.30 Mean = 0.30 Mean difference = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p > 0.05 Secondary
Moderate Number of subsequent pregnancies
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 0.61 Mean = 0.60 Mean difference = 0.01 HomeVEE calculated = 0.01 Not statistically significant, p > 0.05 Secondary
Outcome domain: Child Development and School Readiness Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Moderate Denver Developmental Screening Test-II (DDST-II)
FavorableUnfavorableNo Effect
Philadelphia sample 16 months 287 mothers Not available Not available Not Reported Not available Not statistically significant, p > 0.05 Primary
Moderate Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Full Scale IQ
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 88.44 Mean = 89.53 Mean difference = -1.09 HomeVEE calculated = -0.09 Not statistically significant, p > 0.05 Primary
Moderate Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Language Score
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 90.10 Mean = 90.36 Mean difference = -0.26 HomeVEE calculated = -0.02 Not statistically significant, p > 0.05 Primary
Moderate Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Performance Score
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 89.38 Mean = 91.18 Mean difference = -1.80 HomeVEE calculated = -0.15 Not statistically significant, p > 0.05 Primary
Moderate Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Verbal Score
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 90.33 Mean = 91.02 Mean difference = -0.69 HomeVEE calculated = -0.06 Not statistically significant, p > 0.05 Primary
Outcome domain: Family Economic Self-Sufficiency Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type Notes
Moderate Maternal level of education
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 12.20 Mean = 12.30 Mean difference = -0.10 HomeVEE calculated = -0.05 Not statistically significant, p > 0.05 Secondary
Moderate Monthly income > 2500
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.07 Mean % = 0.07 Percentage difference = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 1000
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.21 Mean % = 0.19 Percentage difference = 0.02 HomeVEE calculated = 0.08 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 1500
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.21 Mean % = 0.17 Percentage difference = 0.04 HomeVEE calculated = 0.14 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 2000
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.07 Mean % = 0.11 Percentage difference = 0.04 HomeVEE calculated = 0.27 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 250
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.18 Mean % = 0.13 Percentage difference = 0.05 HomeVEE calculated = 0.24 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 2500
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.04 Mean % = 0.05 Percentage difference = 0.01 HomeVEE calculated = 0.11 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Monthly income: 500
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.23 Mean % = 0.29 Percentage difference = 0.06 HomeVEE calculated = 0.19 Not statistically significant, p > 0.05 Secondary

footnote173

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

Author calculated <em>p</em>-value for overall difference across income categories = 0.70

Moderate Number of months in school in past year
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 2.00 Mean = 1.40 Mean difference = 0.60 HomeVEE calculated = 0.19 Not statistically significant, p > 0.05 Secondary
Moderate Number of months worked in past year
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 6.80 Mean = 7.10 Mean difference = -0.30 HomeVEE calculated = -0.06 Not statistically significant, p > 0.05 Secondary
Moderate Number of moves in past 33 months
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Mean = 1.10 Mean = 1.10 Mean difference = 0.00 HomeVEE calculated = 0.00 Not statistically significant, p > 0.05 Secondary
Moderate Receipt of public assistance
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.56 Mean % = 0.55 Percentage difference = 0.01 HomeVEE calculated = 0.03 Not statistically significant, p > 0.05 Secondary
Moderate Use of homeless services
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 271 mothers Percentage = 0.10 Mean % = 0.06 Percentage difference = 0.04 HomeVEE calculated = 0.32 Not statistically significant, p > 0.05 Secondary

footnote163

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

Positive value is favorable to the comparison group.

footnote174

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

<abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>-calculated p-value

Outcome domain: Linkages and Referrals Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
Moderate Receipt of early intervention (EI) services
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 287 mothers Percentage = 0.15 Mean % = 0.04 Percentage difference = 0.11 HomeVEE calculated = 0.87 Statistically significant, p < 0.05 Secondary
Moderate Referral to early intervention (EI)
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 287 mothers Percentage = 0.20 Mean % = 0.15 Percentage difference = 0.06 HomeVEE calculated = 0.23 Statistically significant, p < 0.05 Secondary
Moderate Time to first receipt of early intervention (EI) services
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 287 mothers Not available Not available Not Reported Not available Statistically significant, p < 0.05 Secondary
Moderate Time to first referral for early intervention (EI) services
FavorableUnfavorableNo Effect
Philadelphia sample 33 months 287 mothers Not available Not available Not Reported Not available Statistically significant, p < 0.05 Secondary

Study Outcome Measure Summary

Outcome Domain: Maternal Health Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
Moderate

No. of other children

Mean number of other children Parent/caregiver report

Not applicable

Secondary
Moderate

No. of subsequent pregnancies

Mean number of subsequent pregnancies Parent/caregiver report

Not applicable

Secondary
Outcome Domain: Child Development and School Readiness Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
Moderate

Denver Developmental Screening Test-II (DDST-II)

Number of children whose scores indicated abnormal development on the DDST-II. DDST-II is designed to measure developmental skill attainment for children from birth to age 6. DDST-II provides overall ratings of normal, borderline, or abnormal development, with abnormal defined as having two or more areas considered borderline or abnormal. Parent/caregiver report

Interrater reliability = 90%; test-retest reliability = 0.75;

Primary
Moderate

Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Full Scale IQ

Mean full scale IQ score on the WPPSI-III. WPPSI-III includes tasks of language, nonverbal reasoning, concept development, and fine motor skills. Child assessment

Test-retest reliability ranges from 0.86 to 0.92; internal consistency ranges from 0.89 to 0.97

Primary
Moderate

Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Language Score

Mean language score on the WPPSI-III. WPPSI-III includes tasks of language, nonverbal reasoning, concept development, and fine motor skills. Child assessment

Test-retest reliability ranges from 0.86 to 0.92; internal consistency ranges from 0.89 to 0.97

Primary
Moderate

Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Performance Score

Mean performance score on the WPPSI-III. WPPSI-III includes tasks of language, nonverbal reasoning, concept development, and fine motor skills. Child assessment

Test-retest reliability ranges from 0.86 to 0.92; internal consistency ranges from 0.89 to 0.97

Primary
Moderate

Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III), Verbal Score

Mean verbal score on the WPPSI-III. WPPSI-III includes tasks of language, nonverbal reasoning, concept development, and fine motor skills. Child assessment

Test-retest reliability ranges from 0.86 to 0.92; internal consistency ranges from 0.89 to 0.97

Primary
Outcome Domain: Family Economic Self-Sufficiency Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
Moderate

Maternal level of education

Mean years of maternal education Parent/caregiver report

Not applicable

Secondary
Moderate

Mean number of months caregiver was in school during the past year

Number of months in school in past year Parent/caregiver report

Not applicable

Secondary
Moderate

Mean number of months caregiver worked in the past year

Number of months worked in past year Parent/caregiver report

Not applicable

Secondary
Moderate

Mean number of times family moved in the past 33 months

Number of moves in past 33 months Parent/caregiver report

Not applicable

Secondary
Moderate

Mean years of maternal education

Maternal level of education Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families that received public assistance

Receipt of public assistance Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families that used homeless services

Use of homeless services Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income between $1,001 and $1,500

Monthly income: 1500 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income between $1,501 and $2,000

Monthly income: 2000 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income between $2,001 and $2,500

Monthly income: 2500 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income between $251 and $500

Monthly income: 500 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income between $501 and $1,000

Monthly income: 1000 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income greater than $2,500

Monthly income > 2500 Parent/caregiver report

Not applicable

Secondary
Moderate

Percentage of families with monthly income of $250 or less

Monthly income: 250 Parent/caregiver report

Not applicable

Secondary
Outcome Domain: Linkages and Referrals Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
Moderate

Receipt of early intervention (EI) services

Number of children who received EI services Parent/caregiver report

Not applicable

Secondary
Moderate

Referral to early intervention (EI)

Number of children referred to EI services Parent/caregiver report

Not applicable

Secondary
Moderate

Time to first receipt of early intervention (EI) services

Percentage of children who received EI services at one-month intervals when children were between 0 and 33 months of age Parent/caregiver report

Not applicable

Secondary
Moderate

Time to first referral for early intervention (EI) services

Percentage of children referred to EI services at one-month intervals when children were between 0 and 33 months of age Parent/caregiver report

Not applicable

Secondary