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.

Citation Year
Used in Implementation Reports
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.


Denver, Colorado metropolitan area

Home Visiting 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.

Author Affiliation

David L. Olds, a study author, is a developer of this model.

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.

Denver, Colorado Sample
Citation short
Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., et al. (2004)
Confounding Factors
Baseline Equivalence
No relevant differences for nurse home visitor group. Statistically significant different in income between paraprofessional home visitor and comparison group.
Not applicable
Screening Decision
Passes screens
Design Detail
Randomized controlled trial
General Effects Notes
Results with paraprofessional home visitors.
General Outcome Notes
Outcomes measured with paraprofessional home visitors.