Olds, D. L., Holmberg, J. R., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. (2014). Effects of home visits by paraprofessionals and by nurses on children follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics, 168(2), 114-121.
Citation Year
Used in Implementation Reports
Study Participants

Pregnant women were referred to the study by staff at clinics serving low-income women in Denver, Colorado. Women were eligible to be included in the study if they were eligible for Medicaid or were uninsured, and had no previous live births. Women were randomly assigned to one of three treatment conditions: a control condition, paraprofessional home visiting, and nurse home visiting. Randomization occurred within strata defined by maternal race/ethnicity, maternal age, and maternal residence (geography).A total of 735 women were randomized: 255 into the control group, 245 into the paraprofessional home visiting group, and 235 into the nurse home visiting group. A total of 47.3 to 56 percent of children in the final analytic sample were boys (depending on treatment condition and follow-up period). A total of 12.9 to 17.6 percent of women in the final analytic sample were African American, 42.4 to 48.6 percent were Latino, and 33.7 to 40.1 percent were white. On average, at enrollment women had completed 11 years of school and were 19 or 20 years old. Average annual household incomes ranged from $12,308 to $13,561 and census tract poverty ranged from 20 to 21 percent. The percentage of women with low psychological resources ranged from 32.8 to 47.8.


Denver, Colorado

Home Visiting Services

This study had two treatment groups, each of which was compared to the control condition. The first group received home visits from paraprofessionals, the second group received home visits from nurses. Both groups also received free developmental screenings and referrals. Home visits began during pregnancy and lasted until the child's second birthday. Both the nurse and paraprofessional home visits had the same goals: to improve pregnancy outcomes through improved maternal health behaviors, improve child health and development through improved parental care, and assist mothers with planning future pregnancies and pursuing education and employment.

Comparison Conditions

The comparison group did not receive any home visits, but received free developmental screenings and referrals when the child was 6, 12, 15, 21, and 24 months old.

Staff Characteristics and Training

Nurse home visitors were required to have a bachelor's of science in nursing and nursing experience with maternal and child health or in a community setting; paraprofessional home visitors were required to have a high school education with no college work in the helping professions.

Author Affiliation

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

Funding Sources

The Colorado Trust: grants 99030, 2001-049, and 99012; the Administration for Children and Families: grants 90PD0232 and 90XP0017; the Office of Juvenile Justice and Delinquency Prevention: grant 2004-52854-CO-JS; the US Department ofJustice: grant 2005-MU-MU-001; the National Institute of Mental Health: grants 1R01MH069891, 1R01MH62485, and Senior Research Scientist Award 1-K05-MH01382.

Study Reg

Clinicaltrials.gov Identifier: NCT00438282, NCT00438594. Study registration was assessed by HomVEE beginning with the 2014 review.

Citation short
Olds, D. L., Holmberg, J. R., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. (2014)
Confounding Factors
Baseline Equivalence
Established on race; established on SES; outcome measures not assessable at baseline
Screening Decision
Passes screens
Design Detail
Randomized controlled trial
General Effects Notes
Results with paraprofessional home visitors.