Prenatal and Infancy Home Visitation by Nurses: Recent Findings

Abstract

This article describes a 20-year program of research on the Nurse Home Visitation Program, a model in which nurses visit mothers beginning during pregnancy and continuing through their children's second birthdays to improve pregnancy outcomes, to promote children's health and development, and to strengthen families' economic self-sufficiency. The results of two randomized trials (one in Elmira, New York, and the second in Memphis, Tennessee) are summarized, and an ongoing trial in Denver, Colorado, is briefly described. Results of the Elmira and Memphis trials suggest the following: The program benefits the neediest families (low-income unmarried women) but provides little benefit for the broader population. Among low-income unmarried women, the program helps reduce rates of childhood injuries and ingestions that may be associated with child abuse and neglect, and helps mothers defer subsequent pregnancies and move into the workforce. Long-term follow-up of families in Elmira indicates that nurse-visited mothers were less likely to abuse or neglect their children or to have rapid successive pregnancies. Having fewer children enabled women to find work, become economically self-sufficient, and eventually avoid substance abuse and criminal behavior. Their children benefitted too. By the time the children were 15 years of age, they had had fewer arrests and convictions, smoked and drank less, and had had fewer sexual partners. The program produced few effects on children's development or on birth outcomes, except for children born to women who smoked cigarettes when they registered during pregnancy. The positive effects of the program on child abuse and injuries to children were most pronounced among mothers who, at registration, had the lowest psychological resources (defined as high levels of mental health symptoms, limited intellectual functioning, and little belief in their control of their lives). Generally, effects in Elmira were of greater magnitude and covered a broader range of outcomes than in Memphis, perhaps because of differences between the populations studied, community contexts, or a higher rate of turnover among home visitors in Memphis than in Elmira. The article concludes that the use of nurses as home visitors is key; that services should be targeted to the neediest populations, rather than being offered on a universal basis; that clinically tested methods of changing health and behavioral risks should be incorporated into program protocols; and that services must be implemented with fidelity to the model tested if program benefits found in scientifically controlled studies are to be reproduced as the program is replicated in new communities.

School Readiness

“…41 Home visiting by nurses has been shown consistently to reduce rates of childhood injury, to increase fathers' involvement, to reduce family welfare dependency, and to improve school readiness. 42 Housing subsidies have resulted in improved neighborhood safety and reduced exposure to violence. 43 In addition, clinic-based, literacypromoting programs that include the provision of children's books and anticipatory guidance about the importance of reading aloud with young children have been shown to enhance language development in toddlers 44 and preschoolers.…”

The Role of Preschool Home-Visiting Programs in Improving Children's Developmental and Health Outcomes

“…34 • Professional or nurse-based home visiting is generally advantageous for clients. 35 The role of lay paraprofessional home visitors is less known, but paraprofessionals may be helpful depending on the goals and objectives of the home-visiting program and the length of engagement with the home visitor. An advantage of lay home visitors may be the notable cultural bond between the home visitor and mother.…”

Early Parenting Intervention: Family Risk and First-time Parenting Related to Intervention Effectiveness

“…These studies suggest that parents experiencing high levels of stress may be less involved in and committed to the intervention, resulting in less positive outcomes (Kazdin and Wassell 1999;Lundahl et al 2006). However, other studies have shown that maternal depression, lack of psychological resources, low marital satisfaction, and low educational level were positively related to the effectiveness of parenting interventions (Beauchaine et al 2005;Berlin et al 1998;Lundahl et al 2006;Olds et al 1999;Olds and Korfmacher 1998;Reid et al 2003;van Zeijl et al 2006a). It may be that adverse family circumstances lead to increased intervention effectiveness, because these families are in greatest need of support (e.g., Beauchaine et al 2005).…”