Preventing Child Abuse and Neglect: A Randomized Trial of Nurse Home Visitation

Abstract

A program of prenatal and infancy home visitation by nurses was tested as a method of preventing a wide range of health and developmental problems in children born to primiparas who were either teenagers, unmarried, or of low socioeconomic status. Among the women at highest risk for care-giving dysfunction, those who were visited by a nurse had fewer instances of verified child abuse and neglect during the first 2 years of their children's lives (P = .07); they were observed in their homes to restrict and punish their children less frequently, and they provided more appropriate play materials; their babies were seen in the emergency room less frequently during the first year of life. During the second year of life, the babies of all nurse-visited women, regardless of the families' risk status, were seen in the emergency room fewer times, and they were seen by physicians less frequently for accidents and poisonings than comparison group babies (P ≤ .05 for all findings, except where indicated.) Treatment differences for child abuse and neglect and emergency room visits were more significant among women who had a lower sense of control over their lives.

Nurse-led home-visitation programme for first-time mothers in reducing maltreatment and improving child health and development (BB:2-6): longer-term outcomes from a randomised cohort using data linkage

“…[1][2][3] A subgroup analysis of poor unmarried teenage mothers in the first US trial (n=54) found verified maltreatment by age 2 years in 19% of 32 control children and 4% of the 22 children in the group in receipt of NFP during both pregnancy and infancy (mean % difference: 0.15, 95% CI −0.01 to 0.31). 1 Following up the same trial cohort, adjusted rates of verified state reports of child abuse and neglect perpetrated by mothers were lower in the group visited by nurses in pregnancy and infancy (0.29) when compared with the women in the control group (0.54) by 15 years (p<0.001). 4 Additionally, there was a 56% relative reduction in emergency department encounters for injuries and ingestions during the second year of life.…”

Maternal Preconceptions About Parenting Predict Child Temperament, Maternal Sensitivity, and Children's Empathy.

“…Intervention strategies that have been shown effective in improving child outcomes could be drawn upon to help in developing prenatal programs (Daggett et al, 2000;Izard, 2002;Lutenbacher, 2001;Olds, Henderson, Kitzman, et al, 1998;Schaefer, 1991). For instance, Olds and colleagues found that pre-and postnatal home visitation services geared toward the prevention of child maltreatment have significant benefits both in the short-term reduction of negative parenting attitudes (Olds, Henderson, Tatelbaum, & Chamberlin, 1986) as well as in long-term reductions of child maltreatment (Olds, Henderson, Kitzman, et al, 1998) and of later juvenile delinquency (Olds, Henderson, Cole, et al, 1998). Given the strength of negative maternal preconceptions in longitudinally predicting child difficult temperament, less maternal sensitivity, and children's empathy, it seems imperative to develop strategies to ameliorate these preconceptions to provide more optimal opportunities and outcomes for children.…”

A review of programs to promote family wellness and prevent the maltreatment of children.

“…Almost all of the primary prevention applications of this approach are implemented with high-risk families. Outstanding examples of this approach are David Olds' Prenatal/Early Infancy Project (Olds, Henderson, Chamberlin, & Tatelbaum, 1986) and Hawaii's Healthy Start program (Breaky & Pratt, 1991). While these programs vary greatly in terms of the type of home visitor used (e.g., nurses, nonprofessionals), program length, and the number of home visits, most begin prenatally or at birth and focus on the needs of the parent (usually the mother) and the parent-child relationship.…”