Implementation and Randomized Controlled Trial Evaluation of Universal Postnatal Nurse Home Visiting.
ABSTRACT Objectives. We evaluated whether a brief, universal, postnatal nurse home-visiting intervention can be implemented with high penetration and fidelity, prevent emergency health care services, and promote positive parenting by infant age 6 months. Methods. Durham Connects is a manualized 4- to 7-session program to assess family needs and connect parents with community resources to improve infant health and well-being. All 4777 resident births in Durham, North Carolina, between July 1, 2009, and December 31, 2010, were randomly assigned to intervention and control conditions. A random, representative subset of 549 families received blinded interviews for impact evaluation. Results. Of all families, 80% initiated participation; adherence was 84%. Hospital records indicated that Durham Connects infants had 59% fewer infant emergency medical care episodes than did control infants. Durham Connects mothers reported fewer infant emergency care episodes and more community connections, more positive parenting behaviors, participation in higher quality out-of-home child care, and lower rates of anxiety than control mothers. Blinded observers reported higher quality home environments for Durham Connects than for control families. Conclusions. A brief universal home-visiting program implemented with high penetration and fidelity can lower costly emergency medical care and improve family outcomes. (Am J Public Health. Published online ahead of print December 19, 2013: e1-e8. doi:10.2105/AJPH.2013.301361).
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ABSTRACT: Although some home-visiting programs have proven effective with the families they serve, no program has yet demonstrated an impact at the population level. We describe the Durham Connects (DC) initiative, which aims to achieve population impact by coalescing community agencies to serve early-intervention goals through a Preventive System Of Care and by delivering a universal, short-term, postnatal nurse home-visiting program. The home-visitor delivers brief intervention, assesses family needs in 12 domains, and connects the family with community resources to address individualized family needs. Evaluation of DC occurred through a population randomized controlled trial of all 4,777 births in Durham, NC, over an 18-month period. DC was implemented with high penetration and high fidelity. Impact evaluation indicated that by age 6 months, DC infants had 18 percent fewer emergency room visits and 80 percent fewer overnights in the hospital than did control families. We conclude that population impact is achievable if a program attends to challenges of community partnership, universal reach and assessment, rigorous evaluation, and models for sustaining funding.01/2013; 33(3):17-23.
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ABSTRACT: This article describes our state of knowledge regarding the development and prevention of conduct problems in early childhood, then identifies directions that would benefit future basic and applied research. Our understanding about the course and risk factors associated with early-developing conduct problems has been significantly enhanced during the past three decades; however, many challenges remain in understanding the development of early conduct problems for girls, the contribution of poverty across variations in community urbanicity, and developing cascading models of conduct problems that incorporate prenatal risk. Significant advances in early prevention and intervention are also described, as well as challenges for identifying and engaging parents of at-risk children in nontraditional community settings.Journal of Clinical Child & Adolescent Psychology 03/2013; DOI:10.1080/15374416.2013.777918 · 1.92 Impact Factor
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ABSTRACT: OBJECTIVE: As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. METHODS: Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). RESULTS: Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. CONCLUSIONS: Findings suggest that while higher demographic risk increases families' initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.Child abuse & neglect 05/2013; 37(8). DOI:10.1016/j.chiabu.2013.03.012 · 2.34 Impact Factor