Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-Up of a Randomized Trial

Baylor University, Waco, Texas, United States
PEDIATRICS (Impact Factor: 5.47). 11/2007; 120(4):e832-45. DOI: 10.1542/peds.2006-2111
Source: PubMed


Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.
We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women <29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.
Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.
By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.

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    • "Home visiting is a popular mode of service delivery in providing services to families with young children (Daro & Dodge, 2010). Services may be provided by professionals with a particular set of credentials, or by paraprofessionals (Olds et al., 2007). Home visiting may be effective in supporting parenting and children's development (Avellar & Supplee, 2013), but reviews of home visiting evaluations suggest that standard home visiting programs are unlikely to reduce depression among all program participants (Ammerman, Putnam, Altaye, Stevens, Teeters, & Van Ginkel, 2013; Jones Harden, "
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    ABSTRACT: The negative consequences of maternal depression are a major public health concern, both for mothers and for their children. Despite the high prevalence of depression among adolescent mothers, little is known about the patterns of adolescent mothers' depression in the early parenting years. The present study examined mothers' depression during the first 2 years following childbirth in a sample of 428 young mothers (20 or younger at first childbirth) who were participants in a randomized controlled trial of a home visiting parenting support program. Depressive symptoms were assessed using the self-reported Center for Epidemiological Studies Depression Scale (CES-D). Mothers were classified into groups based on whether their depressive symptoms were below or above the cutoff for clinically significant symptomatology. Depression groups (stable nondepressed, stable depressed, remitted depression) were associated with variations in mothers' satisfaction with support from the baby's father and enrollment in the home visiting program. Maternal depression was more likely to remit when mothers were satisfied with father support; assignment to the home visiting program was associated with mothers remaining mentally healthy. Results have clinical and policy implications for prevention and intervention programs. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · American Journal of Orthopsychiatry
    • "In most urban areas throughout the United States, preventive prenatal interventions 30 depend on women trained as visiting nurses and health educators to deliver empiricallyvalidated curricula to higher-risk parents. Recipients of these services are almost always mothers (Lu et al., 2010), and most services are delivered at home rather than in community settings (Olds et al., 2007). Conversely, interventions for expectant urban fathers, typically delivered by male paraprofessional fatherhood specialists, reach fewer parents and have 35 almost always been offered in community-based group settings, to a group gathering of expectant or new fathers simultaneously. "

    No preview · Article · Jul 2015 · The journal of nursing research: JNR
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    • "Although NFP studies have shown encouraging trends in delaying subsequent pregnancies, there is room for improvement (Olds et al., 2013). While results from clinical trials revealed that NFP programs reduce subsequent pregnancies from about 44% to 33% in the nursevisited groups and increased the intervals between subsequent births (Olds et al., 2007), about one in four teenagers receiving NFP home visits for 2 years postpartum still gave birth during this period (Gray, Sheeder, O'Brien, & Stevens-Simon, 2006). One study found that NFP nurses rarely documented that they provided support to teenage clients regarding obtaining contraceptives, suggesting that nurses might have been unaware of lapses in contraceptive use. "
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    ABSTRACT: Objective We examined public health nurses’ beliefs about the safety of dispensing hormonal contraceptives in the home, the extent to which they considered contraceptive dispensing within their scope of practice, and the types of support needed to effectively dispense contraceptives in the home.Design and SampleWe conducted focus groups in Washington State with 24 home visiting nurses participating in a Nurse Family Partnership (NFP) randomized clinical trial in which nurses dispensed hormonal contraceptives during home visits.MeasuresWe assessed the feasibility of the intervention and barriers and facilitators to home dispensing of hormonal contraceptives.ResultsNurses were, on average 52 years old and had been working in nursing approximately 25 years, with between 5 and 18 years of experience working in a family planning setting. Overall, nurses believed that, with the right training and support, dispensing of hormonal contraceptives in the home was safe and fit within their scope of practice. Those nurses who reported resistance to the intervention cited inadequate training, lack of clear protocols, and sufficient support as important deterrents.Conclusions Home-based contraceptive dispensing by nurses is a feasible enhancement of the NFP program. To ensure that nurses are confident and able to dispense hormonal contraceptives, training, clinical protocols, consultation, and logistical support are needed.
    Full-text · Article · Sep 2014 · Public Health Nursing
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