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Project Description

Mothers are enrolled through the third trimester of pregnancy. Visits are scheduled once a week during the first month of enrollment. Thereafter, visits are scheduled every other week until the birth of the baby. Nurses again visit weekly for six weeks after the baby is born. From the child’s 2nd to 21st postnatal month, visits are scheduled twice a month. From the 21st to 24th postnatal month, visits are scheduled once a month. Each visit lasts approximately 90 minutes.

Nurse home visitors follow detailed visit-by-visit program protocols that focus on five domains of functioning: personal health, maternal role development, environmental health, maternal life-course development, and family and friend support. The content of the protocols is organized developmentally to reflect those challenges that women are likely to confront at different stages of pregnancy and during the first 2 years of the child’s life. Within each of the five domains, specific assessments are made of maternal, child, and family functioning, and specific educational content and psychosocial interventions are implemented depending upon the nature and degree of vulnerability revealed in the assessment.

During home visits, nurses carry out three major activities: 1) promoting adaptive change in behavior that affects the outcomes of pregnancy, the health and development of the child, and maternal life course; 2) helping women build supportive relationships with family members and friends; and 3) linking family members with other health and human services. In carrying out these activities, emphasis is placed on the importance of building on parents’ strengths and promoting parental competence and control over life circumstances.

Project duration: Jan 1977 - Dec 1999

Sites studied include Elmira, New York
Memphis, Tennessee
Denver, Colorado

Sample Characteristics and Sites Studied

Elmira: (N=400). Primarily (89%) Caucasian families. 85% women were either low-income, unmarried, or teenaged. Random assignment to Treatment groups 1,2,3, or 4. Families in Treatment 1 (n=94) were provided sensory and developmental screening for the child at 12 and 24 months of age. Families in Treatment 2 (n=90) were provided with screening services offered to those in Treatment 1 plus free transportation. Families in Treatment 3 (n=100) were provided with screening, transportation, and a nurse that visited them at home during pregnancy. Families in Treatment 4 (n=116) were provided all services plus nurse continued home visits until child’s 2nd birthday. The first trial of the program began in 1977.

Memphis: (N=1135). Primarily (92%) African-American families. Participants had to have one of the following risk conditions: 1) unmarried, 2) less than 12 years of education, or 3) unemployed. Randomly assigned to Treatment groups 1, 2 ,3 or 4. Families in Treatment 1 (n=166) were provided transportation to prenatal care but no postnatal visits or screening. Families in Treatment 2 (n=515) were provided transportation to prenatal care, screening, and referral services until 24 months after birth. Families in Treatment 3 (n=230) were provided transportation, screening, and nurse home visits during pregnancy, once at the hospital, and once at home after birth. Families in Treatment 4 (n=228) were provided same services as Treatment 3 plus received home visits until child’s 2nd birthday. Program began June 1990 and ended August 1991.

Denver: (N=735). Including 331 (40%) Mexican-American families. Random assignment to Treatment groups 1, 2, or 3. Families in Treatment 1 (n=255) received screening for children at ages 1 and 2 years and referral to services if needed. Families in Treatment 2 (n=235) received developmental screening and referral plus nurse home visits through pregnancy through child’s 2nd year. Families in Treatment 3 (n=245) received screening and referral plus paraprofessional home visitation from pregnancy through child’s 2nd year.

Recent Findings in Brief

04/19/00: Prenatal and Infancy Home Visitation by Nurses: Enduring Effects of Nurse Home Visitation on Maternal Life Course :A 3-Year Follow-up of a Randomized Trial

Interim Impact Findings:

Compared with the control group, women who received home visits by nurses had fewer subsequent pregnancies (1.15 vs. 1.34; P=.03), fewer closely spaced subsequent pregnancies (0.22 vs. 0.32; P=.03), longer intervals between the birth of the first and second child (30.25 vs. 26.60 months; P=.004), and fewer months of using Aid to Families with Dependent Children (32.55 vs. 36.19; P=.01) and food stamps (41.57 vs. 45.04; P=.005). Compared with the effect of the program while the program was in operation, the effect after it ended was essentially equal for Aid to Families with Dependent Children, greater for food stamps, greater for rates of closely spaced subsequent pregnancies, and smaller for rates of subsequent pregnancy overall.

Enduring effects of a home visitation program were found on the lives of black women living in an urban setting. While these results were smaller in magnitude than those achieved in a previous trial with white women living in a semi-rural setting, the direction of the effects was consistent across the 2 studies.

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