Effects of home visits by paraprofessionals and by nurses: age 4 follow‐up results of a randomized trial

Effects of home visits by paraprofessionals and by nurses: age 4 follow‐up results of a randomized trial.
Olds DL , Robinson J , Pettitt L , Luckey DW , Holmberg J , Ng RK , Isacks K , Sheff K & Henderson CR.(2004)Pediatrics,114,1560–1568.Objective  To examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses from children aged 2–4 years. Methods  We conducted, in public and private care settings in Denver, CO, a randomized, controlled trial with three arms, i.e. control, paraprofessional visits, and nurse visits. Home visits were provided from pregnancy through child age 2 years. We invited 1178 consecutive, low‐income, pregnant women with no previous live births to participate, and we randomized 735; 85% were unmarried, 47% Mexican American, 35% white non‐Mexican American, 15% black, and 3% American Indian/Asian. Outcomes consisted of maternal reports of subsequent pregnancies, participation in education and work, use of welfare, marriage, cohabitation, experience of domestic violence, mental health, substance use, and sense of mastery; observations of mother–child interaction and the home environment; tests of children's language and executive functioning; and mothers’ reports of children's externalizing behaviour problems. Results  Two years after the programme ended, women who were visited by paraprofessionals, compared with control subjects, were less likely to be married (32.2%  vs.  44.0%)  and  to  live  with  the biological father of the child (32.7% vs. 43.1%) but worked more (15.13 vs. 13.38 months) and reported a greater sense of mastery and better mental health [standardized scores (mean = 100, SD = 10) of 101.25 vs. 99.31 and 101.21  vs.  99.16 respectively]. Paraprofessional‐visited women had fewer subsequent miscarriages (6.6% vs. 12.3%) and low‐birthweight newborns (2.8% vs. 7.7%). Mothers and children who were visited by paraprofessionals, compared with control subjects, displayed greater sensitivity and responsiveness toward one another (standardized score [mean = 100, SD = 10] of 100.92 vs. 98.66) and, in cases in which the mothers had low levels of psychologic resources at registration, had home environments that were more supportive of children's early learning (score of 24.63 vs. 23.35). Nurse‐visited women reported greater intervals between the births of their first and second children (24.51 vs. 20.39 months) and less domestic violence (6.9% vs. 13.6%) and enrolled their children less frequently in preschool, Head Start or licensed day care than control subjects did. Nurse‐visited children whose mothers had low levels of psychologic resources at registration, compared with control group counterparts, demonstrated that home environments were more supportive of children's early learning (score of 24.61 vs. 23.35), more advanced language (score of 91.39 vs. 86.73), superior executive functioning (score of 100.16 vs. 95.48) and better behavioural adaptation during testing (score of 100.41 vs. 96.66). There were no statistically significant effects of either nurse or paraprofessional visits on the number of subsequent pregnancies, women's educational  achievement,  use  of  substances,  use of welfare or children's externalizing behaviour problems. Conclusions  Paraprofessional‐visited mothers began to experience benefits from the programme 2 years after the programme ended at child age 2 years, but their first‐born children were not statistically distinguishable from their control group counterparts. Nurse‐visited mothers and children continued to benefit from the programme 2 years after it ended. The impact of the nurse‐delivered programme on children was concentrated on children born to mothers with low levels of psychologic resources.