Prenatal and infancy home visitation by nurses: Recent findings

This article describes a 20-year program of research on the Nurse Home Visi tation Program, a model in which nurses visit mothers beginning during preg nancy and continuing through their children's second birthdays to improve p regnancy outcomes, to promote children's health and development, and to str engthen families' economic self-sufficiency The results of two randomized trials (one in Elmira, New Yolk, and the seco nd in Memphis, Tennessee) are summarized, and an ongoing trial in Dem er, C olorado, is briefly described. Results of the Elmira and Memphis trials sug gest the following: The program benefits the neediest families (low income unmarried women) but provides little benefit for the broader population. Am ong low income unmarried women, the program helps reduce rates of childhood injuries and ingestions that may be associated with child abuse and neglec t, and helps mothers defer subsequent pregnancies and move into the workfor ce. Long-term follow-up of families in Elmira indicates that nurse-visited mothers were less likely to abuse or neglect their children or to have rapi d successive pregnancies. Having fewer children enabled women to find work, become economically self-sufficient, and eventually avoid substance abuse and criminal behavior Their children benefitted too. By the time the childr en were 15 years of age, they had had fewer arrests and convictions, smoked and drank less, and had had fewer sexual partners. The program produced fe w effects on children's development or on birth outcomes, except for childr en born to women who smoked cigarettes when they registered during pregnanc y The positive effects of the program on child abuse and injuries to childr en were most pronounced among mothers who, at registration, had the lowest psychological resources (defined as high levels of mental health symptoms, limited intellectual functioning, and little belief in their control of the ir lives). Generally; effects in Elmira were of greater magnitude and covered a broade r range of outcomes than in Memphis, perhaps because of differences between the populations studied, community contexts, or a higher rate of turnover er among home visitors in Memphis than in Elmira. The article concludes that the use of nurses as home visitors is key; that services should be targeted to the neediest populations, rather than being offered on a universal basis: that clinically tested methods of changing he alth and behavioral risks should be incorporated into program protocols; an d that services must be implemented with fidelity to the model tested if pr ogram benefits found in scientifically controlled studies are to be reprodu ced as the program is replicated in new communities.