Differences in program implementation between nurses and paraprofessionalsproviding home visits during pregnancy and infancy: A randomized trial

Objectives. This study examined differences between nurses and paraprofessi onals in implementation of a home visiting program for low-income, first-ti me parents during pregnancy and the first 2 years of the child's life. Methods. Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and para profess ional-visited families were compared on number and length of visits, topics covered number of program dropouts. and relationship with home visitor. Results. On average, nmses completed more visits than parapofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues duri ng infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental healt h and safety issues (15% vs 7% pregnancy, 15% vs 8% infancy; P < 001). Whil e home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 45%; P = .04). More paraproess ional-visited families than nurse-visited families experienced staff turnov er. Conclusions. Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways.