Nurse home visits benefited at-risk children

Children of low-income women had some positive benefits on cognitive and behavioral measures after home visits by nurses and paraprofessionals, according to recent study findings published in JAMA Pediatrics.

David L. Olds, PhD, of the department of pediatrics at the University of Colorado Denver School of Medicine, and colleagues conducted a follow-up study on a randomized trial in Denver that included 735 low-income women and their first-born children as part of the Nurse-Family Partnership (NFP) program to determine the effects on child development at age 6 and 9 years. Participants were divided into three treatment groups: 255 received free developmental screening and referral for their child; 245 received screening and a paraprofessional home visit during pregnancy and the child’s first 2 years; and 235 received screening and a nurse home visit during pregnancy and the child’s first 2 years.

David L. Olds

Children of mothers with low psychological resources who were visited by a paraprofessional showed fewer errors in visual attention/task switching at age 9 years (P=.08). Children visited by nurses were less likely to have total emotional/behavioral problems at age 6 years (P=.08) and less likely to have internalizing problems (P=.08) and dysfunctional attention (P=.07) at age 9 years. Children visited by nurses were more likely to have better receptive language (P=.01) and better sustained attention at age 4, 6 and 9 years (P=.006), at age 6 years (P=.048), and at age 9 years (P=.08).

“Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching,” the researchers wrote. “Consistent with an earlier trial of the NFP in Memphis, nurse-visited children showed improved behavioral functioning, and those born to low-resource mothers benefited in language and attention; unlike their counterparts in Memphis, though, they did not improve in intellectual functioning or academic achievement.”

In an accompanying editorial, Jack P. Shonkoff, MD, of the Center on the Developing Child at Harvard University, said programs like NFP should be used to help children whose lives are threatened by adversity.

“Improving program quality, enhancing service coordination, and scaling effective interventions are necessary but not sufficient,” he wrote. “The marching orders are clear — we must embrace a spirit of constructive dissatisfaction with best practices, continually design and test new ideas, learn from things that do not work, and settle for nothing less than breakthrough impacts on important outcomes.”

David L. Olds, PhD, can be reached at 13121 E. 17th Ave., MS 8410, Education 2 South, Room 5317, Aurora, CO 80045; email: david.olds@ucdenver.edu.

For more information:

Olds DL. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.3817.

Shonkoff JP. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.4212.

Disclosure: See study for a full list of disclosures.