The Nurse-Family Partnership, one of the nations largest programs providing home visitation support for at-risk mothers and children, may not be as successful in reducing early childhood injuries as it was in earlier evaluations, according to one study.
Researchers with PolicyLab at The Childrens Hospital of Philadelphia evaluated the NFP over seven years of widespread implementation in Philadelphia. They found children served by the program had no fewer injuries than children in comparable families not enrolled in the program, and had higher injury rates in some less serious cases such as superficial injuries (abrasions, bruises, lacerations).
“A lot of evidence for the home visitation program had shown positive outcomes for mothers and children within the targeted geographic areas of randomized clinical trials,” David Rubin, MD, MSCE, a study author and co-director of PolicyLab, said in a news release.
“Our research has previously reported on continued effectiveness for some of these outcomes as the service area grew larger, such as reducing rapid-succession second pregnancies and smoking among mothers. However, regrettably, this study failed to demonstrate the programs previous success in preventing child injuries.”
The latest, peer-reviewed evaluation found that nearly a third of the families served by NFP in Pennsylvania had ED visits for injuries to children from birth through the second birthday, a rate 12% greater than for similar families not enrolled in the program.
“We should not be surprised that there have been some bumps in the road as we increase the scale of home visiting programs,” said Meredith Matone, MHS, the studys lead researcher. “This research highlights the need to continue evaluating these programs after they have been implemented in communities.
“Evaluation should focus on identifying local barriers that may be undermining a programs success. By identifying these barriers, we can foster smarter programs that are better equipped to serve families in diverse communities.”
As programs such as NFP achieve increased public funding, policymakers and program managers must allocate sufficient resources for effective program evaluation and quality improvement initiatives to ensure the programs respond quickly to challenges at the local level, the study authors noted.
“This kind of study has its limitations, which the authors note in their paper,” said NFP president and CEO Thomas R. Jenkins Jr. “However, the PolicyLab findings were sufficiently important for us to take action to improve our implementation of the NFP as it is spread to new communities throughout the country.
Jenkins said the findings spurred the implementation of new training for nurses “to enhance their effect on reducing serious childhood injuries among the families they serve. This adds to our ongoing continuous quality improvement work using thorough data collection and analysis.”
The study is scheduled for publication in the Maternal and Child Health Journal and is available at http://link.springer.com/article/10.1007/s10995-011-0921-7/fulltext.html.
For information about the Nurse-Family Partnership, visit www.nursefamilypartnership.org/.