Home visits by nurses and paraprofessionals to children of low-income women had some positive benefits on cognitive and behavioral measures for the children, according to results of a clinical trial.
Home visits by nurses to low-income families have been promoted as one strategy to improve health and development outcomes for first-born children from those families, according to background information in the study, which was published Dec. 2 as an online-first article in JAMA Pediatrics.
David L. Olds, PhD, of the University of Colorado Denver, and colleagues followed up on a randomized trial in Denver that included 735 low-income women, most of them unmarried, and their first-born children as part of the Nurse-Family Partnership, a program that has been conducted in other cities.
The goals of the NFP are to improve pregnancy outcomes by helping women improve their health-related behavior, improve their childrens subsequent health and development by helping parents provide competent care, and enhance a mothers personal development by promoting the planning of future pregnancies. The Denver trial was meant to test the program model when it is delivered by paraprofessionals, who were required to have a high school education and no college preparation in the helping professions and who also shared many of the same social characteristics as the families they visited.
Women in the study were divided into three treatment groups: The first group of 255 women received free developmental screening and referral for their child, the second group of 245 women received the screening plus a paraprofessional home visit during pregnancy and the childs first two years of life, and the third group of 235 women were provided the screening plus a nurse home visit during pregnancy and the childs first two years of life.
The researchers found that children born to mothers with low psychological resources but visited by paraprofessionals showed fewer errors in visual attention or task switching at age 9. Children visited by nurses were less likely to be classified as having total emotional or behavioral problems at age 6, internalizing problems at age 9 and dysfunctional attention at age 9.
Nurse-visited children born to low-resource mothers also had better receptive language and sustained attention averaged over time, the researchers reported.
Unlike in a similar trial that previously was conducted in Memphis, children visited by nurses in the Denver trial did not display significant benefits in cognition or in reading and math achievement.
Possible reasons for the disparity, the researchers said, include that the benefit of the nurse-delivered program for children born to low-resource mothers is most pronounced for families living in highly disadvantaged neighborhoods. The families studied in Memphis tended to live in more disadvantaged neighborhoods than those in Denver.
Control-group children in Memphis had a lower average IQ than their counterparts in Denver, and the benefit of the program could be greatest where there is most room for improvement, the researchers noted.
Study abstract: http://archpedi.jamanetwork.com/article.aspx?articleid=1785480
Nurse-Family Partnership: http://www.nursefamilypartnership.org/