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Nurse home visitation program reduces reported maltreatment of children

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Published: 1 Sep 2010

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Nurse home visitation program reduces reported maltreatment of children

 

Source: Zielinski, D.S., Eckenrode, J., & Olds, D.L. (2009). Nurse home visitation and the prevention of child maltreatment: Impact on the timing of official reports. Development and Psychopathology, 21(2), 441-453.

Reviewed by:  Sydney Duder

This was a study of the effects of the Nurse Family Partnership (NFP), a program of prenatal and infancy home visiting by nurses, on later reports of child maltreatment. The study took place in a small, semi-rural city in the Appalachian region of New York State. High-risk young mothers (< 19 years, single-parent status, low SES) were actively recruited for the study; to study the effect of risk level, any volunteer who had no previous live birth was also accepted. Subjects were stratified by sociodemographic characteristics and randomized to treatment conditions:

  • Home visitation services from pregnancy until child was age 2 (final n = 93). A major program goal was to reduce risks for child abuse and neglect; nurses worked directly with the mothers, linked families with needed health and human services, and attempted to involve other family members and friends in the pregnancy, birth and early care of the child. Program fidelity was good; nurses completed an average of 9 visits during pregnancy and 23 from birth to the child’s second birthday.  
  • Control group: screening plus referral for further clinical evaluation and treatment where needed (final n = 144).

Occurrences of maltreatment were recorded during a 13-year follow-up period — until a child’s 15th birthday; mothers provided consent for research staff to review relevant state CPS records. In data analysis, Kaplan-Meier survival functions were used to compare onset rates for maltreatment in the two groups; 76% of children in the nurse-visited group “survived” to age 15 without a maltreatment report, compared to only 68% in the control group. The difference was even greater for high-risk and neglect cases; for neglect only, comparative figures were 83% and 73%. Group survival functions remained nearly identical until age 4, when the nurse-visited group diverged, showing a marked improvement. This pattern was supported in a Cox regression model examining the joint effects of treatment and time period (ages 0 – 4 vs. 4 – 15); a highly significant group x time interaction was found. The authors argued that the program’s success in reducing the number of maltreatment reports was partly due to this impact on the timing of the maltreatment process.

Methodological Notes:

Strengths of this study were the randomized experimental design, treatment fidelity, 13-year follow-up period and sophisticated statistical analysis. In a recent review of research (Reynolds,  Mathieson & Topitzes, 2009) this NFP program was rated as one of two that showed strong evidence of long-term maltreatment prevention.  Program features mentioned were relatively high intensity, implementation by well-trained professional staff, and provision of comprehensive family services.  One limitation was noted — evaluation by the program designers, rather than by independent researchers—but the focus on substantiated reports strengthened confidence in the findings. A particularly interesting element of the review was the inclusion of cost benefit analyses; the benefit to cost ratio for this NFP program was estimated at US$2.88 : 1.

Reference: Reynolds, A.J., Mathieson, L.C., & Topitzes, J.W. (2009). Do early childhood interventions prevent child maltreatment? A review of research. Child Maltreatment, 14(2), 182-206.



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