Contact Name
Barbara Dietsch
562-985-9488

Contact Email
bdietsc@WestEd.org

Peggy Hill, M.S.
Kempe Prevention Research Center
University of Colorado

For the past 20 years, Dr. David Olds and his associates have been studying what works to help young families get off to a good start and increase the likelihood that their entire life course will be healthy. Through a series of randomized longitudinal research trials, they have tested the hypothesis that a well-designed program of home-visiting by nurses working with first-time mothers can positively influence family health and prevent a host of later problems, including poor birth outcomes, child abuse and neglect, and chronic welfare dependency.

The result is an effective preventive intervention called the Prenatal and Early Childhood Home Visitation Program. The program sets three major inter-related goals: improve the health of newborns by improving the mother's health-related behavior during pregnancy; improve the young child's health and development by enhancing the parent's caregiving skills; and help put the parent's own life on a good course through further education, employment, healthy relationships and fewer subsequent (unintended) pregnancies.

Nurses visit mothers every one to two weeks, beginning early in pregnancy and continuing until the child turns two years old. Each nurse works with no more than 25 families, and receives specialized training and weekly supervision to help learn to implement the program effectively. Nurses utilize a set of home visit guidelines and matching resources that they use to address topics relevant to each family in the domains of health; child development and parenting; safety and the home environment; building support from friends and family; utilizing community resources; and reaching personal goals in the area of family planning, education and employment. A major emphasis of the intervention across all these areas is the development of self-efficacy - the beliefs and competencies necessary to be healthy, parent well, and achieve personal goals for a healthy, economically self-sufficient future.

The program has been tested now in three randomized, clinical research trials. These are the kinds of studies used by the Food and Drug Administration to determine if new medications are both safe and effective. The first study began in Elmira, New York in the late 1970's and enrolled 400 first-time mothers who agreed to be randomly assigned to either a control group or an intervention group. The mothers assigned to the control group received standard health care in the community as well as help with transportation and child development screenings. The intervention group received home visits by nurses following the model described above. Dr. Olds and colleagues studied the development of these families until the child born into the study reached the age of 15 to find out if the intervention had both short-term and lasting effects. Highlights of the results include1, 2:

• 25% reduction in cigarette smoking during pregnancy among women who smoked cigarettes at registration
  
• 79% reduction in rates of child maltreatment among at-risk families from birth through the child's 15th year
  
• 31% reduction in mothers' subsequent pregnancies through child's age 15, with two years' greater interval between birth of first and second children
  
• 83% increase in the rates of labor force participation by first child's fourth birthday
  
• 30 month reduction in AFDC utilization among low-income, unmarried women by first child's 15th birthday
  
• 44% reduction in low-income, unmarried mothers' behavioral problems due to alcohol and drug abuse over the 15 years following program enrollment
  
• 69% fewer arrests among low-income, unmarried mothers over the 15 years following program enrollment
  
• 54% fewer arrests and 69% fewer convictions among the 15 year old children of mothers enrolled in the program
  
• 58% fewer sexual partners among the 15 year old children of mothers enrolled in the program
  
• 28% fewer cigarettes smoked and 51% fewer days consuming alcohol among the 15 year old children of mothers enrolled in the program

When the early results of the program appeared to be so positive, Dr. Olds chose to replicate the study in Memphis, Tennessee. This was important because it allowed the program to be put to the test in an urban area, with African-American families, when services were delivered through a city/county public health department. A similar pattern of results is appearing3. A third randomized, controlled trial began in 1994 in Denver, Colorado, implementing the model with a population of low-income women, over 40% of whom were Mexican-American. In this third study, the program was also delivered to a group of families using trained paraprofessionals as home visitors to determine if the program could be effective when staffed with lay people recruited from the neighborhoods where many of Denver's low-income women lived. The results of this third study should be available early next year.

Staff at the Kempe Prevention Research Center for Family and Child Health in Denver are now helping interested communities implement the nurse home visitor program as an effective health promotion strategy for low-income, first-time parents. In many locations around the country, states and communities are targeting teen mothers for the program because of their particular vulnerability. The program costs about $2800 per family per year to operate, once initial start-up costs are met. An economic evaluation of the program conducted by the RAND Corporation4 found that when the program is properly targeted, the cost of the program is repaid four times over by the time children reach age 15.

For more information about the program model, the research that has been conducted to test its effects, or about the process for developing the program locally, contact Peggy Hill, Kempe Prevention Research Center for Family and Child Health, 1825 Marion St., Denver, CO 80218, phone: 303-864-5207, e-mail: Hill.Peggy@tchden.org.

1 Olds, Eckenrode, et al, 1997 - JAMA
2 Olds, Henderson, et al, 1998 - JAMA
3 Kitzman, Olds, et al, 1997 - JAMA
4 Karoly, Greenwood, et al, 1998