Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT)

Model Effectiveness
Evidence Based Model
MIECHV Eligible

7

Manuscripts

Released in 2002 through 2021

4

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
0-6 months
07-11 months
12-23 months
24-35 months
Favorable results from well-defined research
Child development and school readiness
Child health
Positive parenting practices

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Where to find out more

Effectiveness

This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

7

Manuscripts

Released in 2002 through 2021

5

Manuscripts

Eligible for review

4

Manuscripts

Impact studies rated high or moderate quality

Note: When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child development and school readiness View 1 Manuscript 5 11 0
Child health View 2 Manuscripts 6 19 7
Family economic self-sufficiency Not measured - - -
Linkages and referrals Not measured - - -
Maternal health Not measured - - -
Positive parenting practices View 2 Manuscripts 15 38 9
Reductions in child maltreatment Not measured - - -
Reductions in juvenile delinquency, family violence, and crime Not measured - - -

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics:

Race/Ethnicity

Asian
2.93%
Black or African American
5.46%
Hispanic or Latino
6.38%
Native Hawaiian or Pacific Islander
0.31%
White
90.17%
Unknown
1.11%

Maternal Education

Some college or Associate's degree
20.12%
Bachelor's degree or higher
63.29%
Unknown
16.63%

Well-designed impact studies about this model were conducted in the following locations:

  • Northeast
  • Pennsylvania
Indigenous population
0.42%

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

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Support Availability

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Service Delivery

Model services, adaptions and enhancements, model intensity and length.

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Requirements

Staffing and organizational requirements.

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Overview

Theoretical approach

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) parenting model was designed to prevent rapid infant weight gain and childhood obesity. The model was grounded in developmental literature on responsive parenting and parenting sensitivities, which encourages mothers to respond to their child’s emotional and physical signals. INSIGHT focuses on responsive feeding, in which mothers respond to their baby’s hunger and satiety cues. Responsive feeding teaches children to eat in response to physiological needs and could encourage self-regulation in eating.

Intended population

INSIGHT served first-time mothers and their infants from birth until about the child’s third birthday.

Targeted outcomes

The model aimed to prevent obesity in children at age 36 months by promoting a mother’s developmentally appropriate, prompt, and contingent responses to a child’s needs. Specifically, INSIGHT was designed to meet the following objectives:

  • Improve mothers’ responsive feeding practices
  • Reduce mothers’ use of food to soothe and increase use of alternative soothing strategies in response to infant fussiness
  • Improve infants’ sleep duration and reduce nocturnal awakenings
  • Reduce infants’ screen time
  • Increase the amount of time mothers and children engage in interactive play

Highlights

Populations Intended
Families with low-income
Services intended at ages
0-6 months
07-11 months
12-23 months
24-35 months

Support Availability

Implementation support availability

INSIGHT was a demonstration project implemented from 2012 to 2017 that was tested using a prospective, randomized controlled trial. The trial was led by researchers from Penn State College of Medicine and Penn State College of Health and Human Development. The information in this profile represents how the model was implemented during the demonstration trial.

Support to implement the model may be available upon request to the model developers.

Highlights

Locations where model has been implemented
Within the U.S.

Service Delivery

Model services

INSIGHT was a responsive parenting model that guided mothers on how to respond to their child’s needs across four behavioral states: (1) drowsy, (2) sleeping, (3) fussy, and (4) alert (interactive play and feeding).

The model development team mailed mothers the following materials when their child was two weeks old, to review and practice techniques before the first home visit: a DVD demonstrating infant soothing; a CD with white noise tracks; and handouts on infant stomach size, feeding guidance, lactation support, and postpartum depression.

Mothers were invited to participate in four home visits in the child’s first year, and two clinic visits and two telephone contacts between the child’s first and third birthdays. Home visitors taught mothers how to read growth charts that display typical patterns of child growth and weight gain. The home visitors also provided guidance on emotional regulation, feeding, sleeping, and interactive play, including the following topics:

Emotional regulation

  • Understanding developmental norms for fussing and crying
  • Establishing routines and expectations
  • Setting limits, rules, and consequences
  • Using strategies other than feeding to calm fussy but not hungry infants
  • Providing positive reinforcement

Feeding

  • Recognizing hunger and satiety cues
  • Providing age-appropriate portion sizes
  • Avoiding use of control-based feeding practices, such as restricting food, pressuring infants to eat, and using food as a reward
  • Using repeated exposure to promote food acceptance
  • Establishing consistent meal and snack routines
  • Modeling healthy eating behaviors

Sleeping

  • Putting infants to bed drowsy but awake
  • Avoiding feeding infants to sleep
  • Anticipating and responding to night awakenings
  • Establishing bedtime and naptime routines

Interactive play

  • Working toward language and motor milestones
  • Fostering developmentally appropriate physical activities
  • Setting limits on screen time

Home visitors followed a manualized curriculum that included facilitator guides and handouts that were developmentally appropriate for the timing of each visit.

Model intensity and length

Mothers participated in four home visits when the child was 3 to 4 weeks old, 16 weeks old, 28 weeks old, and 40 weeks old; two clinic visits when the child was 12 and 24 months old; and two telephone contacts when the child was 18 and 30 months old. The model provided services from the child’s birth until age 30 months.

The home visits typically lasted 60 minutes, clinic visits were 30 minutes, and phone contacts were approximately 20 minutes.

Adaptations and enhancements

No adaptations or enhancements have been made to the model. The model development team will consider proposals for adaptations in the future.

Highlights

Maximum program duration
More than one year up to three years
Visit frequency
Visit frequency varies
Delivery Method Supported
Supports hybrid in-person and virtual service delivery

Requirements

Staffing requirements

Nurses implemented the model under the supervision of the model development team, whose members, at a minimum, held master’s degrees.

Supervisors monitored nurses’ fidelity to the model. Please contact the model developer for information on whether regular, ongoing reflective supervision was provided; the mode of supervision; the frequency of supervision; and whether supervisors were offered oversight or support.

The model development team provided in-person training for the nurses. Please contact the model developer for additional information about the pre-service training and ongoing professional development requirements.

Organizational requirements

The model development team does not have any recommendations or requirements about the types of or characteristics of organizations that can implement the intervention.

Home visitors were required to meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

Highlights

Minimum education requirement
Associate’s degree

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.