Olds, D. L., Henderson Jr., C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65–78.
Model(s) Reviewed:
Nurse-Family Partnership (NFP)®
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race and SES. | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
In 2020, HomVEE updated this review to move four findings related to "mother-reported positive mood" and crying from the Child Health domain to the Child Development and School Readiness domain because ACF determined that all measures of child behavioral health, including internalizing and externalizing behaviors belong in HomVEE's Child Development and School Readiness domain.
The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.
| Study participants | The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. Roughly 42 percent of the sample was married. This study measured the sample at registration and at 6, 10, 12, 22, and 24 months of the infant’s life. The study sample included 354 women, 189 in the program group and 165 in the comparison group. |
|---|---|
| Setting | The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents. |
| Intervention services | The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. |
| Comparison conditions | The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). • Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy or unmarried and low-income teen) |
| Funding sources | Bureau of Community Health Services (HHS-MCR-360403-06); the Robert Wood Johnson Foundation (grant 5263); and the W. T. Grant Foundation (grant 0723-80). |
| Author affiliation | David L. Olds, a study author, is a developer of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | BSID MDI | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison | 12 months | 204 children | Adjusted mean = 111.23 | Adjusted mean = 109.94 | Mean difference = 1.29 | Not available | Not statistically significant, p > 0.05 |
|
| High | Cattell | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison | 24 months | 193 children | Adjusted mean = 109.34 | Adjusted mean = 106.49 | Mean difference = 2.85 | Not available | Not statistically significant, p > 0.05 |
|
| High | Crying (mother-reported number of episodes last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 163 children | Adjusted mean = 3.44 | Adjusted mean = 3.93 | Mean difference = -0.49 | Not available | Not statistically significant, p > 0.05 |
|
| High | Mother-reported positive mood | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 209 children | Adjusted mean = 2.40 | Adjusted mean = 2.29 | Mean difference = 0.11 | Not available | Statistically significant, p < 0.05 |
|
| High | BSID Mental Development Index (MDI) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison | 12 months | 199 children | Adjusted mean = 105.44 | Adjusted mean = 109.94 | Mean difference = -4.50 | Not available | Statistical significance not reported | |
| High | Cattell | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison | 24 months | 186 children | Adjusted mean = 105.73 | Adjusted mean = 106.49 | Mean difference = -0.76 | Not available | Statistical significance not reported | |
| High | Crying (mother-reported number of episodes last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 164 children | Adjusted mean = 4.05 | Adjusted mean = 3.93 | Mean difference = 0.12 | Not available | Statistical significance not reported | |
| High | Mother- reported positive mood | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 199 children | Adjusted mean = 2.34 | Adjusted mean = 2.29 | Mean difference = 0.05 | Not available | Statistical significance not reported |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Night awake (mother-reported number of episodes last 2 weeks | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 163 children | Adjusted mean = 2.69 | Adjusted mean = 2.83 | Mean difference = -0.14 | Not available | Not statistically significant, p > 0.05 |
|
| High | Number of emergency room visits (first year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 1-year follow-up | 223 children | Adjusted mean = 0.74 | Adjusted mean = 1.02 | Mean difference = -0.28 | Not available | Statistically significant, p < 0.05 |
|
| High | Number of emergency room visits (second year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 2-year follow-up | 196 children | Adjusted mean = 0.74 | Adjusted mean = 1.09 | Mean difference = -0.35 | Not available | Statistically significant, p < 0.01 |
|
| High | Resist eating (mother-reported number of episodes last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 163 children | Adjusted mean = 2.29 | Adjusted mean = 1.72 | Mean difference = 0.57 | Not available | Statistically significant, p < 0.01 |
|
| High | Night awake (mother-reported number of episodes last 2 weeks | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 164 children | Adjusted mean = 3.25 | Adjusted mean = 2.83 | Mean difference = 0.42 | Not available | Statistical significance not reported | |
| High | Number of emergency room visits (first year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 1-year follow-up | 205 children | Adjusted mean = 1.12 | Adjusted mean = 1.02 | Mean difference = 0.10 | Not available | Statistical significance not reported | |
| High | Number of emergency room visits (second year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 2-year follow-up | 185 children | Adjusted mean = 1.04 | Adjusted mean = 1.09 | Mean difference = -0.05 | Not available | Statistical significance not reported | |
| High | Resist eating (mother-reported number of episodes last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 164 children | Adjusted mean = 2.01 | Adjusted mean = 1.72 | Mean difference = 0.29 | Not available | Statistical significance not reported |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | HOME (avoidance of restriction and punishment) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 22 months | 180 mothers | Adjusted mean = 5.82 | Adjusted mean = 6.28 | Mean difference = -0.46 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | HOME (avoidance of restriction and punishment) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 10 months | 191 mothers | Adjusted mean = 5.40 | Adjusted mean = 5.60 | Mean difference = -0.20 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | HOME (provision of appropriate play materials) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 10 months | 201 mothers | Adjusted mean = 7.36 | Adjusted mean = 7.26 | Mean difference = 0.10 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | HOME (provision of appropriate play materials) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 22 months | 198 mothers | Adjusted mean = 8.68 | Adjusted mean = 8.65 | Mean difference = 0.03 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Conflict | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 163 mothers | Adjusted mean = 0.29 | Adjusted mean = 0.25 | Mean difference = 0.04 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Spank or hit (number of times last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 159 mothers | Adjusted mean = 0.19 | Adjusted mean = 1.09 | Mean difference = -0.90 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Worry or concern (Sum of positive responses for behavioral problems) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 163 mothers | Adjusted mean = 0.83 | Adjusted mean = 0.54 | Mean difference = 0.29 | Not available | Statistically significant, p < 0.05 |
|
| High | Yell or scold (number of times last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 6 months | 159 mothers | Adjusted mean = 3.99 | Adjusted mean = 7.90 | Mean difference = -3.91 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | HOME (avoidance of restriction and punishment) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 10 months | 184 mothers | Adjusted mean = 5.77 | Adjusted mean = 5.60 | Mean difference = 0.17 | Not available | Statistical significance not reported | |
| High | HOME (avoidance of restriction and punishment) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 22 months | 171 mothers | Adjusted mean = 5.53 | Adjusted mean = 6.28 | Mean difference = -0.75 | Not available | Statistical significance not reported | |
| High | HOME (provision of appropriate play materials) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 22 months | 190 mothers | Adjusted mean = 8.66 | Adjusted mean = 8.65 | Mean difference = 0.01 | Not available | Statistical significance not reported | |
| High | HOME (provision of appropriate play materials) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 10 months | 195 mothers | Adjusted mean = 7.45 | Adjusted mean = 7.26 | Mean difference = 0.19 | Not available | Statistical significance not reported | |
| High | Conflict | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 164 mothers | Adjusted mean = 0.27 | Adjusted mean = 0.25 | Mean difference = 0.02 | Not available | Statistical significance not reported | |
| High | Spank or hit (number of times last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 151 mothers | Adjusted mean = 1.71 | Adjusted mean = 1.09 | Mean difference = 0.62 | Not available | Statistical significance not reported | |
| High | Worry or concern (Sum of positive responses for behavioral problems) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 164 mothers | Adjusted mean = 0.61 | Adjusted mean = 0.54 | Mean difference = 0.07 | Not available | Statistical significance not reported | |
| High | Yell or scold (number of times last 2 weeks) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 6 months | 151 mothers | Adjusted mean = 7.56 | Adjusted mean = 7.90 | Mean difference = -0.34 | Not available | Statistical significance not reported |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Substantiated abuse or neglect | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison | 2-year follow-up | 256 children | % (adjusted) = 5.00 | Adjusted mean % = 10.00 | Mean difference = -5.00 | HomVEE calculated = -0.45 | Not statistically significant, p > 0.10 |
|
| High | Number of emergency room visits for accidents and poisonings (first year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 1-year follow-up | 223 children | Adjusted mean = 0.12 | Adjusted mean = 0.06 | Mean difference = 0.06 | Not available | Not statistically significant, p > 0.05 |
|
| High | Number of emergency room visits for accidents and poisonings (second year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 2-year follow-up | 196 children | Adjusted mean = 0.15 | Adjusted mean = 0.34 | Mean difference = -0.19 | Not available | Statistically significant, p < 0.05 |
|
| High | Substantiated abuse or neglect | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison | 2-year follow-up | 247 children | % (adjusted) = 8.00 | Adjusted mean % = 10.00 | Mean difference = -2.00 | HomVEE calculated = -0.15 | Not statistically significant, p > 0.10 |
|
| High | Number of emergency room visits for accidents and poisonings (first year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 1-year follow-up | 205 children | Adjusted mean = 0.12 | Adjusted mean = 0.06 | Mean difference = 0.06 | Not available | Statistical significance not reported | |
| High | Number of emergency room visits for accidents and poisonings (second year of life) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 2-year follow-up | 185 children | Adjusted mean = 0.32 | Adjusted mean = 0.34 | Mean difference = -0.02 | Not available | Statistical significance not reported |