Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA: The Journal of the American Medical Association, 278(8), 637–643.
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:
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. The study actively recruited and included pregnant, first-time mothers who were less than 25 weeks pregnant, were less than 19 years old, were single parents, or had low socioeconomic status. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. This study is a longitudinal follow-up at 15 years for the women originally enrolled in the study and their children. At this follow-up, the study included data on 324 of the original mothers (176 in the program group and 148 in the comparison group) and 315 children of the original mothers (171 in the program group and 144 in the comparison group). At enrollment, on average, the women included in this study were about 19 years old and had approximately 11 years of education. Roughly 40 percent of the sample was married. |
|---|---|
| Setting | The study was conducted in and around Elmira, NY, a small city of 40,000 residents in a semi-rural county in the Appalachian region of New York. |
| 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. The 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 once a week 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 (unmarried and low income) |
| Funding sources | Senior Research Scientist Award (1-K05-MH01382-01) (Dr. Olds); grants from the Prevention Research and Behavioral Medicine Branch of the National Institute of Mental Health, Rockville, Md (R01-MH49381), and the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC (grant 96ASPE278A). |
| 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 | Months employed | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 96.40 | Adjusted mean = 89.70 | Mean difference = 6.70 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Months receiving AFDC | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 52.80 | Adjusted mean = 65.90 | Mean difference = -13.10 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Months receiving Medicaid | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 61.80 | Adjusted mean = 70.00 | Mean difference = -8.20 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Months receiving food stamps | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy, and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 47.90 | Adjusted mean = 56.40 | Mean difference = -8.50 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Months employed | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 87.50 | Adjusted mean = 89.70 | Mean difference = -2.20 | Not available | Statistical significance not reported | |
| High | Months receiving AFDC | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 70.20 | Adjusted mean = 65.90 | Mean difference = 4.30 | Not available | Statistical significance not reported | |
| High | Months receiving food stamps | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 62.00 | Adjusted mean = 56.40 | Mean difference = 5.60 | Not available | Statistical significance not reported | |
| High | Months receiving Medicaid | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 71.10 | Adjusted mean = 70.00 | Mean difference = 1.10 | 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 | Incidence of substance use impairments | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.34 | Adjusted mean = 0.43 | Mean difference = -0.09 | Not available | Not statistically significant, p ≥ 0.05 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Months between birth of first and second child | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 41.70 | Adjusted mean = 37.30 | Mean difference = 4.40 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Subsequent births | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 1.30 | Adjusted mean = 1.60 | Mean difference = -0.30 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Subsequent pregnancies | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 1.70 | Adjusted mean = 2.10 | Mean difference = -0.40 | Not available | Not statistically significant, p ≥ 0.05 |
|
| High | Months between birth of first and second child | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 39.80 | Adjusted mean = 37.30 | Mean difference = 2.50 | Not available | Statistical significance not reported | |
| High | Subsequent births | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 1.40 | Adjusted mean = 1.60 | Mean difference = -0.20 | Not available | Statistical significance not reported | |
| High | Subsequent pregnancies | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 1.90 | Adjusted mean = 2.10 | Mean difference = -0.20 | Not available | Statistical significance not reported | |
| High | Substance use impairments since birth of first child | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.45 | Adjusted mean = 0.43 | Mean difference = 0.02 | 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 reports of child abuse and neglect (incidence) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.29 | Adjusted mean = 0.54 | Mean difference = -0.25 | Not available | Statistically significant, p < 0.01 |
Statistical significance reported on authors’ calculations of the log-incidence difference.
|
| High | Substantiated reports of child abuse and neglect (incidence) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.35 | Adjusted mean = 0.54 | Mean difference = -0.19 | 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 | NYS arrests (incidence; administrative records) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.12 | Adjusted mean = 0.38 | Mean difference = -0.26 | Not available | Not statistically significant, p > 0.05 |
|
| High | NYS convictions (incidence; administrative records) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.12 | Adjusted mean = 0.27 | Mean difference = -0.15 | Not available | Not statistically significant, p > 0.05 |
|
| High | Arrests (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 244 mothers | Adjusted mean = 0.09 | Adjusted mean = 0.22 | Mean difference = -0.13 | Not available | Not statistically significant, p > 0.05 |
Information on sample sizes for this study was received through communication with the authors. HomVEE previously rated 24-month outcomes for nurse home visitors Moderate due to high attrition. Upon further examination, HomVEE noted that the outcomes had low attrition, and therefore they rate High. |
| High | Convictions (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.03 | Adjusted mean = 0.13 | Mean difference = -0.10 | Not available | Not statistically significant, p > 0.05 |
|
| High | Days in jail (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy + infancy and comparison (Elmira) | 15-year follow-up | 245 mothers | Adjusted mean = 0.01 | Adjusted mean = 0.65 | Mean difference = -0.64 | Not available | Not statistically significant, p > 0.05 |
|
| High | NYS arrests (incidence; administrative records) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.34 | Adjusted mean = 0.38 | Mean difference = -0.04 | Not available | Statistical significance not reported | |
| High | NYS convictions (incidence; administrative records) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.28 | Adjusted mean = 0.27 | Mean difference = 0.01 | Not available | Statistical significance not reported | |
| High | Arrests (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 226 mothers | Adjusted mean = 0.16 | Adjusted mean = 0.22 | Mean difference = -0.06 | Not available | Statistical significance not reported | Information on sample sizes for this study was received through communication with the authors. HomVEE previously rated 24-month outcomes for nurse home visitors Moderate due to high attrition. Upon further examination, HomVEE noted that the outcomes had low attrition, and therefore they rate High. |
| High | Convictions (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.05 | Adjusted mean = 0.13 | Mean difference = -0.08 | Not available | Statistical significance not reported | |
| High | Days in jail (incidence; self-report) | FavorableUnfavorable or ambiguousNo Effect |
Nurse visited during pregnancy and comparison (Elmira) | 15-year follow-up | 227 mothers | Adjusted mean = 0.13 | Adjusted mean = 0.65 | Mean difference = -0.52 | Not available | Statistical significance not reported |