Manuscript Detail | Home Visiting Evidence of Effectiveness

Kitzman, H., Olds, D. L., Knudtson, M. D., Cole, R., Anson, E., Smith, J. A., Fishbein, D., DiClemente, R., Wingood, G., Caliendo, A. M., Hopfer, C., Miller, T., & Conti, G. (2019). Prenatal and/or infancy nurse home visiting and 18-year outcomes of a randomized trial. Pediatrics, 144(6). https://doi.org/10.1542/peds.2018-3876

Manuscript screening details
Screening decision	Screening conclusion	HomVEE procedures and standards version
Passes screens	Eligible for review	Version 2

Study design details
Rating	Design	Attrition	Baseline equivalence	Compromised randomization	Confounding factors	Valid, reliable measure(s)
High	Randomized controlled trial	Low	Not assessed for randomized controlled trials with low attrition	No	No	Yes

Notes:

Findings on mother’s partnership status and costs for public benefits were ineligible for review because they are not in one of HomVEE's eligible outcome domains. Findings for mother’s Social Security Administration earnings when children were 12 months to 16 years of age were not eligible for review because findings at each follow-up time were not available for review, as required by HomVEE standards. Findings for maternal substance abuse received an indeterminate rating because HomVEE could not confirm the reliability of the measure. Information on sample sizes, reliability and validity of measures, and means and standard deviations for the impact estimates is based on correspondence with the authors.

Study characteristics
Study participants	Participants were recruited from an obstetric and pediatric care clinic in Memphis, Tennessee. To be eligible, participants had to be pregnant (< 29 weeks’ gestation), have no previous live births, and have at least two sociodemographic risk factors (unmarried, no high school diploma, or unemployed). They were randomly assigned to either the Nurse-Family Partnership intervention (228 participants) or the comparison condition (514 participants). Six hundred and eighteen mothers were included in the analyses in this manuscript (192 in the intervention group and 426 in the comparison group). Participants were in the study from the time of enrollment at pregnancy until the child was 24 months old. Selected outcomes collected from administrative records were obtained every year from baseline until the 18-year follow-up. All other outcomes were measured at the 18-year follow-up. In the study, 92 percent of the participants were African American; at enrollment, 98 percent were unmarried, 64 percent were younger than 18 years of age, and 85 percent were from households with incomes below the federal poverty guidelines.
Setting	The study took place in Memphis, Tennessee.
Intervention services	As described in this manuscript, the Nurse-Family Partnership intervention consisted of prenatal and infancy home visits until the focal child was 24 months old. Participants also received free transportation for scheduled prenatal care. Children received developmental screening and referral at ages 6, 12, and 24 months. All participants received four weekly home visits at the beginning of the intervention to establish a relationship with the nurse. The initial visits focused on mothers’ aspirations, concerns about their prenatal health, the developing fetus, birth, and the challenges of caring for a newborn. To address individual needs revealed in the visits, nurses used their clinical judgment to adjust the dosage and content of the visit, and used telephone communications when in-person visits were not possible. Nurses completed an average of seven home visits during pregnancy and 26 visits during the first two years postpartum. All visits took place in the families’ homes.
Comparison conditions	Participants assigned to the comparison condition were not eligible to receive home visits through Nurse-Family Partnership. They received free transportation for scheduled prenatal care. The children in the study received developmental screening and referral at ages 6, 12, and 24 months.
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). • Mother has psychological vulnerability (yes or no) • Child gender (boy or girl)
Funding sources	This research was supported by Award Number R01DA021624 from the National Institutes of Health.
Author affiliation	The study authors are affiliated with the University of Colorado Anschutz Medical Campus, University of Rochester, Curtin University, and University College London. David Olds, one of the authors of the manuscript, is a developer of the Nurse-Family Partnership home visiting model.
Peer reviewed	Yes

Study Registration:

Clinicaltrials.gov Identifier: NCT00708695. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.

Findings that rate moderate or high

Child development and school readiness
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Achenbach System of Empirically Based Assessment (ASEBA), Externalizing Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	12 years	574 children	Unadjusted proportion = 0.21	Unadjusted proportion = 0.18	Mean difference = 0.02	HomVEE calculated = 0.09	Not statistically significant, p = 0.50	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Achenbach System of Empirically Based Assessment (ASEBA), Externalizing Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	611 children	Adjusted proportion = 0.08	Adjusted proportion = 0.07	Odds ratio = 1.13	HomVEE calculated = 0.07	Not statistically significant, p= 0.72	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Achenbach System of Empirically Based Assessment (ASEBA), Internalizing Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	6 years	618 children	Unadjusted proportion = 0.13	Unadjusted proportion = 0.15	Mean difference = -0.02	HomVEE calculated = -0.08	Not statistically significant, p = 0.62	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Achenbach System of Empirically Based Assessment (ASEBA), Internalizing Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	12 years	577 children	Unadjusted proportion = 0.25	Unadjusted proportion = 0.32	Mean difference = -0.07	HomVEE calculated = -0.21	Not statistically significant, p = 0.09	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Achenbach System of Empirically Based Assessment (ASEBA), Internalizing Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	625 children	Adjusted proportion = 0.17	Adjusted proportion = 0.18	Odds ratio = 0.92	HomVEE calculated = -0.05	Not statistically significant, p= 0.73	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Achenbach System of Empirically Based Assessment (ASEBA), Total Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	12 years	575 children	Unadjusted proportion = 0.25	Unadjusted proportion = 0.21	Mean difference = 0.04	HomVEE calculated = 0.13	Not statistically significant, p = 0.31	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Achenbach System of Empirically Based Assessment (ASEBA), Total Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	611 children	Adjusted proportion = 0.07	Adjusted proportion = 0.04	Odds ratio = 1.60	HomVEE calculated = 0.28	Not statistically significant, p= 0.22	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Achenbach System of Empirically Based Assessment (ASEBA), Total Behavior Problems (borderline or clinical threshold)	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	6 years	616 children	Unadjusted proportion = 0.03	Unadjusted proportion = 0.06	Mean difference = -0.03	HomVEE calculated = -0.48	Not statistically significant, p = 0.11	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Achenbach System of Empirically Based Assessment (ASEBA) Externalizing Behavior Problems, borderline or clinical threshold	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	6 years	620 children	Unadjusted proportion = 0.18	Unadjusted proportion = 0.20	Mean difference = -0.02	HomVEE calculated = -0.09	Not statistically significant, p = 0.51	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Current drug use in the past month or positive lab test result	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	613 children	Adjusted proportion = 0.51	Adjusted proportion = 0.48	Odds ratio = 1.11	HomVEE calculated = 0.06	Not statistically significant, p= 0.55	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Facial Emotion Recognition Task, Emotion recognition	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	617 children	Adjusted mean = 53.75	Adjusted mean = 52.55	Mean difference = 1.20	Study reported = 0.14	Not statistically significant, p= 0.08
High	Graduated from high school	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	619 children	Adjusted proportion = 0.76	Adjusted proportion = 0.72	Odds ratio = 1.21	HomVEE calculated = 0.12	Not statistically significant, p= 0.35	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Graduated with honors	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	619 children	Adjusted proportion = 0.09	Adjusted proportion = 0.04	Odds ratio = 2.12	HomVEE calculated = 0.46	Statistically significant, p= 0.03	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	HIV risk	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	604 children	Adjusted mean = -13.77	Adjusted mean = -13.50	Mean difference = -0.27	Study reported = -0.08	Not statistically significant, p= 0.38	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Peabody Picture Vocabulary Test III (PPVT-III), Receptive language	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	6 years	612 children	Unadjusted mean = 83.65	Unadjusted mean = 82.49	Mean difference = 1.16	HomVEE calculated = 0.09	Not statistically significant, p = 0.31	Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Peabody Picture Vocabulary Test III (PPVT-III), Receptive language	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	621 children	Adjusted mean = 82.34	Adjusted mean = 81.60	Mean difference = 0.74	Study reported = 0.05	Not statistically significant, p= 0.55
High	Any positive STI laboratory test result	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (boys)	18 years	286 children	Adjusted proportion = 0.15	Adjusted proportion = 0.15	Odds ratio = 0.95	HomVEE calculated = -0.03	Not statistically significant, p= 0.89	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Time to first live birth	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (boys)	18 years	305 children	Adjusted proportion = 0.08	Adjusted proportion = 0.06	Incidence rate = 0.01	Study reported = 1.20	Not statistically significant, p= 0.62
High	Time to first pregnancy	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (boys)	18 years	305 children	Adjusted proportion = 0.15	Adjusted proportion = 0.17	Incidence rate = -0.02	Study reported = 0.86	Not statistically significant, p= 0.57
High	Any positive STI laboratory test result	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (girls)	18 years	319 children	Adjusted proportion = 0.26	Adjusted proportion = 0.23	Odds ratio = 1.16	HomVEE calculated = 0.09	Not statistically significant, p= 0.60	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Time to first live birth	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (girls)	18 years	324 children	Adjusted proportion = 0.14	Adjusted proportion = 0.17	Incidence rate = -0.03	Study reported = 0.80	Not statistically significant, p= 0.44
High	Time to first pregnancy	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (girls)	18 years	324 children	Adjusted proportion = 0.23	Adjusted proportion = 0.26	Incidence rate = -0.04	Study reported = 0.85	Not statistically significant, p= 0.46
High	Facial Emotion Recognition Task, Emotion recognition	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	329 children	Adjusted mean = 54.19	Adjusted mean = 52.32	Mean difference = 1.87	Study reported = 0.22	Statistically significant, p= 0.04
High	Graduated from high school	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	333 children	Adjusted proportion = 0.71	Adjusted proportion = 0.70	Odds ratio = 1.06	HomVEE calculated = 0.04	Not statistically significant, p= 0.83	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Graduated with honors	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	333 children	Adjusted proportion = 0.08	Adjusted proportion = 0.03	Odds ratio = 3.34	HomVEE calculated = 0.73	Statistically significant, p= 0.02	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Peabody Picture Vocabulary Test III (PPVT-III), Receptive language	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	331 children	Adjusted mean = 82.32	Adjusted mean = 79.02	Mean difference = 3.30	Study reported = 0.24	Statistically significant, p= 0.05
High	Peabody Picture Vocabulary Test III (PPVT-III), Receptive language	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	6 years	323 children	Unadjusted mean = 81.13	Unadjusted mean = 79.49	Mean difference = 1.64	HomVEE calculated = 0.13	Not statistically significant, p = 0.28	Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.

Family economic self-sufficiency
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Supplemental Security Income, disability enrollment	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	619 children	Adjusted proportion = 0.03	Adjusted proportion = 0.06	Odds ratio = 0.58	HomVEE calculated = -0.33	Not statistically significant, p= 0.19	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Supplemental Security Income, disability enrollment	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	330 children	Adjusted proportion = 0.04	Adjusted proportion = 0.11	Odds ratio = 0.33	HomVEE calculated = -0.67	Statistically significant, p= 0.01	Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.

Reductions in juvenile delinquency, family violence, and crime
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Ever in a gang	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	625 children	Adjusted proportion = 0.11	Adjusted proportion = 0.09	Odds ratio = 1.35	HomVEE calculated = 0.18	Not statistically significant, p= 0.27	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by barbara on Fri, 04/12/2019 - 18:55 HomVEE calculated the effect size based on the study-reported odds ratio.
High	Number of arrests	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	629 children	Adjusted mean = 0.36	Adjusted mean = 0.35	Incidence rate = 0.01	Study reported = 1.02	Not statistically significant, p= 0.93	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of convictions	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	629 children	Adjusted mean = 0.24	Adjusted mean = 0.28	Incidence rate = -0.04	Study reported = 0.86	Not statistically significant, p= 0.59	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of interpersonal violence arrests	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	629 children	Adjusted mean = 0.19	Adjusted mean = 0.14	Incidence rate = 0.05	Study reported = 1.39	Not statistically significant, p= 0.32	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of interpersonal violence convictions	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014, full sample	18 years	629 children	Adjusted mean = 0.13	Adjusted mean = 0.10	Incidence rate = 0.03	Study reported = 1.33	Not statistically significant, p= 0.43	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of interpersonal violence arrests	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (girls)	18 years	324 children	Adjusted mean = 0.14	Adjusted mean = 0.09	Incidence rate = 0.05	Study reported = 1.48	Not statistically significant, p= 0.42	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of interpersonal violence convictions	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Child gender (girls)	18 years	324 children	Adjusted mean = 0.07	Adjusted mean = 0.08	Incidence rate = -0.01	Study reported = 0.81	Not statistically significant, p= 0.69	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of arrests	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	324 children	Adjusted mean = 0.19	Adjusted mean = 0.23	Incidence rate = -0.04	Study reported = 0.84	Not statistically significant, p= 0.65	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Number of convictions	FavorableUnfavorable or ambiguousNo Effect	NFP vs. Resource referral RCT, Memphis TN, 1990-2014; Subgroup: Mother has psychological vulnerability	18 years	324 children	Adjusted mean = 0.10	Adjusted mean = 0.21	Incidence rate = -0.11	Study reported = 0.47	Not statistically significant, p= 0.08	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.