White
88%
Source
Eckenrode, J., Zielinski, D., Smith, E., Marcynyszyn, L. A., Henderson, C. R., Kitzman, H., et al. (2001). Child maltreatment and the early onset of problem behaviors: Can a program of nurse home visitation break the link? Development and Psychopathology, 13(4), 873–890.
Model(s) Reviewed
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
Funding Sources
Prevention Research Branch of the National Institute of Mental Health (R01-MH49381); the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (96ASPE278A); the Children’s Bureau, U.S. Department of Health and Human Services (90-CA1631); a Senior Research Scientist Award (1-K05-MH01382-01); and the Smith–Richardson Foundation.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race and SES (assuming same sample characteristics as reported in previous analyses using the 15 year follow-up). |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
In 2020, HomVEE updated this review to move one finding, number of early onset of problem behaviors, from the Reductions in Juvenile Delinquency, Family Violence, and Crime 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 fewer than 30 weeks pregnant. The study actively recruited and included pregnant, first-time mothers who were fewer than 25 weeks pregnant, were younger 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. At enrollment, on average, 47 percent were younger than 19 years old, 61 percent came from households in which the head of household was an unskilled or semiskilled worker, and 38 percent were married. This study measured the sample when the children were 15 years old. The study sample included 228 women, 91 in the program group and 137 in the comparison group. (Information on samples sizes for this study was received through communication with the authors.)
Setting
The study was conducted in and around Elmira, New York, a small city of 40,000 residents in a semirural county in the Appalachian region of New York. According to other studies of the Elmira sample, the county included approximately 100,000 residents.
Home Visiting 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.
Model(s) Reviewed
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
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.
Findings that rate moderate or high in this manuscript
Reductions in child maltreatment
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Percentage neglected |
15-year follow-up |
High | Statistical significance not reported |
228 adolescents | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Percentage abused |
15-year follow-up |
High | Statistical significance not reported |
228 adolescents | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Child development and school readiness
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Number of early onset of problem behaviors |
15-year follow-up |
High | Not statistically significant, |
228 adolescents | Nurse visited during pregnancy + infancy and comparison (Elmira) |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- New York