Black or African American
16%
Source
Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114(6), 1560-1568.
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
The Colorado Trust (grant 99030); the Administration for Children and Families, Department of Health and Human Services (grant 90PD0232); and a Senior Research Scientist Award (grant 1-K05-MH01382-01) to D.L.O.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | No relevant differences for nurse home visitor group. Statistically significant different in income between paraprofessional home visitor and comparison group. |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
In 2020, HomVEE updated this review to remove eight mother's partnership status/family structure findings from the Family Economic Self-Sufficiency domain because ACF determined that mother's partnership status is ineligible for review by HomVEE.
This study includes three groups: nurse home visits, paraprofessional home visits, and a comparison group. The high rating is based on the comparison between nurse home visits and the comparison group. The comparison between the paraprofessional and comparison groups receives a moderate rating because of a statistically significant difference in income at baseline that was not controlled.
Study Participants
Women were recruited through 21 antepartum clinics that served low-income pregnant women. Recruitment focused on women who had no previous live births and either qualified for Medicaid or had no private health insurance. Between March 1994 and June 1995, 1,178 women were invited to participate and 735 consented and were randomly assigned to one of three conditions: a control group, nurse home visiting, and paraprofessional home visiting. Randomization was conducted within strata based on maternal race (Hispanic, white, black, American Indian, or Asian), maternal gestational age (less than 32 weeks, 32 weeks or more), and geographic region. This study measured the sample when the children were 4 years old. The sample of women who completed the interviews when children were 4 years old included 635 women, 204 in the nurse home visiting program group, 211 in the paraprofessional home visiting program group, and 220 in the comparison group.
Setting
Denver, Colorado metropolitan area
Home Visiting Services
The study included two program groups: one serviced by paraprofessionals and one serviced by nurses. Women assigned to both groups received developmental screening and referral services for their children and home visits during pregnancy and infancy (until the child was 2 years old). Both groups had the same goals: (1) to improve women’s health-related behavior, (2) to support parents in providing competent care, and (3) to encourage planning future pregnancies and promote education and employment. Paraprofessionals conducted 6.3 home visits on average during pregnancy and 16 visits during infancy. Nurses conducted 6.5 home visits on average during pregnancy and 21 visits during infancy.
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
Women in the comparison group received developmental screening and referral services for their children at 6, 12, 15, 21, and 24 months.
Were any subgroups examined?
Yes
Subgroups examined
• Mother has psychological vulnerability (yes or no)
Findings that rate moderate or high in this manuscript
Maternal health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Number of subsequent pregnancies |
4-year follow-up |
High | 0.04 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Number of subsequent live births |
4-year follow-up |
High | 0.13 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Months between births of first and second children |
4-year follow-up |
High | 0.32 | Statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent miscarriage |
4-year follow-up |
High | 0.19 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent abortion |
4-year follow-up |
High | 0.04 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Currently using marijuana |
4-year follow-up |
High | 0.09 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days) |
4-year follow-up |
High | 0.06 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Behavioral problems attributable to substance use |
4-year follow-up |
High | 0.15 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Pearlin Mastery Scale |
4-year follow-up |
High | 0.12 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
MHI |
4-year follow-up |
High | 0.04 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Number of subsequent pregnancies |
4-year follow-up |
Moderate | 0.00 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Number of subsequent live births |
4-year follow-up |
Moderate | 0.06 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Months between births of first and second children |
4-year follow-up |
Moderate | 0.14 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Subsequent miscarriage |
4-year follow-up |
Moderate | 0.42 | Statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Subsequent abortion |
4-year follow-up |
Moderate | 0.10 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Currently using marijuana |
4-year follow-up |
Moderate | 0.04 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison, (Denver) |
||
Moderate/heavy drinker (= 3 drinks, = 3 times in 14 days) |
4-year follow-up |
Moderate | 0.21 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Behavioral problems attributable to substance use |
4-year follow-up |
Moderate | 0.12 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Pearlin Mastery Scale |
4-year follow-up |
Moderate | 0.20 | Statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
MHI |
4-year follow-up |
Moderate | 0.03 | Statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Subsequent low birth weight newborns |
4-year follow-up |
High | 0.17 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent special care admissions |
4-year follow-up |
High | 0.26 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent low birth weight newborns |
4-year follow-up |
Moderate | 0.64 | Statistically significant, |
431 mothers | Paraprofessional. home visitor and comparison (Denver) |
||
Subsequent special care admissions |
4-year follow-up |
Moderate | 0.38 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
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 | |
|---|---|---|---|---|---|---|---|---|
Child attended Head Start, preschool, center-based day care, or government-supported family care |
4-year follow-up |
High | 0.29 | Statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
PLS-3 (total language score) |
4-year follow-up |
High | 0.04 | Not statistically significant, |
408 children | Nurse home visitor and comparison (Denver) |
||
Executive function composite |
4-year follow-up |
High | 0.09 | Not statistically significant, |
408 children | Nurse home visitor and comparison (Denver) |
||
Behavioral adaptation in testing |
4-year follow-up |
High | 0.01 | Not statistically significant, |
408 children | Nurse home visitor and comparison (Denver) |
||
Emotional regulation in testing |
4-year follow-up |
High | 0.01 | Not statistically significant, |
408 children | Nurse home visitor and comparison (Denver) |
||
Externalizing behavior problems |
4-year follow-up |
High | 0.01 | Not statistically significant, |
408 children | Nurse home visitor and comparison (Denver) |
||
Child attended Head Start, preschool, center-based day care, or government-supported family care |
4-year follow-up |
Moderate | 0.17 | Not statistically significant, |
431 children | Paraprofessional home visitor and comparison (Denver) |
||
PLS-3 (total language score) |
4-year follow-up |
Moderate | 0.08 | Not statistically significant, |
412 children | Paraprofessional home visitor and comparison (Denver) |
||
Executive function composite |
4-year follow-up |
Moderate | 0.00 | Not statistically significant, |
412 children | Paraprofessional home visitor and comparison (Denver) |
||
Behavioral adaptation in testing |
4-year follow-up |
Moderate | 0.09 | Not statistically significant, |
412 children | Paraprofessional home visitor and comparison (Denver) |
||
Emotional regulation in testing |
4-year follow-up |
Moderate | 0.13 | Not statistically significant, |
412 children | Paraprofessional home visitor and comparison (Denver) |
||
Externalizing behavior problems |
4-year follow-up |
Moderate | 0.08 | Not statistically significant, |
412 children | Paraprofessional home visitor and comparison (Denver) |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
PLS-3 (Total language score) |
4-year follow-up |
High | 0.31 | Statistically significant, |
144 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Executive function composite |
4-year follow-up |
High | 0.47 | Statistically significant, |
144 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Behavioral adaptation in testing |
4-year follow-up |
High | 0.38 | Statistically significant, |
144 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Emotional regulation in testing |
4-year follow-up |
High | 0.11 | Not statistically significant, |
144 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Externalizing behavior problems |
4-year follow-up |
High | 0.03 | Not statistically significant, |
144 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
PLS-3 (Total language score) |
4-year follow-up |
High | 0.23 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Executive function composite |
4-year follow-up |
High | 0.29 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Behavioral adaptation in testing |
4-year follow-up |
High | 0.28 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Emotional regulation in testing |
4-year follow-up |
High | 0.09 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Externalizing behavior problems |
4-year follow-up |
High | 0.00 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
Reductions in juvenile delinquency, family violence, and crime
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Any domestic violence (past 6 months) |
4-year follow-up |
High | 0.46 | Statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Any domestic violence (since child age 2) |
4-year follow-up |
High | 0.31 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Any domestic violence (past 6 months) |
4-year follow-up |
Moderate | 0.03 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Any domestic violence (since child age 2) |
4-year follow-up |
Moderate | 0.06 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
Positive parenting practices
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
HOME total score |
4-year follow-up |
High | 0.07 | Not statistically significant, |
408 mothers | Nurse home visitor and comparison (Denver) |
||
Sensitive/responsive interaction |
4-year follow-up |
High | 0.18 | Not statistically significant, |
408 mothers | Nurse home visitor and comparison (Denver) |
||
HOME total score |
4-year follow-up |
Moderate | 0.00 | Not statistically significant, |
412 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Sensitive/responsive interaction |
4-year follow-up |
Moderate | 0.23 | Statistically significant, |
412 mothers | Paraprofessional home visitor and comparison (Denver) |
Family economic self-sufficiency
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Months mother employed (25–48 months postpartum) |
4-year follow-up |
High | 0.04 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Months of AFDC (25–48 months postpartum) |
4-year follow-up |
High | 0.01 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Months of food stamps (25–48 months postpartum) |
4-year follow-up |
High | 0.07 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Months of Medicaid (25–48 months postpartum) |
4-year follow-up |
High | 0.03 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Graduated from high school or earned GED |
4-year follow-up |
High | 0.14 | Not statistically significant, |
424 mothers | Nurse home visitor and comparison (Denver) |
||
Months mother employed (25–48 months postpartum) |
4-year follow-up |
Moderate | 0.11 | Statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Months of AFDC (25–48 months postpartum) |
4-year follow-up |
Moderate | 0.19 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Months of food stamps (25–48 months postpartum) |
4-year follow-up |
Moderate | 0.21 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Months of Medicaid (25–48 months postpartum) |
4-year follow-up |
Moderate | 0.02 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Graduated from high school or earned GED |
4-year follow-up |
Moderate | 0.20 | Not statistically significant, |
431 mothers | Paraprofessional home visitor and comparison (Denver) |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Colorado