Black or African American
16%
Source
Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., et al. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110(3), 486.
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 (93059); a contract with Abt Associates (105–94-1925) under a grant from the Administration for Children and Families (HHS); and a Senior Research Scientist Award to David Olds from the National Institute of Mental Health (K05-MH01382).
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established for race/ethnicity and SES |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
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.
This study received a mixed rating. All of the outcomes comparing paraprofessional-visited mothers versus the control condition for the main sample rate high. Outcomes for the low resources subgroup, for both the nurse-visited and paraprofessional-visited versus control comparisons, rate high. In addition, outcomes for the main sample for the nurse-visited versus control comparison at the 21-month follow-up rate high. Due to high attrition, the nurse-visited versus control comparison for the other follow-ups rate moderate.
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. From March 1994 through 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 measures the sample when the children were 6 months to 2 years old. The study sample at the 24-month parent interview included 630 women, 194 in the nurse home visiting program group, 213 in the paraprofessional home visiting program group, and 223 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) • Smoking status (current smoker)
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 | |
|---|---|---|---|---|---|---|---|---|
Use of preventative services |
36 weeks (prenatal) |
Moderate | 0.09 | Not statistically significant, |
353 mothers | Nurse home visitor and comparison (Denver) |
||
Use of emergency services |
36 weeks (prenatal) |
Moderate | 0.27 | Not statistically significant, |
353 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent pregnancy (24 months postpartum) |
24 months |
High | 0.32 | Statistically significant, |
436 mothers | Nurse home visitor and comparison (Denver) |
||
Subsequent birth (24 months postpartum) |
24 months |
High | 0.33 | Statistically significant, |
436 mothers | Nurse home visitor and comparison (Denver) |
||
Use of preventative services |
36 weeks (prenatal) |
High | Not statistically significant, |
344 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Use of emergency services |
36 weeks (prenatal) |
High | 0.00 | Not statistically significant, |
344 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Subsequent pregnancy (24 months postpartum) |
24 months |
High | 0.21 | Not statistically significant, p > 0.05 |
417 mothers | Paraprofessional home visitor and comparison (Denver) |
||
Subsequent birth (24 months postpartum) |
24 months |
High | 0.27 | Not statistically significant, p > 0.05 |
417 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 | |
|---|---|---|---|---|---|---|---|---|
Infant vulnerability: fear stimuli (video coding) |
6 months |
Moderate | 0.34 | Statistically significant, |
363 children | Nurse home visitor and comparison (Denver) |
||
Infant low vitality: joy stimuli (video coding) |
6 months |
Moderate | 0.23 | Not statistically significant, |
363 children | Nurse home visitor and comparison (Denver) |
||
Infant low vitality: anger stimuli (video coding) |
6 months |
Moderate | 0.31 | Not statistically significant, |
363 children | Nurse home visitor and comparison (Denver) |
||
Irritable temperament |
6 months |
Moderate | Not statistically significant, |
363 children | Nurse home visitor and comparison (Denver) |
|||
BSID MDI |
24 months |
Moderate | Not statistically significant, |
372 children | Nurse home visitor and comparison (Denver) |
|||
BSID, MDI: Mental development delay |
24 months |
Moderate | 0.12 | Not statistically significant, |
372 children | Nurse home visitor and comparison (Denver) |
||
CBCL (Behavior problems score) |
24 months |
Moderate | Not statistically significant, |
372 children | Nurse home visitor and comparison (Denver) |
|||
PLS-3 (language delay) |
21 months |
High | 0.45 | Statistically significant, |
406 children | Nurse home visitor and comparison (Denver) |
||
PLS-3 (language development) |
21 months |
High | Not statistically significant, p ≥ 0.05 |
406 children | Nurse home visitor and comparison (Denver) |
|||
Vulnerable: fear stimuli (video coding) |
6 months |
High | 0.25 | Not statistically significant, |
377 children | Paraprofessional home visitor and comparison (Denver) |
||
Low vitality: joy stimuli (video coding) |
6 months |
High | 0.08 | Not statistically significant, |
377 children | Paraprofessional home visitor and comparison (Denver) |
||
Low vitality: anger stimuli (video coding) |
6 months |
High | 0.06 | Not statistically significant, |
377 children | Paraprofessional home visitor and comparison (Denver) |
||
Irritable temperament (video coding) |
6 months |
High | Not statistically significant, |
377 children | Paraprofessional home visitor and comparison (Denver) |
|||
PLS-3 (language delay) |
21 months |
High | 0.06 | Not statistically significant, |
420 children | Paraprofessional home visitor and comparison (Denver) |
||
PLS-3 (language development) |
21 months |
High | Not statistically significant, |
420 children | Paraprofessional home visitor and comparison (Denver) |
|||
BSID (mental development delay) |
24 months |
High | Not statistically significant, |
392 children | Paraprofessional home visitor and comparison (Denver) |
|||
BSID (Mental Developmental Index) |
24 months |
High | Not statistically significant, |
392 children | Paraprofessional home visitor and comparison (Denver) |
|||
CBCL |
24 months |
High | Not statistically significant, |
392 children | Paraprofessional home visitor and comparison (Denver) |
|||
PLS-3 (language delay) |
21 months |
High | 0.45 | Statistically significant, |
406 children | Nurse home visitor and comparison (Denver) |
||
PLS-3 (language development) |
21 months |
High | Not statistically significant, |
406 children | Nurse 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 | |
|---|---|---|---|---|---|---|---|---|
Infant vulnerability: fear stimuli (video coding) |
6-month follow-up |
High | 0.34 | Not statistically significant, |
138 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Infant low vitality: joy stimuli (video coding) |
6-month follow-up |
High | 0.45 | Statistically significant, |
138 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Infant low vitality: anger stimuli (video coding) |
6-month follow-up |
High | 0.31 | Statistically significant, |
138 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Irritable temperament |
6-month follow-up |
High | Not statistically significant, |
138 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
PLS-3 (language delay) |
21-month follow-up |
High | 0.65 | Statistically significant, |
142 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
PLS-3 (language development) |
21-month follow-up |
High | Statistically significant, |
142 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
BSID (mental development delay) |
24-month follow-up |
High | 0.12 | Not statistically significant, |
136 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
BSID (mental development index) |
24-month follow-up |
High | Statistically significant, |
136 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
CBCL |
24-month follow-up |
High | Not statistically significant, |
136 children | Nurse home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
Infant vulnerability: fear stimuli (video coding) |
6-month follow-up |
High | 0.16 | Not statistically significant, |
158 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Infant low vitality: joy stimuli (video coding) |
6-month follow-up |
High | 0.27 | Not statistically significant, |
158 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Infant low vitality: anger stimuli (video coding) |
6-month follow-up |
High | 0.31 | Not statistically significant, |
158 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
Irritable temperament |
6-month follow-up |
High | HomVEE = > 0.05 |
158 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
PLS-3 (language delay) |
21-month follow-up |
High | 0.23 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
PLS-3 (language development) |
21-month follow-up |
High | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
BSID (Mental development delay) |
24-month follow-up |
High | 0.00 | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
||
BSID (Mental development index) |
24-month follow-up |
High | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
|||
CBCL |
24-month follow-up |
High | Not statistically significant, |
163 children | Paraprofessional home visitors and comparison (Denver); Subgroup: Mother has psychological vulnerability |
Positive parenting practices
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
HOME environment score |
Unknown |
Moderate | Not statistically significant, |
406 mothers | Nurse home visitor and comparison (Denver) |
|||
Mother-infant responsive interaction |
Unknown |
Moderate | Statistically significant, |
372 mothers | Nurse home visitor and comparison (Denver) |
|||
HOME environment score |
21 months |
High | Not statistically significant, |
420 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Mother-infant responsive interaction |
24 months |
High | Not statistically significant, p ≥ 0.05 |
392 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 | |
|---|---|---|---|---|---|---|---|---|
Educational achievement (years) |
21 months |
High | Not statistically significant, |
427 mothers | Nurse home visitor and comparison (Denver) |
|||
Months employed (1–12 months postpartum) |
12 months |
Moderate | Not statistically significant, |
406 mothers | Nurse home visitor and comparison (Denver) |
|||
Months on AFDC (1–12 months postpartum) |
12 months |
Moderate | Not statistically significant, |
406 mothers | Nurse home visitor and comparison (Denver) |
|||
Months employed (13–24 months postpartum) |
24 months |
Moderate | Statistically significant, |
419 mothers | Nurse home visitor and comparison (Denver) |
|||
Months on AFDC (13–24 months postpartum) |
24 months |
Moderate | Not statistically significant, |
419 mothers | Nurse home visitor and comparison (Denver) |
|||
Months employed (1–12 months postpartum) |
12 months |
High | Not statistically significant, |
425 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Months on AFDC (1–12 months postpartum) |
12 months |
High | Not statistically significant, |
425 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Educational achievement (years) |
21 months |
High | Not statistically significant, |
440 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Months employed (13–24 months postpartum) |
24 months |
High | Not statistically significant, |
439 mothers | Paraprofessional home visitor and comparison (Denver) |
|||
Months on AFDC (13–24 months postpartum) |
24 months |
High | Not statistically significant, |
439 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