Manuscript Details

Source

Olds, D. L., Henderson Jr., C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65–78.

High rating
Study reviewed under: Handbook of Procedures and Standards, Version 1

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.

Author Affiliation

David L. Olds, a study author, is a developer of this model.

Funding Sources

Bureau of Community Health Services (HHS-MCR-360403-06); the Robert Wood Johnson Foundation (grant 5263); and the W. T. Grant Foundation (grant 0723-80).

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low

Established on race and SES.

None

Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1
Notes

In 2020, HomVEE updated this review to move four findings related to "mother-reported positive mood" and crying from the Child Health 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 less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. Roughly 42 percent of the sample was married. This study measured the sample at registration and at 6, 10, 12, 22, and 24 months of the infant’s life. The study sample included 354 women, 189 in the program group and 165 in the comparison group.

Setting

The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has 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. This 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 weekly 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.

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.

Subgroups examined

• Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy or unmarried and low-income teen)

Findings that rate moderate or high in this manuscript

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

Mother- reported positive mood

6 months

High

Statistical significance not reported

199 children

Nurse visited during pregnancy and comparison (Elmira)

Crying (mother-reported number of episodes last 2 weeks)

6 months

High

Statistical significance not reported

164 children

Nurse visited during pregnancy and comparison (Elmira)

Mother-reported positive mood

6 months

High

Statistically significant,
p < 0.05

209 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Crying (mother-reported number of episodes last 2 weeks)

6 months

High

Not statistically significant,
p > 0.05

163 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

BSID Mental Development Index (MDI)

12 months

High

Statistical significance not reported

199 children

Nurse visited during pregnancy and comparison

BSID MDI

12 months

High

Not statistically significant,
p > 0.05

204 children

Nurse visited during pregnancy + infancy and comparison

Cattell

24 months

High

Statistical significance not reported

186 children

Nurse visited during pregnancy and comparison

Cattell

24 months

High

Not statistically significant,
p > 0.05

193 children

Nurse visited during pregnancy + infancy and comparison

Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Child health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description

Resist eating (mother-reported number of episodes last 2 weeks)

6 months

High

Statistical significance not reported

164 children

Nurse visited during pregnancy and comparison (Elmira)

Night awake (mother-reported number of episodes last 2 weeks

6 months

High

Statistical significance not reported

164 children

Nurse visited during pregnancy and comparison (Elmira)

Resist eating (mother-reported number of episodes last 2 weeks)

6 months

High

Statistically significant,
p < 0.01

163 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Night awake (mother-reported number of episodes last 2 weeks

6 months

High

Not statistically significant,
p > 0.05

163 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Number of emergency room visits (first year of life)

1-year follow-up

High

Statistical significance not reported

205 children

Nurse visited during pregnancy and comparison (Elmira)

Number of emergency room visits (first year of life)

1-year follow-up

High

Statistically significant,
p < 0.05

223 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Number of emergency room visits (second year of life)

2-year follow-up

High

Statistical significance not reported

185 children

Nurse visited during pregnancy and comparison (Elmira)

Number of emergency room visits (second year of life)

2-year follow-up

High

Statistically significant,
p < 0.01

196 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Reductions in child maltreatment
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description

Number of emergency room visits for accidents and poisonings (first year of life)

1-year follow-up

High

Statistical significance not reported

205 children

Nurse visited during pregnancy and comparison (Elmira)

Number of emergency room visits for accidents and poisonings (first year of life)

1-year follow-up

High

Not statistically significant,
p > 0.05

223 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Number of emergency room visits for accidents and poisonings (second year of life)

2-year follow-up

High

Statistical significance not reported

185 children

Nurse visited during pregnancy and comparison (Elmira)

Substantiated abuse or neglect

2-year follow-up

High
0.15

Not statistically significant,
p > 0.10

247 children

Nurse visited during pregnancy and comparison

Number of emergency room visits for accidents and poisonings (second year of life)

2-year follow-up

High

Statistically significant,
p < 0.05

196 children

Nurse visited during pregnancy + infancy and comparison (Elmira)

Substantiated abuse or neglect

2-year follow-up

High
0.45

Not statistically significant,
p > 0.10

256 children

Nurse visited during pregnancy + infancy and comparison

Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive parenting practices
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description

Worry or concern (Sum of positive responses for behavioral problems)

6 months

High

Statistical significance not reported

164 mothers

Nurse visited during pregnancy and comparison (Elmira)

Conflict

6 months

High

Statistical significance not reported

164 mothers

Nurse visited during pregnancy and comparison (Elmira)

Yell or scold (number of times last 2 weeks)

6 months

High

Statistical significance not reported

151 mothers

Nurse visited during pregnancy and comparison (Elmira)

Spank or hit (number of times last 2 weeks)

6 months

High

Statistical significance not reported

151 mothers

Nurse visited during pregnancy and comparison (Elmira)

HOME (avoidance of restriction and punishment)

10 months

High

Statistical significance not reported

184 mothers

Nurse visited during pregnancy and comparison (Elmira)

HOME (provision of appropriate play materials)

10 months

High

Statistical significance not reported

195 mothers

Nurse visited during pregnancy and comparison (Elmira)

HOME (avoidance of restriction and punishment)

22 months

High

Statistical significance not reported

171 mothers

Nurse visited during pregnancy and comparison (Elmira)

HOME (provision of appropriate play materials)

22 months

High

Statistical significance not reported

190 mothers

Nurse visited during pregnancy and comparison (Elmira)

Worry or concern (Sum of positive responses for behavioral problems)

6 months

High

Statistically significant,
p < 0.05

163 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

Conflict

6 months

High

Not statistically significant,
p ≥ 0.05

163 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

Yell or scold (number of times last 2 weeks)

6 months

High

Not statistically significant,
p ≥ 0.05

159 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

Spank or hit (number of times last 2 weeks)

6 months

High

Not statistically significant,
p ≥ 0.05

159 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

HOME (avoidance of restriction and punishment)

10 months

High

Not statistically significant,
p ≥ 0.05

191 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

HOME (provision of appropriate play materials)

10 months

High

Not statistically significant,
p ≥ 0.05

201 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

HOME (avoidance of restriction and punishment)

22 months

High

Not statistically significant,
p ≥ 0.05

180 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

HOME (provision of appropriate play materials)

22 months

High

Not statistically significant,
p ≥ 0.05

198 mothers

Nurse visited during pregnancy + infancy and comparison (Elmira)

Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant