Black or African American
15%
Source
Olds, D. L., Holmberg, J. R., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. (2014). Effects of home visits by paraprofessionals and by nurses on children follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics, 168(2), 114-121.
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.
Study Registration
Funding Sources
The Colorado Trust: grants 99030, 2001-049, and 99012; the Administration for Children and Families: grants 90PD0232 and 90XP0017; the Office of Juvenile Justice and Delinquency Prevention: grant 2004-52854-CO-JS; the US Department ofJustice: grant 2005-MU-MU-001; the National Institute of Mental Health: grants 1R01MH069891, 1R01MH62485, and Senior Research Scientist Award 1-K05-MH01382.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race; established on SES; outcome measures not assessable at baseline |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
In the full sample, the comparison of nurse home visiting to no home visiting at the 9-year follow-up rates moderate for three outcomes with high attrition: total behavioral problems, internalizing behavior, and externalizing behavior. Outcomes for the low psychological resources subgroup rate moderate because attrition information was not reported and was not available from the author.
Study Participants
Pregnant women were referred to the study by staff at clinics serving low-income women in Denver, Colorado. Women were eligible to be included in the study if they were eligible for Medicaid or were uninsured, and had no previous live births. Women were randomly assigned to one of three treatment conditions: a control condition, paraprofessional home visiting, and nurse home visiting. Randomization occurred within strata defined by maternal race/ethnicity, maternal age, and maternal residence (geography).A total of 735 women were randomized: 255 into the control group, 245 into the paraprofessional home visiting group, and 235 into the nurse home visiting group. A total of 47.3 to 56 percent of children in the final analytic sample were boys (depending on treatment condition and follow-up period). A total of 12.9 to 17.6 percent of women in the final analytic sample were African American, 42.4 to 48.6 percent were Latino, and 33.7 to 40.1 percent were white. On average, at enrollment women had completed 11 years of school and were 19 or 20 years old. Average annual household incomes ranged from $12,308 to $13,561 and census tract poverty ranged from 20 to 21 percent. The percentage of women with low psychological resources ranged from 32.8 to 47.8.
Setting
Denver, Colorado
Home Visiting Services
This study had two treatment groups, each of which was compared to the control condition. The first group received home visits from paraprofessionals, the second group received home visits from nurses. Both groups also received free developmental screenings and referrals. Home visits began during pregnancy and lasted until the child's second birthday. Both the nurse and paraprofessional home visits had the same goals: to improve pregnancy outcomes through improved maternal health behaviors, improve child health and development through improved parental care, and assist mothers with planning future pregnancies and pursuing education and employment.
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 comparison group did not receive any home visits, but received free developmental screenings and referrals when the child was 6, 12, 15, 21, and 24 months old.
Were any subgroups examined?
Yes
Subgroups examined
• Mother has psychological vulnerability (yes or no)
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 | |
|---|---|---|---|---|---|---|---|---|
Total behavioral problems - 6 year, treatment 1 vs. 3 |
6 years |
High | 0.45 | Not statistically significant, p = 0.08 |
396 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Internalizing - 6 year, treatment 1 vs. 3 |
6 years |
High | 0.42 | Not statistically significant, p = 0.28 |
396 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Externalizing - 6 year, treatment 1 vs. 3 |
6 years |
High | 0.76 | Not statistically significant, p = 0.42 |
396 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Attention dysfunction - 9 year, treatment 1 vs. 3 |
9 years |
High | 0.34 | Not statistically significant, p = 0.07 |
378 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Total behavioral problems - 9 year, treatment 1 vs. 3 |
9 years |
Moderate | 0.76 | Not statistically significant, p = 0.46 |
378 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Internalizing - 9 year, treatment 1 vs. 3 |
9 years |
Moderate | 0.44 | Not statistically significant, p = 0.08 |
378 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Externalizing - 9 year, treatment 1 vs. 3 |
9 years |
Moderate | 0.64 | Not statistically significant, p = 0.25 |
378 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Total behavioral problems - 6 year, treatment 1 vs. 2 |
6 years |
High | 1.04 | Not statistically significant, p = 0.91 |
411 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Internalizing - 6 year, treatment 1 vs. 2 |
6 years |
High | 1.35 | Not statistically significant, p = 0.60 |
411 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Externalizing - 6 year, treatment 1 vs. 2 |
6 years |
High | 0.87 | Not statistically significant, p = 0.66 |
411 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver) |
||
Total behavioral problems - 9 year, treatment 1 vs. 2 |
9 years |
High | 0.97 | Not statistically significant, p = 0.94 |
394 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Internalizing - 9 year, treatment 1 vs. 2 |
9 years |
High | 0.96 | Not statistically significant, p = 0.90 |
394 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Externalizing - 9 year, treatment 1 vs. 2 |
9 years |
High | 1.34 | Not statistically significant, p = 0.33 |
394 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
||
Attention dysfunction - 9 year, treatment 1 vs. 2 |
9 years |
High | 0.53 | Not statistically significant, p = 0.22 |
394 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver) |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Receptive language - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.21 | Not statistically significant, p = 0.16 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Receptive language - averaged over 2, 4, and 6 years, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.30 | Statistically significant, p = 0.01 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.33 | Statistically significant, p = 0.05 |
138 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Intellectual functioning - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.16 | Not statistically significant, p = 0.35 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.13 | Not statistically significant, p = 0.44 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.13 | Not statistically significant, p = 0.46 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Dysregulated aggression - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.26 | Not statistically significant, p = 0.12 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Percent incoherent stories - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.23 | Not statistically significant, p = 0.17 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Behvioral regulation in testing - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.23 | Not statistically significant, p = 0.18 |
140 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Any therapeutic services - 6 year, low psych resources, treatment 1 vs. 3 |
6 years |
Moderate | 0.63 | Statistically significant, p = 0.01 |
141 children | Nurse home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.33 | Not statistically significant, p = 0.08 |
126 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - averaged over 4, 6, and 9 years, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.36 | Statistically significant, p = 0.01 |
126 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Visual attention/task switching errors - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.25 | Not statistically significant, p = 0.16 |
126 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Working memory errors - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.26 | Not statistically significant, p = 0.15 |
123 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.02 | Not statistically significant, p = 0.93 |
128 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - averaged over 6 and 9 years, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.07 | Not statistically significant, p = 0.63 |
128 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.21 | Not statistically significant, p = 0.22 |
128 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - averaged over 6 and 9 years, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.17 | Not statistically significant, p = 0.27 |
128 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Any therapeutic services - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.15 | Not statistically significant, p = 0.51 |
127 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Special education/remedial services - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.46 | Not statistically significant, p = 0.06 |
127 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Grade retention - 9 year, low psych resources, treatment 1 vs. 3 |
9 years |
Moderate | 0.29 | Not statistically significant, p = 0.38 |
127 children | Nurse home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Receptive language - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.16 | Not statistically significant, p = 0.28 |
163 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Receptive language - averaged over 2, 4, and 6 years, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.02 | Not statistically significant, p = 0.22 |
163 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.13 | Not statistically significant, p = 0.39 |
160 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Intellectual functioning - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.18 | Not statistically significant, p = 0.26 |
166 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.03 | Not statistically significant, p = 0.85 |
164 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.22 | Not statistically significant, p = 0.17 |
164 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Dysregulated aggression - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.36 | Statistically significant, p = 0.02 |
162 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Percent incoherent stories - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.50 | Statistically significant, p = 0.00 |
162 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Behvioral regulation in testing - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.32 | Statistically significant, p = 0.05 |
164 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Any therapeutic services - 6 year, low psych resources, treatment 1 vs. 2 |
6 years |
Moderate | 0.40 | Not statistically significant, p = 0.07 |
165 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (6 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.03 | Not statistically significant, p = 0.86 |
153 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Sustained attention - averaged over 4, 6, and 9 years, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.14 | Not statistically significant, p = 0.24 |
153 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Visual attention/task switching errors - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.30 | Not statistically significant, p = 0.08 |
154 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Working memory errors - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.13 | Not statistically significant, p = 0.46 |
150 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.05 | Not statistically significant, p = 0.77 |
156 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Arithmetic achievement standard score - averaged over 6 and 9 years, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.04 | Not statistically significant, p = 0.79 |
156 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.21 | Not statistically significant, p = 0.18 |
156 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Reading achievement standard score - averaged over 6 and 9 years, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.22 | Not statistically significant, p = 0.13 |
156 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Any therapeutic services - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.25 | Not statistically significant, p = 0.23 |
155 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Special education/remedial services - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.03 | Not statistically significant, p = 0.89 |
155 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
||
Grade retention - 9 year, low psych resources, treatment 1 vs. 2 |
9 years |
Moderate | 0.15 | Not statistically significant, p = 0.62 |
155 children | Paraprofessional home visiting pregnancy to 2 years vs. comparison (9 year follow up, Denver); Subgroup: Mother has psychological vulnerability |
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