Manuscript Detail | Home Visiting Evidence of Effectiveness

Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93(1), 89–98.

Manuscript screening details
Screening decision	Screening conclusion	HomVEE procedures and standards version
Passes screens	Eligible for review	Version 1

Study design details
Rating	Design	Attrition	Baseline equivalence	Compromised randomization	Confounding factors	Valid, reliable measure(s)
High	Randomized controlled trial	Low	Established on race and SES.	None	None	Not assessed in manuscripts reviewed before 2021

Notes:

In 2020, HomVEE updated this review to move the two findings on the number of child behavioral/parental coping problems in physician record 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.

footnote30

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.

footnote207

The cases of abuse and neglect findings had high attrition and therefore rate moderate.

Study characteristics
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. This study measured the sample at registration and at the 34th, 36th, 46th, and 48th months of the child’s life. For the data collection ant 48 months postpartum, the study sample included 343 women, 183 in the program group and 160 in the comparison group. (Information on sample size for this follow-up was received through communication with the author.)
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.
Intervention 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. After the child’s second birthday, home visitors provided any appropriate social service referrals to families and children with special needs. Nurses worked in two-person teams (one primary and one backup home visitor).
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	This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). • Race/ethnicity (White) • Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy or unmarried and low-income teen)
Funding sources	Bureau of Community Health Services (MCJ-360579 and MCJ-360403); the National Center for Nursing Research (R01 NR001691-01A1); the Robert Wood Johnson Foundation (grants 5263 and 6729); the W.T. Grant Foundation (grants 800723-80); the Ford Foundation (grants 840-0545 and 840723-0559); a Biomedical Research Support Grant (National Institutes of Health) (PHSS7RR05403-25); the Commonwealth Fund (grant 10443); and a William T. Grant Faculty Scholars Award to the first author (grant 861-080-86).
Author affiliation	David L. Olds, a study author, is a developer of this model.
Peer reviewed	Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings that rate moderate or high

Child development and school readiness
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Number of child behavioral/parental coping problems in physician record (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 mothers	Adjusted mean = 0.39	Adjusted mean = 0.71	Mean difference = -0.32	Not available	Statistically significant, p ≤ .01	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	Stanford Binet	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	36 months	236 children	Adjusted mean = 103.57	Adjusted mean = 101.95	Mean difference = 1.62	Not available	Not statistically significant, p > 0.05
High	Stanford Binet	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	48 months	236 children	Adjusted mean = 111.52	Adjusted mean = 108.93	Mean difference = 2.59	Not available	Not statistically significant, p ≥ 0.05
High	Number of child behavioral/parental coping problems in physician record (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 mothers	Adjusted mean = 0.43	Adjusted mean = 0.71	Mean difference = -0.28	Not available	Statistical significance not reported
High	Stanford Binet	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	48 months	226 children	Adjusted mean = 111.25	Adjusted mean = 108.93	Mean difference = 2.32	Not available	Not statistically significant, p > 0.05
High	Stanford Binet	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	36 months	226 children	Adjusted mean = 104.20	Adjusted mean = 101.95	Mean difference = 2.25	Not available	Not statistically significant, p > 0.05

Child health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Number of days hospitalized (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 0.49	Adjusted mean = 0.31	Mean difference = 0.18	Not available	Statistically significant, p ≤ 0.05	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	Number of emergency department visits (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 1.00	Adjusted mean = 1.53	Mean difference = -0.53	Not available	Statistically significant, p ≤ .01	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	Number of hospital admissions (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 0.14	Adjusted mean = 0.11	Mean difference = 0.03	Not available	Not statistically significant, p > 0.05	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	Number of scheduled health supervision visits (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 1.26	Adjusted mean = 1.56	Mean difference = -0.30	Not available	Not statistically significant, p > 0.05
High	Number of scheduled health supervision visits with problems (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 6.24	Adjusted mean = 6.72	Mean difference = -0.48	Not available	Not statistically significant, p > 0.05
High	Number of days hospitalized (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 0.43	Adjusted mean = 0.31	Mean difference = 0.12	Not available	Statistical significance not reported
High	Number of emergency department visits (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 1.24	Adjusted mean = 1.53	Mean difference = -0.29	Not available	Statistical significance not reported
High	Number of hospital admissions (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 0.11	Adjusted mean = 0.11	Mean difference = 0.00	Not available	Statistical significance not reported
High	Number of scheduled health supervision visits (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 1.27	Adjusted mean = 1.56	Mean difference = -0.29	Not available	Statistical significance not reported
High	Number of scheduled health supervision visits with problems (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 5.18	Adjusted mean = 6.72	Mean difference = -1.54	Not available	Statistical significance not reported

Positive parenting practices
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	HOME inventory (total score)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	34 months	238 mothers	Adjusted mean = 39.08	Adjusted mean = 39.03	Mean difference = 0.05	Not available	Not statistically significant, p ≥ 0.05
High	HOME inventory (total score)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	46 months	238 mothers	Adjusted mean = 39.66	Adjusted mean = 39.67	Mean difference = -0.01	Not available	Not statistically significant, p ≥ 0.05
High	Hazardous exposures observed in home	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	46 months	209 mothers	Adjusted mean = 0.21	Adjusted mean = 0.46	Mean difference = -0.25	Not available	Statistically significant, p < 0.01	footnote4 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculation of incidence ratio.
High	Hazardous exposures observed in home	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	34 months	209 mothers	Adjusted mean = 0.22	Adjusted mean = 0.38	Mean difference = -0.16	Not available	Statistically significant, p < 0.05	footnote4 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculation of incidence ratio.
High	HOME inventory (total score)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	46 months	227 mothers	Adjusted mean = 40.18	Adjusted mean = 39.67	Mean difference = 0.51	Not available	Statistical significance not reported
High	HOME inventory (total score)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	34 months	227 mothers	Adjusted mean = 38.45	Adjusted mean = 39.03	Mean difference = -0.58	Not available	Statistical significance not reported
High	Hazardous exposures observed in home	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	46 months	202 mothers	Adjusted mean = 0.31	Adjusted mean = 0.46	Mean difference = -0.15	Not available	Statistical significance not reported
High	Hazardous exposures observed in home	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	34 months	202 mothers	Adjusted mean = 0.23	Adjusted mean = 0.38	Mean difference = -0.15	Not available	Statistical significance not reported

Reductions in child maltreatment
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Number of emergency department visits for injuries/ingestions (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 0.47	Adjusted mean = 0.61	Mean difference = -0.14	Not available	Not statistically significant, p > 0.05	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	Number of injuries/ingestions in physician record (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	50 months	221 children	Adjusted mean = 0.34	Adjusted mean = 0.57	Mean difference = -0.23	Not available	Statistically significant, p ≤ 0.05	footnote1 Submitted by user on Fri, 03/15/2019 - 14:29 Statistical significance reported on authors’ calculations of the log-incidence difference.
High	New substantiated cases of abuse/neglect from 25 to 48 months	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy + infancy and comparison (Elmira)	48 months	253 children	% (adjusted) = 8.00	Adjusted mean % = 5.00	OR = 1.80	Study reported = 0.30	Not statistically significant p > 0.05	footnote7 Submitted by user on Fri, 03/15/2019 - 14:29 The <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> reversed the odds ratio from the study-reported calculation to reflect the odds of the treatment versus the control group.
High	New substantiated cases of abuse/neglect from 25 to 48 months	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	48 months	245 children	% (adjusted) = 4.00	Adjusted mean % = 5.00	Mean difference = -1.00	HomVEE calculated = -0.14	Statistical significance not reported
Moderate	Number of emergency department visits for injuries/ingestions (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 0.46	Adjusted mean = 0.61	Mean difference = -0.15	Not available	Statistical significance not reported
Moderate	Number of injuries/ingestions in physician record (25 to 50 months)	FavorableUnfavorable or ambiguousNo Effect	Nurse visited during pregnancy and comparison (Elmira)	50 months	209 children	Adjusted mean = 0.56	Adjusted mean = 0.57	Mean difference = -0.01	Not available	Statistical significance not reported