Three new studies highlight the value of home visits by nurses in pregnancy and throughout infancy.
Dr. Harriet Kitzman and her team of the University of Rochester in New York looked at the effect of prenatal and infancy home visits by nurses on children’s later substance abuse, behavioral problems, and academic achievement.
They analyzed figures from over 630 12-year-old firstborn children of mothers who were primarily African-American and economically disadvantaged. Mothers were randomly assigned to receive either home visits during pregnancy and until their child turned 2 years old, or normal care in pregnancy as well as developmental screening and referral for the children, but not home visits.
The researchers found that “through age 12, the program reduced children’s use of substances and internalizing mental health problems, and improved the academic achievement of children born to mothers with low psychological resources.”
Children who were visited by nurses reported significantly fewer days of having used cigarettes, alcohol, and marijuana in the month before the interview. These children were also less likely to report having “internalizing disorders,” such as such as phobia, depression, panic disorder, and other anxiety disorders, that met the borderline or clinical threshold.
The group of nurse-visited children scored significantly higher on achievement tests in reading and math. Full results are published in Archives of Pediatrics & Adolescent Medicine.
The second study was carried out by Dr. David Olds of the University of Colorado and colleagues. Using the same group of mothers, they examined partner relationships, fertility, economic self-sufficiency and government spending on the families, by the time the firstborn child was 12 years old.
Mothers who had received nurse visits at home had less “role impairment due to substance use” (0 percent compared with 2.5 percent), longer partner relationships (59.6 months vs. 52.6 months) and “a greater sense of mastery” in their parenting.
They also received less support through government (food stamps, Medicaid, Aid to Families with Dependent Children and Temporary Assistance for Needy Families), making the cost of the visits financially worthwhile. Nevertheless, the nurse visits did not appear to improve the likelihood of the mother cohabiting with the child’s biological father, or reduce their risk of intimate partner violence.
The researchers write, “In general, these findings support the effectiveness of the Nurse-Family Partnership (the program providing the nurse visits). The partnership offers a means of reducing government spending and family poverty, improving children’s health and development, and grounded policies.”
The third study involved 310 girls from families enrolled in a nurse-family partnership program in a semi-rural community in New York. Again, families randomly received either approximately 32 home visits during pregnancy and from birth to the child’s second birthday.
When the girls reached 19 years of age, they were interviewed about educational achievement, sexual behaviors and pregnancy, welfare use, and criminal involvement. Girls who had received the nurse visits were 67 percent less likely to have been arrested (ten percent of the group versus 30 percent).
They were significantly less likely to be convicted if they were arrested, and had fewer arrests and convictions. They tended to have fewer pregnancies and less Medicaid use than the unvisited girls. This study also looked at the effect on boys, but no beneficial outcomes were found.
The researchers conclude, “Prenatal and infancy home visitation reduced the proportion of girls entering the criminal justice system. For girls born to high-risk mothers, there were additional positive program effects consistent with results from earlier phases of this trial.”
Previous results from the same team indicate that nurse-visited children show higher intellectual functioning and better vocabulary scores. Nurse-visited children born to mothers with psychological problems exhibit less aggression. Overall, the children are better prepared to enter school.
Dr. Kitzman says, “These visits are intense and comprehensive. Over two decades, we’ve refined the program to make sure we’re addressing the vital needs of these women and their families. Our research is showing lasting effects on their lives. The investment that society can make at this critical stage in a woman’s life pays off over the long run in many ways having to do not only with care of the children but also with the woman’s potential for economic self-sufficiency and the stability in her relationships.”
Lessons from this research have become the founding principles behind the Nurse-Family Partnership, a national organization that pairs up registered nurses with low-income pregnant women. Nurses guide participants toward healthy pregnancies, coach them in child development, and help them make decisions about work and family.
“Many visits center on helping the women envision the future and to set goals for themselves,” says Kitzman. “The nurse became the person to help the mother see the opportunities, and to develop the resources and skills to take advantage of them.”
Kitzman, H. J. et al. Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Children: Follow-up of a Randomized Trial Among Children at Age 12 Years. Archives of Pediatrics & Adolescent Medicine, Vol. 164, May 2010, pp. 412-18.
Olds, D. L. et al. Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Maternal Life Course and Government Spending: Follow-up of a Randomized Trial Among Children at Age 12 Years. Archives of Pediatrics & Adolescent Medicine, Vol. 164, May 2010, pp. 419-24.
Eckenrode, J. et al. Long-term Effects of Prenatal and Infancy Nurse Home Visitation on the Life Course of Youths: 19-Year Follow-up of a Randomized Trial. Archives of Pediatrics & Adolescent Medicine, Vol. 164, May 2010, pp. 9-15.