Positive Effects in Children After Home Visits by Nurses, Paraprofessionals


Home visits by nurses and paraprofessionals to children of low-income women had some positive benefits for the children on cognitive and behavioral measures, according to the results of a clinical trial published by JAMA Pediatrics, a JAMA Network publication.

Home visits by nurses to low-income families have been promoted as one strategy to improve health and development outcomes for first-born children from those families, according to the study background.

David L. Olds, Ph.D., of the University of Colorado Denver, and colleagues did follow-up on a randomized trial in Denver that included 735 low-income women, most of them unmarried, and their first-born children as part of the Nurse-Family Partnership (NFP), a program that has been conducted in other cities. The goals of the NFP are to improve outcomes of pregnancy by helping women improve their health-related behavior, improve their children’s subsequent health and development by helping parents provide competent care, and enhancing a mother’s personal development by promoting the planning of future pregnancies. The Denver trial was meant to test the program model when it is delivered by paraprofessionals, who were required to have a high school education and no college preparation in the helping professions and who also shared many of the same social characteristics as the families they visited.

Women were divided into three treatment groups: the first group (n=255) received free developmental screening and referral for their child, the second group (n=245) received the screening plus a paraprofessional home visit during pregnancy and the child’s first two years of life, and the third group (n=235)  were provided the screening plus a nurse home visit during pregnancy and the child’s first two years of life.

Researchers found that children born to mothers with low psychological resources but visited by paraprofessionals showed fewer errors in visual attention/task switching at age 9 years. Children visited by nurses were less likely to be classified as having total emotional/behavioral problems at age 6 years, internalizing problems at age 9 years, and dysfunctional attention at age 9 years. Nurse-visited children born to low-resource mothers also had better receptive language and sustained attention averaged over time.

“As the NFP is replicated and tested in new randomized clinical trials throughout the United States and other societies, it will be important to determine whether it is particularly successful in reducing disparities in health, achievement and economic productivity among children born to mothers who have limited psychological resources and who are living in severely disadvantaged neighborhoods, as this will enable policy makers to focus NFP resources where they produce the greatest benefit,” the authors conclude.

(JAMA Pediatr. Published online November 25, 2013. doi:10.1001/jamapediatrics.2013.3817.