Browsing by Author "Goodman, W Benjamin"
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Item Open Access Birth Spacing and Child Maltreatment: Population-Level Estimates for North Carolina.(Child maltreatment, 2023-04) Rybińska, Anna; Bai, Yu; Goodman, W Benjamin; Dodge, Kenneth AWe examine population-level associations between birth spacing and child maltreatment using birth records and child welfare records for 1,099,230 second or higher parity children born in North Carolina between 1997 and 2013. Building upon previous research, administrative data linkages were used to address out-of-state migration and family-level heterogeneity in birth spacing and child maltreatment risk factors. Findings provide the strongest evidence to date that very short birth spacing of zero through 6 months from last birth to the index child's conception is a prenatal predictor of child maltreatment (indexed as child welfare involvement) throughout early childhood. Consequently, information about optimal family planning during the postpartum period should become a standard component of universal and targeted child maltreatment prevention programs. However, challenging previous empirical evidence, this study reports inconsistent results for benefits of additional spacing delay beyond 6 months with regard to child maltreatment risk reduction, especially for children of racial and ethnic minorities. These findings call for further inquiry about the mechanisms driving the connections between birth spacing and Child Protective Services assessments.Item Open Access Can typical US home visits affect infant attachment? Preliminary findings from a randomized trial of Healthy Families Durham.(Attach Hum Dev, 2017-12) Berlin, Lisa J; Martoccio, Tiffany L; Appleyard Carmody, Karen; Goodman, W Benjamin; O'Donnell, Karen; Williams, Janis; Murphy, Robert A; Dodge, Kenneth AUS government-funded early home visiting services are expanding significantly. The most widely implemented home visiting models target at-risk new mothers and their infants. Such home visiting programs typically aim to support infant-parent relationships; yet, such programs' effects on infant attachment quality per se are as yet untested. Given these programs' aims, and the crucial role of early attachments in human development, it is important to understand attachment processes in home visited families. The current, preliminary study examined 94 high-risk mother-infant dyads participating in a randomized evaluation of the Healthy Families Durham (HFD) home visiting program. We tested (a) infant attachment security and disorganization as predictors of toddler behavior problems and (b) program effects on attachment security and disorganization. We found that (a) infant attachment disorganization (but not security) predicted toddler behavior problems and (b) participation in HFD did not significantly affect infant attachment security or disorganization. Findings are discussed in terms of the potential for attachment-specific interventions to enhance the typical array of home visiting services.Item Open Access Effect of a Community Agency-Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial.(JAMA network open, 2019-11) Dodge, Kenneth A; Goodman, W Benjamin; Bai, Yu; O'Donnell, Karen; Murphy, Robert AImportance:Postnatal home visitation to support parenting and infant healthy development is becoming increasingly common based on university efficacy studies, but effectiveness when disseminated by communities is not clear. Objective:To test implementation and impact of the Family Connects (FC) program when administered by a community agency. Design, Setting, and Participants:In this randomized clinical trial, births were randomly assigned to receive FC or treatment as usual. Independent evaluation was conducted through parent interviews and review of health and child protective services records. Interviewers were blind to the experimental condition of participants, and participants were blind about the purpose of the interview as an intervention evaluation. A total of 936 consecutive residential births at Duke University Hospital from January 1, 2014, through June 30, 2014, were included. Data were analyzed preliminarily for reporting to funders in early 2015 before all birth-record covariates were scored and were analyzed more comprehensively in mid-2019 after administrative birth and child protective service records became available. Interventions:The goals of the FC brief universal program were to assess family-specific needs, complete brief interventions, and connect families with community resources. Community agencies and families were aligned through an electronic data system. Main Outcomes and Measures:Case records documented program penetration and quality. The primary outcome was child protective services investigations for maltreatment. Secondary outcomes were the number of sustained community connections, maternal mental health, parenting behavior, infant well-child care visits and maternal postpartum care compliance, and emergency health care utilization. Results:Of 936 births, 451 infants (48.2%) were female and 433 (46.3%) were from racial/ethnic minority groups. In all, 456 births (46.5%) were randomized to the intervention and 480 (53.5%) were randomized to the control. All analyses were based on intention to treat. The impact analysis included 158 intervention families and 158 control families. Intervention penetration was 76%, adherence to the protocol was 90%, and independent agreement in scoring (κ) was 0.75. Nurses identified and addressed minor problems for 52% of families and connected an additional 42% to community resources. Analysis of the primary outcome of child abuse investigations revealed a mean (SD) of 0.10 (0.30) investigations for the intervention group vs 0.18 (0.56) investigations for the control group (b = -0.09; 90% CI, -0.01 to -0.12; 95% CI, -0.18 to 0.01; P = .07). The intervention group's rate of possible maternal anxiety or depression was 18.2% vs 25.9% for the control group (b = -7.70; 90% CI, -15.2 to -0.1; 95% CI, -16.6 to 1.3; P = .09). Conclusions and Relevance:This study indicates that a nurse home visitation program for families of newborns can be implemented by a community agency with high penetration and quality. Other communities could benefit from wider dissemination of the program provided that quality remains strong and evaluation continues. Trial Registration:ClinicalTrials.gov identifier: NCT01843036.Item Open Access Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial.(JAMA network open, 2021-07) Goodman, W Benjamin; Dodge, Kenneth A; Bai, Yu; Murphy, Robert A; O'Donnell, KarenImportance
The Family Connects (FC) program, a community-wide nurse home visiting program for newborns, has been shown to provide benefits for children and families through the first 2 years of life. Potential longer-term outcomes for child well-being remain unknown.Objective
To determine the effect of randomization to FC on child maltreatment investigations and emergency medical care through 5 years of age.Design, setting, and participants
In this randomized clinical trial, families of all 4777 resident births in Durham County, North Carolina, from July 1, 2009, to December 31, 2010, were randomly assigned to receive the FC program or treatment as usual. Impact evaluation was on an intent-to-treat basis and focused on a subsample of 549 families randomly selected from the full population and included review of hospital and Child Protective Services (CPS) administrative records. Statistical analysis was conducted from November 6, 2020, to April 25, 2021.Interventions
The FC programs includes 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs, deliver education and intervention, and connect families with community resources matched to their needs. Ongoing program engagement with service professionals and an electronic resource directory facilitate effective family connections to the community.Main outcomes and measures
Two primary trial outcomes were CPS-recorded child maltreatment investigations and emergency medical care use based on hospital records.Results
Of the 4777 randomized families, 2327 were allocated to the intervention, and 2440 were allocated to services as usual. Among the children in the full study population, 2380 (49.8%) were female, 2397 (50.2%) were male, and 3359 (70.3%) were from racial/ethnic minority groups; of the 531 children included in the impact evaluation follow-up, 284 (53.5%) were female, 247 (46.5%) were male, and 390 (73.4%) were from racial/ethnic minority groups. Negative binomial models indicated that families assigned to FC had 39% fewer CPS investigations for suspected child maltreatment through 5 years of age (95% CI, -0.80 to 0.06; 90% CI, -0.73 to -0.01; control = 44 total investigations per 100 children and intervention = 27 total investigations per 100 children); intervention effects did not differ across subgroups. Families assigned to FC also had 33% less total child emergency medical care use (95% CI, -0.59 to -0.14; 90% CI, -0.55 to -0.18; control = 338 visits and overnight hospital stays per 100 children and intervention = 227 visits and overnight hospital stays per 100 children). Positive effects held across birth risk, child health insurance, child sex, single-parent status, and racial/ethnic groups. Effects were larger for nonminority families compared with minority families.Conclusions and relevance
The findings of this randomized clinical trial suggest that, when implemented with high quality and broad reach, a brief postpartum nurse home visiting program can reduce population rates of child maltreatment and emergency medical care use in early childhood.Trial registration
ClinicalTrials.gov Identifier: NCT01406184.Item Open Access Evaluation of a Family Connects Dissemination to Four High-Poverty Rural Counties.(Maternal and child health journal, 2022-05) Goodman, W Benjamin; Dodge, Kenneth A; Bai, Yu; Murphy, Robert A; O'Donnell, KarenObjectives
Home visiting is a popular approach to improving the health and well-being of families with infants and young children in the United States; but, to date, no home visiting program has achieved population impact for families in rural communities. The current report includes evaluation results from the dissemination of a brief, universal postpartum home visiting program to four high-poverty rural counties.Methods
The study utilized a quasi-experimental design. From Sept. 1, 2014-Dec. 31, 2015, families of all 994 resident births in four rural eastern North Carolina counties were assigned to receive Family Connects (FC; intervention group). A representative subsample of families participated in impact evaluation when the infants were 6 months old: 392 intervention group families and 126 families with infants born between Feb. 1, 2014-July 31, 2014 (natural comparison group). Data were analyzed preliminarily for reporting to funders in 2016 and, more comprehensively, using propensity score matching in 2020.Results
Of FC-eligible families, 78% initiated participation; 83% of participating families completed the program (net completion = 65%). At age 6 months, intervention parents reported more community connections, more frequent use of community services, greater social support, and greater success with infants sleeping on their backs. Intervention infants had fewer total emergency department and urgent care visits. Intervention parents had more total emergency department and urgent care visits and (marginally) fewer overnights in the hospital.Conclusions for practice
FC can be implemented successfully in high-poverty rural communities with broad reach and positive benefits for infants and families.Item Open Access Home Visiting Services During the COVID-19 Pandemic: Program Activity Analysis for Family Connects.(Maternal and child health journal, 2022-01-10) Rybińska, Anna; Best, Debra L; Goodman, W Benjamin; Weindling, Winona; Dodge, Kenneth APurpose
Early reports highlighted challenges in delivering home visiting programs virtually during the COVID-19 pandemic but the extent of the changes in program implementation and their implications remains unknown. We examine program activity and families' perceptions of virtual home visiting during the first nine months of the pandemic using implementation data for Family Connects (FC), an evidence-based and MIECHV-eligible, postpartum nurse home visiting program.Description
Aggregate program implementation data for five FC sites for January-November of 2019 and 2020 are compared. The COVID-19 Modification Survey is used to analyze families' reactions to virtual program delivery.Assessment
Post-pandemic onset, FC's program completion rates amounted to 86% of the pre-pandemic activity level. Activity in key components of the intervention-home-visitor education and referrals to community agencies-was maintained at 98% and 87% of the pre-pandemic level respectively. However, education and referrals rates declined among families of color and low-income families. Finally, families reported a positive response to the program, with declines in feelings of isolation and increases in positive attitudes toward in-person medical care-seeking due to FC visits.Conclusions
During the first nine months of the COVID-19 pandemic, families' interest in home visiting remained strong, performance metrics were maintained at high levels, and families responded positively to the virtual delivery of home visiting. Home visiting programs should continue implementation with virtual modifications during the remainder of the pandemic but attention is needed to address growing disparities in access to home visiting benefits among marginalized communities.Item Open Access Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomised controlled trials and a field quasi-experiment.(Lancet regional health. Americas, 2022-11) Dodge, Kenneth A; Goodman, W Benjamin; Bai, Yu; Best, Debra L; Rehder, Peter; Hill, SherikaBackground
Public health interventions must become accountable for reduction of race disparities, particularly among Black, Hispanic, and Non-Hispanic White families in the United States. Family Connects (FC) is a universal perinatal home-visiting program that assesses family-specific needs, offers support, and provides connections to community resources to address identified needs. Two previously-published randomised controlled trials and a field quasi-experiment have shown positive impact on maternal mental health, infant emergency medical care utilization, and government investigations for child maltreatment; however, these reports have not tested impact on reducing race disparities in these outcomes. The current report examined three questions in these trials: 1) the extent of race disparities in maternal and infant health and well-being, absent intervention; 2) whether intervention can be implemented with high reach and fidelity among all race groups; and 3) whether assignment to intervention reduces race disparities in important outcomes.Methods
Data were re-examined from: 1) a randomised controlled trial of 4777 birthing families in Durham, NC, USA; 2) a replication randomised controlled trial of 923 birthing families in Durham, NC, USA; and 3) a quasi-experiment of 988 birthing families in rural NC, USA. Families were classified as Black, Hispanic, Non-Hispanic White, or Other. Disparity reduction was tested by the interaction effect between treatment assignment and race.Findings
1) In the absence of intervention, large and statistically significant differences between Black familes and Non-Hispanic White families were found in maternal anxiety, maternal depression, father non-support, child emergency medical care, and child maltreatment investigations. Few differences were found between Non-Hispanic White familes and Hispanic families.2) High rates of participation in treatment were found for each race group.3) Across studies, assignment to FC was associated with statistically significant reductions in 7 of 12 disparities, in maternal anxiety and depression, father non-support, infant emergency medical care, and child maltreatment investigations.Interpretation
This study provides a method, metric, and mandate to prioritise testing of whether public health interventions reduce race disparities in family outcomes.Funding
This research was supported by grant R01HD069981 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and a grant from The Duke Endowment.Item Open Access Moving Beyond Program to Population Impact: Toward a Universal Early Childhood System of Care(Journal of Family Theory and Review, 2018-01-01) Goodman, W Benjamin; O'Donnell, Karen; Murphy, Robert A; Dodge, Kenneth A© 2018 National Council on Family Relations Families have clearly benefited from increased availability of evidence-based intervention, including home-visiting models and increased federal funding for programs benefiting parents and children. The goal of population-level impact on the health and well-being of infants and young children across entire communities, however, remains elusive. New approaches are needed to move beyond scaling of individual programs toward an integrated system of care in early childhood. To advance this goal, the current article provides a framework for developing an early childhood system of care that pairs a top-down goal for the alignment of services with a bottom-up goal of identifying and addressing needs of all families throughout early childhood. Further, we describe how universal newborn home visiting can be utilized to both support alignment of, and family entry into, an early childhood system of care with broad reach, high quality, and evidence of population impact for families and children.Item Open Access Nonstandard Work Schedules, Perceived Family Well-Being, and Daily Stressors.(J Marriage Fam, 2008-11) Davis, Kelly D; Goodman, W Benjamin; Pirretti, Amy E; Almeida, David MData from two studies assessed the effects of nonstandard work schedules on perceived family well-being and daily stressors. Study 1, using a sample of employed, married adults aged 25 - 74 (n = 1,166) from the National Survey of Midlife in the United States, showed that night work was associated with perceptions of greater marital instability, negative family-work, and work-family spillover than weekend or daytime work. In Study 2, with a subsample of adults (n = 458) who participated in the National Study of Daily Experiences, weekend workers reported more daily work stressors than weekday workers. Several sociodemographic variables were tested as moderators. Both studies demonstrated that nonstandard work schedules place a strain on working, married adults at the global and daily level.Item Open Access Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months(Development and Psychopathology) Goodman, W Benjamin; Dodge, Kenneth A; Bai, Yu; O'Donnell, Karen J; Murphy, Robert AAbstractOne of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.Item Open Access Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care.(Pediatrics, 2013-11) Dodge, Kenneth A; Goodman, W Benjamin; Murphy, Robert A; O'Donnell, Karen; Sato, JeannineBACKGROUND AND OBJECTIVES: Although nurse home visiting has proven efficacious with small samples, scaling up to community populations with diverse families has not yet proven effective. The Durham Connects program was developed in collaboration with community leaders as a brief, universal, postnatal nurse home visiting intervention designed to screen for risk, provide brief intervention, and connect families with more intensive evidence-based services as needed. This study tested program effectiveness in reducing infant emergency medical care between birth and age 12 months. METHODS: All 4777 resident births in Durham, North Carolina across 18 months were randomly assigned, with even birth date families to intervention and odd birth date families to control. Intervention families were offered 3 to 7 contacts between 3 and 12 weeks after birth to assess family needs and connect parents with community resources to improve infant health and well-being. Hospital records were analyzed by using an intent-to-treat design to evaluate impact among a representative subset of 549 families. RESULTS: After demographic factors (ie, birth risk, Medicaid status, ethnicity, and single parenthood) were covaried, relative to control families, families assigned to intervention had 50% less total emergency medical care use (mean [M] emergency department visits and hospital overnights) (M(intervention) = 0.78 and M(control) = 1.57; P < .001, effect size = 0.28) across the first 12 months of life. CONCLUSIONS: This brief, universal, postnatal nurse home visiting program improves population-level infant health care outcomes for the first 12 months of life. Nurse home visiting can be implemented universally at high fidelity with positive impacts on infant emergency health care that are similar to those of longer, more intensive home visiting programs. This approach offers a novel solution to the paradox of targeting by offering individually tailored intervention while achieving population-level impact.Item Open Access The effects of a universal short-term home visiting program: Two-year impact on parenting behavior and parent mental health.(Child abuse & neglect, 2023-06) Baziyants, Gayane A; Dodge, Kenneth A; Bai, Yu; Goodman, W Benjamin; O'Donnell, Karen; Murphy, Robert ABackground
At the time of childbirth, families face heightened levels of unmet need. These needs, if left unmet, can lead parents to engage in less positive parenting practices, which in turn, increase the risk of child maltreatment. Family Connects (FC) is a universal postnatal nurse home-visiting program designed to prevent child maltreatment by supporting all families in a community through one to three visits to improve parent mental health and parenting behaviors. A randomized controlled trial of FC demonstrated improving positive parenting and reducing postpartum depression through age 6 months.Objective
To determine sustained (2-year) impact of random assignment to FC on parenting behavior and parent mental health and identify heterogeneity of effects.Participants and setting
A representative subsample of 496 families that had been randomized to FC (255 treatment; 241 control) of infants born between July 1, 2009, and December 31, 2010, in Durham County, North Carolina.Methods
Demographic characteristics were collected through hospital discharge data. Treatment-blinded interviewers collected maternal reports of parenting behavior and mental health at infant age two years. Moderation and subgroup analyses were conducted to estimate heterogeneity in impact of FC.Results
Mothers assigned to FC engaged in more self-reported positive parenting relative to control mothers (B = 0.21; p < 0.05). Hispanic mothers assigned to FC reported greater sense of parenting competence (B = 1.28; p < 0.05). No significant main effect differences were identified for negative parenting, maternal depression, or father involvement.Conclusions
Assignment to FC was associated with improvements in population-level self-reported scores of positive parenting 2 years post-intervention.Item Open Access The O*Net jobs classification system: A primer for family researchers(FAMILY RELATIONS, 2006-10) Crouter, Ann C; Lanza, Stephanie T; Pirretti, Amy; Goodman, W Benjamin; Neebe, Eloise; Key Family Life Project InvestigatorsItem Open Access Toward Population Impact from Home Visiting.(Zero Three, 2013-01-01) Dodge, Kenneth A; Goodman, W Benjamin; Murphy, Robert; O'Donnell, Karen; Sato, JeannineAlthough some home-visiting programs have proven effective with the families they serve, no program has yet demonstrated an impact at the population level. We describe the Durham Connects (DC) initiative, which aims to achieve population impact by coalescing community agencies to serve early-intervention goals through a Preventive System Of Care and by delivering a universal, short-term, postnatal nurse home-visiting program. The home-visitor delivers brief intervention, assesses family needs in 12 domains, and connects the family with community resources to address individualized family needs. Evaluation of DC occurred through a population randomized controlled trial of all 4,777 births in Durham, NC, over an 18-month period. DC was implemented with high penetration and high fidelity. Impact evaluation indicated that by age 6 months, DC infants had 18 percent fewer emergency room visits and 80 percent fewer overnights in the hospital than did control families. We conclude that population impact is achievable if a program attends to challenges of community partnership, universal reach and assessment, rigorous evaluation, and models for sustaining funding.Item Open Access Transitioning to virtual interaction during the COVID-19 pandemic: Impact on the family connects postpartum home visiting program activity.(Infant mental health journal, 2022-01-08) Rybińska, Anna; Best, Debra L; Goodman, W Benjamin; Bai, Yu; Dodge, Kenneth AIn this paper, we analyze program activity for Family Connects (FC), an evidence-based postpartum home-visiting intervention, during the COVID-19 pandemic. When the pandemic began, FC transitioned to a virtual protocol which maintains key psychosocial components of the in-person protocol and adjusts health assessments to address the lack of in-person contact. Program performance is contrasted for periods before the pandemic onset (April 2019-March 2020) and after the onset (April 2020-March 2021), involving 10,280 scheduled visits and 6696 visited families (46% non-Hispanic white; 20% non-Hispanic Black; 23% Hispanic; and 10% other race). Post-pandemic onset, FC program participation rates were at 89.8% of pre-pandemic levels. Home visitors observed post-onset increases in families' concerns about home safety but declines in families' needs related to infant care. Community connections were facilitated for 42.9% of visited families post-pandemic onset compared to 51.1% pre-pandemic onset. We conclude that post-pandemic onset virtual delivery rates of FC declined but are high enough to merit continued implementation during a period when some families will decline in-person visits. When in-person visits are deemed safe per public health guidelines, the findings suggest a hybrid approach that could maximize program outreach by prioritizing in-person contact and offering virtual delivery as a second choice.