Effect of a Community Agency-Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial.
Abstract
Importance: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.
Type
Journal articleSubject
Science & TechnologyLife Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
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https://hdl.handle.net/10161/20388Published Version (Please cite this version)
10.1001/jamanetworkopen.2019.14522Publication Info
Dodge, Kenneth A; Goodman, W Benjamin; Bai, Yu; O'Donnell, Karen; & Murphy, Robert
A (2019). 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, 2(11). pp. e1914522. 10.1001/jamanetworkopen.2019.14522. Retrieved from https://hdl.handle.net/10161/20388.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Yu Bai
Statistician III
Kenneth A. Dodge
William McDougall Distinguished Professor of Public Policy Studies
Kenneth A. Dodge is the William McDougall Distinguished Professor of Public Policy
and Professor of Psychology and Neuroscience at Duke University. He is also the founding
and past director of the Center for Child and Family Policy, as well as the founder
of Family Connects International.
Dodge is a leading scholar in the development and prevention of aggressive and violent
beha
Ben Goodman
Research Scientist
Ben Goodman is a research scientist at the Center for Child and Family Policy. His
research interests focus broadly on the implementation and evaluation of population-based
interventions to reduce child maltreatment and improve parent and child health and
well-being, including the evidence-based Family Connects postpartum nurse home visiting
program. His research also examines how sources of stress and support shape the quality
of parent-child relationships, parents’ own well- being, an
Robert A. Murphy
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Murphy is a licensed clinical psychologist focused on child traumatic stress,
including its treatment and prevention and development and dissemination of evidence-based
interventions. He is an Associate Professor in the Department of Psychiatry and Behavioral
Sciences at Duke University School of Medicine. Dr. Murphy serves as Executive Director
for the Center for Child & Family Health (CCFH), a community and three university
partnership (Duke University, the University of North Carolina
Alphabetical list of authors with Scholars@Duke profiles.

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