Effect of a Community Agency-Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial.

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2019-11

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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.

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10.1001/jamanetworkopen.2019.14522

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Dodge, Kenneth A, W Benjamin Goodman, Yu Bai, Karen O'Donnell and Robert A Murphy (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). p. e1914522. 10.1001/jamanetworkopen.2019.14522 Retrieved from https://hdl.handle.net/10161/20388.

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Scholars@Duke

Dodge

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 behaviors. His work provides a model for understanding how some young children grow up to engage in aggression and violence and provides a framework for intervening early to prevent the costly consequences of violence for children and their communities.

Dodge joined the faculty of the Sanford School of Public Policy in September 1998. He is trained as a clinical and developmental psychologist, having earned his B.A. in psychology at Northwestern University in 1975 and his Ph.D. in psychology at Duke University in 1978. Prior to joining Duke, Dodge served on the faculty at Indiana University, the University of Colorado, and Vanderbilt University.

Dodge's research has resulted in the Family Connects Program, an evidence-based, population health approach to supporting families of newborn infants. Piloted in Durham, NC, and formerly known as Durham Connects, the program attempts to reach all families giving birth in a community to assess family needs, intervene where needed, and connect families to tailored community resources. Randomized trials indicate the program's success in improving family connections to the community, reducing maternal depression and anxiety, and preventing child abuse. The model is currently expanding to many communities across the U.S.

Dodge has published more than 500 scientific articles which have been cited more than 120,000 times.

Elected into the National Academy of Medicine in 2015, Dodge has received many honors and awards, including the following:

  • President (Elected), Society for Research in Child Development
  • Fellow, Society for Prevention Research
  • Distinguished Scientist, Child Mind Institute
  • Research Scientist Award from the National Institutes of Health
  • Distinguished Scientific Award for Early Career Contribution from the American Psychological Association
  • J.P. Scott Award for Lifetime Contribution to Aggression Research from the International Society for Research on Aggression
  • Science to Practice Award from the Society for Prevention Research
  • Inaugural recipient of the “Public Service Matters” Award from the Network of Schools of Public Policy, Affairs and Administration
  • Inaugural recipient of the Presidential Citation Award for Excellence in Research from the Society for Research on Adolescence
Goodman

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, and child development.

Research Interests:
  • Home Visiting
  • Child Maltreatment
  • Parenting
  • Program Evaluation
Education:
  • Ph.D. The Pennsylvania State University - 2009
Bai

Yu Bai

Statistician III
Murphy

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 at Chapel Hill, and North Carolina Central University) dedicated to research, training, and intervention related to child trauma and maltreatment. Interests include treatment and prevention of child maltreatment and traumatic stress, dissemination of evidence based interventions, and improving mental health care for military families. In partnership with the Duke Sanford School of Public Policy Center for Child and Family Policy, he has been active in the development and evaluation, via two randomized controlled trials, of a brief, postnatal, universal nurse home visiting program (Family Connects) that has demonstrated improved parenting and parental distress, as well as reduced emergency medical care costs and lower rates of reported child maltreatment. Since 2003, CCFH has been a community treatment and services center within the National Child Traumatic Stress Network focused on improving access to evidence based mental health care for foster care youth and developing trauma informed child welfare systems.


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