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.
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2022-11
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Abstract
Background
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.Type
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Dodge, Kenneth A, W Benjamin Goodman, Yu Bai, Debra L Best, Peter Rehder and Sherika Hill (2022). 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, 15. p. 100356. 10.1016/j.lana.2022.100356 Retrieved from https://hdl.handle.net/10161/27406.
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Ben Goodman
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
- Ph.D. The Pennsylvania State University - 2009
Yu Bai
Debra Lynn Best
The tenets of advocacy have been intentionally woven into my work in all domains from clinical service to education to scholarship. Defined broadly by Earnest, et.al., advocacy is “activity that promotes the social, economic, educational, and political changes that ameliorate threats to human health and advance the well-being of people”. Under that umbrella, the foci that I have pursued through the years have been varied, ranging from childhood obesity prevention to teen parenting to universal newborn home visiting. Currently, my area of focus is in supporting early relational health and social emotional development. Throughout each endeavor, I have focused on lifting the voices of those in marginalized populations and intentionally partnering with the community to provide holistic approaches to meet both medical and psychosocial needs of individuals.
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