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.

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Published Version (Please cite this version)

10.1016/j.lana.2022.100356

Publication Info

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.

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.

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
Best

Debra Lynn Best

Associate Professor of Pediatrics

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. 

Hill

Sherika N Hill

Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences

As a clinical epidemiologist, I conduct biopsychosocial research to better understand how social factors, biological mechanisms (epigenetics), or health outcomes relate to pediatric mental health and well-being. I am particularly interested in knowing the extent to which different developmental trajectories are driven by low socioeconomic status, rural geography, minority race/ethnicity, chronic childhood health conditions, or childhood maltreatment. 


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