Early detection of parenting and developmental problems in toddlers: A randomized trial of home visits versus well-baby clinic visits in the Netherlands.

Staal II, van Stel HF, Hermanns JM, Schrijvers AJ.

Prev Med. 2015 Dec;81:236-42. doi:10.1016/j.ypmed.2015.09.003. Epub 2015 Sep 12.


OBJECTIVE: The early detection of parenting and developmental problems by preventive child health care (CHC) services in the Netherlands takes place almost exclusively at the well-baby clinic. This study assesses whether, compared to a visit to the well-baby clinic, a home visit improves early detection.

METHODS: 4481 eligible 18-month-old children and their parents were randomized to either a visit to the well-baby clinic or a home visit in the period from December 2006 to January 2008. A CHC nurse held structured interviews using the validated Structured Problem Analysis of Raising Kids (SPARK). Differences in the percentage of children with high or increased risks of parenting and developmental problems as assessed by the SPARK were analyzed with ordinal regression. Secondary outcomes included the percentage of parents attending, parents' concerns, needs assessment by parents and CHC professionals and user experience.

RESULTS: Response rates were 94.0% for the home visit group and 93.2% for the well-baby clinic group. Using the SPARK at home identified significantly more high-risk children compared to clinic visits (3.7 vs. 2.6%) and fewer children with increased risk (19.1 vs. 20.7%; overall p=0.028). Home visits more often involved both parents and other children. At home, parents reported more concerns. Both parents and CHC nurses more often expressed the need for support and reported significantly better experiences at home.

CONCLUSIONS: Aided by a validated structured interview, CHC professionals detect more children with high risks of parenting and child-developmental problems during home visits than during clinic visits.

CLINICAL TRIAL REGISTRATION: www.trialregister.nl Identifier: NTR1413.

Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial.

Olds DL, Kitzman H, Knudtson MD, et al. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. 2014 Sep 1;168(9):800-6. doi: 10.1001/jamapediatrics.2014.472. (Original) PMID: 25003802

IMPORTANCE: Mothers and children living in adverse contexts are at risk of premature death.

OBJECTIVE: To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011).

DESIGN, SETTING AND

PARTICIPANTS: A randomized clinical trial was designed originally to assess the home visiting program`s effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obstetric and pediatric care in Memphis, Tennessee. Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods, who were assigned to 1 of 4 treatment groups: treatment 1 (transportation for prenatal care [n = 166]), treatment 2 (transportation plus developmental screening for infants and toddlers [n = 514]), treatment 3 (transportation plus prenatal/postpartum home visiting [n = 230]), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visiting [n = 228]). Treatments 1 and 3 were included originally to increase statistical power for testing pregnancy outcomes. For determining mortality, background information was available for all 1138 mothers assigned to all 4 treatments and all but 2 live-born children in treatments 2 and 4 (n = 704). Inclusion of children in treatments 1 and 3 was not possible because background information was missing on too many children.

INTERVENTIONS: Nurses sought to improve the outcomes of pregnancy, children`s health and development, and mothers` health and life-course with home visits beginning during pregnancy and continuing through child age 2 years. MAIN OUTCOMES AND MEASURES: All-cause mortality in mothers and preventable-cause mortality in children (sudden infant death syndrome, unintentional injury, and homicide) derived from the National Death Index.

RESULTS: The mean (SE) 21-year maternal all-cause mortality rate was 3.7% (0.74%) in the combined control group (treatments 1 and 2), 0.4% (0.43%) in treatment 3, and 2.2% (0.97%) in treatment 4. The survival contrast of treatments 1 and 2 combined with treatment 3 was significant (P = .007); the contrast of treatments 1 and 2 combined with treatment 4 was not significant (P = .19), and the contrast of treatments 1 and 2 combined with treatments 3 and 4 combined was significant (post hoc P = .008). At child age 20 years, the preventable-cause child mortality rate was 1.6% (0.57%) in treatment 2 and 0.0% (SE not calculable) in treatment 4; the survival contrast was significant (P = .04). CONCLUSIONS AND RELEVANCE: Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings.

Home visiting and outcomes of preterm infants: a systematic review.

Pediatrics. 2013 Sep;132(3):502-16. doi: 10.1542/peds.2013-0077. Epub 2013 Aug12.
Goyal NK, Teeters A, Ammerman RT.

BACKGROUND AND OBJECTIVES: Home visiting is 1 strategy to improve child health
and parenting. Since implementation of home visiting trials 2 decades ago, US
preterm births (<37 weeks) have risen by 20%. The objective of this study was to 
review evidence regarding home visiting and outcomes of preterm infants
METHODS: Searches of Medline, Cumulative Index to Nursing and Allied Health
Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial
Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1)
cohort or controlled trial designs; (2) home-based, preventive services for
infants at medical or social risk; and (3) outcomes reported for infants born
preterm or low birth weight (<2500 g). Data from eligible reports were abstracted
by 2 reviewers. Random effects meta-analysis was used to synthesize data for
developmental and parent interaction measures.
RESULTS: Seventeen studies (15 controlled trials, 2 cohort studies) were
reviewed. Five outcome domains were identified: infant development, parent-infant
interaction, morbidity, abuse/neglect, and growth/nutrition. Six studies (n =
336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence
interval 0.57 to 1.02) in Home Observation for Measurement of the Environment
Inventory scores at 1 year in the home-visited groups versus control. Evidence
for other outcomes was limited. Methodological limitations were common.
CONCLUSIONS: Reviewed studies suggest that home visiting for preterm infants
promotes improved parent-infant interaction. Further study of interventions
targeting preterm infants within existing programs may strengthen the impact and 
cost benefits of home visiting in at-risk populations.