A program that sends nurses to visit economically disadvantaged, single mothers during pregnancy and for the child's first 2 years can have long-term benefits, recent data show.
The analysis, which was recently commissioned by the Washington state legislature, shows the largest cost savings of any home visit, child welfare, or early intervention program.
The home visitation program has been developed over 25 years and operates in 21 states and focuses on improving birth outcomes, parenting skills, and children's health and development. It also promotes economic self-sufficiency for families.
Each mother in the Nurse-Family Partnership develops a long-term relationship with one nurse who follows detailed guidelines and is trained in prenatal care and early child development.
The latest data, published in two articles in the journal Pediatrics, come from controlled, randomized trials that have been conducted in two settings: among low-income African American mothers in Memphis, and among an ethnically and racially diverse group of low-income women in Denver.
The women and children in Memphis were interviewed and evaluated 4 years after the program ended, near the child's sixth birthday. Those in Denver were evaluated 2 years after the program had ended.
“The effects of the program …increase the likelihood that nurse-visited children will adjust more effectively as they proceed through elementary school,” reported David L. Olds, Ph.D., of the department of pediatrics at the University of Colorado Health Sciences Center in Denver, and his associates (Pediatrics 2004;114:1550–9).
Of the 743 women in Memphis who were randomized to the nurse home visitation program or one of three other intervention groups, those enrolled in the nurse visitation program had fewer subsequent pregnancies and births (1 vs. 1.3 births), and longer intervals between births of their first and second children (34 vs. 30 months).
They also had longer relationships with their partners, used welfare and food stamps for fewer months, and were more likely to enroll their children in some form of preschool or licensed day care.
The children of these nurse-visited women had higher scores on tests of intellectual functioning and receptive language, and fewer behavioral problems in the borderline or clinical range (2% vs. 5%, based on the Achenbach Child Behavior Checklist).
Among children born to women with low psychological resources (limited intellectual functioning, mental health, and sense of control), those whose mothers met with the nurses had higher arithmetic achievement test scores and expressed less dysregulated aggression and incoherence when asked to respond to and finish story beginnings, the investigators said.
The program “is so effective [because] they've tested [and shown] the importance of using nurses instead of social workers,” said Steve Aos, associate director of the Washington State Institute for Public Policy, a nonpartisan organization that produced the analysis that is now gaining focus in Washington state.
“And especially since the program has gone national, Dr. Olds makes sure the program is done by the book. … [He appears to have] hit on a better theoretical model for intervention. But he's also a stickler for training and quality control,” Mr. Aos said.
Dr. Olds, who developed and has refined the program over the years, said he hopes to examine more the extent to which the program produces comparable effects across different populations.
Some effects—such as reductions in prenatal tobacco use and reductions in the rates and intervals of subsequent pregnancies—-seem to be fairly consistent. Other effects vary among populations.
The Denver data are particularly complex because that study involves a more diverse group of women who were enrolled in various public and private care settings, he noted.
The first trial of the program, which began about 20 years ago, involved low-income white families in rural New York. Researchers showing less alcohol use and better behavior among teenage children of nurse-visited mothers has been published, and the families are still being followed, Dr. Olds noted.
The evaluation done by Mr. Aos' organization at the request of the Washington state legislature showed that the Nurse-Family Partnership costs about $9,000 per family and had a record net benefit of more than $17,000 per child, in terms of welfare, criminal justice system, medical, and other cost savings.
Most of the 160 Nurse-Family Partnership programs across the country are administered through county health programs.
In the long term, however, “things will have to change—there just aren't enough funding streams,” said Matt Buhr-Vogel, manager of site development for the new Nurse-Family Partnership national office in Denver.
Hopefully, he said, the data suggesting improved school readiness will interest departments of education and other funders.