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The Prenatal and Early Childhood Nurse Home Visitation Program is a well-tested model
that improves the health and social functioning of low-income first-time mothers and their
babies. Nurse home visitors develop a supportive relationship with the mother and family
which emphasizes education, mutual goal setting, and the development of the parents' own
problem-solving skills and sense of self-efficacy. Beginning in pregnancy, the nurses help
women to improve their health behaviors related to substance abuse (smoking, drugs,
alcohol) and nutrition, significant risk factors for pre-term delivery, low birth weight, and
infant neuro-developmental impairment. After delivery, the emphasis is on enhancing
qualities of care-giving for infants and toddlers, thereby preventing child maltreatment,
childhood injuries, developmental delay, and behavioral problems. Among the mothers, the
program also focuses on preventing unintended subsequent pregnancies, school drop out,
and failure to find work resulting in ongoing welfare dependence - factors that conspire to
enmesh families in poverty and that increase the likelihood that women will have poor
subsequent pregnancies and increase the likelihood for sub-optimal care of children. In
order to achieve maximum outcomes in the preceding domains of functioning, nurses work to
improve environmental contexts by enhancing informal support and by linking families with
needed health and human services.
Using developmentally established protocols, nurses visit families as follows: (a) weekly
during the first month following enrollment, (b) every other week throughout the remainder of
the woman's pregnancy, (c) weekly for the first six weeks postpartum, (d) every other week
thereafter through the child's 21st month, and (e) then monthly until the child reaches age
two. Visit protocols focus on five domains of functioning: personal health, environmental
health, maternal role, maternal life course development, and family and friend support.
A summary of the major findings on maternal and child outcomes from two randomized
clinical trials show a 25% reduction in cigarette smoking during pregnancy among women,
who smoked cigarettes at registration; 25% reduction in the rates of hypertensive disorders
of pregnancy and less severe cases among those with the condition; 80% reduction in rates
of child maltreatment among at-risk families from birth through the child's second year; 56%
reduction in the rates of children's health-care encounters for injuries and ingestions from
birth through child's second birthday; 43% reduction in subsequent pregnancy among low-
income, unmarried women by first child's birthday; 83% increase in the rates of labor force
participation by first child's fourth birthday; 30-month reduction in AFDC utilization among
low-income, unmarried women by first child's 15th birthday.
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Implementation Costs:
During the three years of 1999-2001, the Prenatal and Early Childhood Nurse Home
Visitation Program will be made available to a limited number of sites for replication. This is
being done to afford an adequate opportunity to implement the model successfully in different
settings before seeking to promote its broader adoption. Information on how to apply to
become one of these sites is available upon request.
Replication sites are expected to commit to serving a minimum of 100 families for the full
program cycle (pregnancy through child's second birthday). A program for 100 families
requires four full-time nurses, a half-time nursing supervisor and a half-time clerical support
person. The cost to implement the program for 100 families is estimated at $780,000 for
three years (approximate time needed to enroll families in program and provide service
through child's second birthday); costs, however, may vary by region depending on
prevailing salaries for nursing personnel.
Training Costs:
Training includes: (a) prior to program implementation, a five-day intensive training in Denver
for nurses and supervisor in the program model, use of prenatal home visit guidelines, and
use of the program's Clinical Information System, (b) Four months after program
implementation begins, a three-day on-site training in use of the infancy home visit guidelines
and Partners in Parenting Education curriculum, and (c) as children in the program approach
one year of age, a two-day on-site training in use of the toddler home visit guidelines. On-
going technical assistance in clinical aspects of the program implementation and use of the
program's Clinical Information System to monitor program performance is provided
throughout the first full program cycle. Costs for training are $2,000 per person as well as
travel costs (airfare, hotel, per diem) for two trainers for on-site training workshops.
Purchase of home visit guidelines and Partners in Parenting Education curriculum materials
average about $525 per person. Sites must also arrange for nurses and supervisor to be
trained in method of assessing early infant development and parent-child interaction known
as the Nursing Child Assessment Satellite Training (NCAST) system if staff are not already
certified in these assessment procedures.
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