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The Prenatal and Early Childhood Nurse Home Visitation Program

Program
Program

David Olds, Ph.D.
(Contact) Ruth A. O'Brien, Ph.D., RN
Kempe Prevention Research Ctr. for Family & Child Health
1825 Marion Street
Denver, CO 80218

(303) 864-5210         Fax: (303) 864-5236
obrien.ruth@tchden.org

Family In-HomeSupport Speciality
0-5 years Target
Exemplary II Rating
 
Description

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.

Description


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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