Preventing maltreatment and promoting healthy infant development with high-risk maternal and child populations: An effectiveness study of nurse home visiting

Project: Research project


Maltreatment in the first years of life can disrupt a child’s physical, emotional, and cognitive development. Childhood abuse and neglect have been linked with health disparities that persist into adulthood. Optimal child development requires a safe environment and stable, nurturing caregiving relationships. Home-visiting programs targeted to early childhood offer a promising approach to preventing maltreatment by helping parents develop positive caregiving relationships. The most encouraging results come from nurse home-visiting models that provide education and support to expectant and new mothers. Although maltreatment prevention has been identified as the “bottom-line benefit” of home visiting, results have been modest and mixed. A recent systematic review of the efficacy of home-visiting interventions concluded the primary gap in the field was the limited available evidence showing program effectiveness. This proposal addresses this evidence gap by conducting a quasi-experimental study of an established but understudied community-based program, Nurses for Newborns (NFN). Home-visiting models vary widely across target populations, timing, and intensity of services, making it unlikely that a single program can adequately serve all families. Therefore, it is critical to determine under what conditions and for whom a given program is most effective. This study compares outcomes across high-risk subgroups and different levels of service intensity. The aims of this study align with the objectives of Healthy People 2020 to reduce child maltreatment (IVP-38) and to use health professionals to promote positive parenting in early childhood (EMC-2); the study aims are also consistent with Maternal and Child Health Bureau Strategic Research Issues 2 and 4, which seek to eliminate health disparities and to improve healthy child development. In Aim 1, the health outcomes of children served by NFN are compared with outcomes on non-NFN served children on rates of injury, preventable hospitalizations, and health care use related to maltreatment. All children in the study were insured by Medicaid and were born in the same geographic region. To control for other between-group differences that could affect outcomes, this study uses propensity score matching to balance the groups on observed covariates. Multivariate survival analysis (Cox regression) and generalized mixed modeling are used to compare risk for and counts of adverse health outcomes occurring from birth to age 3 years. NFN is unique among home-visiting programs in that it purposefully includes diverse high-risk families often excluded from other programs even though they face greater risk of maltreatment. Aim 2 examines outcomes for 4 underserved policy-relevant subgroups: medically fragile newborns; families in rural areas; mothers with multiple children; and mothers with mental health/substance-abuse problems. Aim 3 seeks to understand the impact of service dose and timing on outcomes. Learning from innovative community-based models provides a promising approach to effective maltreatment prevention to improve child health.
Effective start/end date4/1/143/31/16


  • HRSA Maternal and Child Health Bureau


Community Health Nurses
Child Development
Newborn Infant
Outcome Assessment (Health Care)
Propensity Score
Health Services Needs and Demand
Child Abuse
Program Evaluation
Survival Analysis
Substance-Related Disorders
Mental Health
Multivariate Analysis