Prenatal, Infancy Home Visits Boost Achievement Into Early Adulthood
NEW YORK (Reuters Health) – Young adults whose mothers participated in a home-visit program during their pregnancy, infancy and toddlerhood have better language and math skills than children whose mothers didn’t participate, according to new findings.
“There’s a lot of interest these days in the role of early intervention in shaping the life course of children born into adversity, and the results of this trial show that children born into adverse circumstances can be helped to function better cognitively and academically by having nurses visit their mothers during pregnancy and during the early years of the child’s life,” Dr. David L. Olds of the University of Colorado, Anschutz Medical Campus in Aurora, told Reuters Health by phone.
“Part of these effects can be attributed to nurses helping mothers to gain control over their longer-term life circumstances by helping them to develop a vision for the future, continue their education, find work and, critically, plan the timing of subsequent pregnancies, because that positions them to gain traction in the world of work,” he added.
Dr. Olds and his colleagues developed the Nurse-Family Partnership (NFP), in which nurses visit low-income women having their first child from pregnancy through toddlerhood, and tested it in three randomized controlled trials in Elmira, New York; Memphis, Tennessee; and Denver, Colorado.
In two studies published online November 20 in Pediatrics, the authors followed up with 618 mothers and 629 children from the Memphis study site. At age 18, young people from the nurse visit group had better receptive language (effect size, 0.24; P=0.05) and math achievement (effect size, 0.38; P=0.002).
There was also a trend toward female children having fewer convictions than those in the control group.
Public benefit costs were $17,310 less (P=0.03), on average, for the women who received nurse visits compared to controls. By comparison, the program costs were $12,578.
The effect was strongest in the women with higher levels of psychological resources, and there were no cost savings for women with lower psychological resources.
Women in the nurse-visit group were also more likely to be married during the course of the study (19.2% vs. 14.8%, P=0.04), and they spent 4.64 fewer years in total raising children than women in the control group.
Dr. Olds noted that previous studies by his group found lower mortality from preventable causes among children in the nurse-visit group.
The NFP program is now running in 41 states, he added, and serves about 50,000 families a year. In the U.S., federal funds from the Affordable Care Act help support the programs, which also receive funding from child-abuse-prevention funds, TANF flexible dollars, Medicaid and other sources.
“The findings suggest we need to bring NFP to families with limited psychological resources, but given how complicated the formula is to identify this subgroup (ie, they must have low intelligence, high mental health needs, and a low sense of mastery), how do we find them at a population level to have a public health impact?” Dr. Kenneth A. Dodge of Duke University in Durham, North Carolina, writes in an editorial accompanying the study.
“The answer is that we need to create a universal system of care in which all birthing families are reached early in pregnancy, screened for psychosocial and financial needs, and matched with the community resources they need to succeed,” he adds.
“The NFP program is a brilliant invention that has paved the way for many contemporary early childhood interventions. However, let us reconsider the return on investment, identify who benefits and in what ways, and figure out how to create a universal system of care so that families can receive the community resources they need,” he concludes.
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