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Toward Population Impact from Home Visiting
Kenneth A Dodge1, W Benjamin Goodman, Robert Murphy
1Duke University.
Zero to Three
|March 26, 2013
Summary
The Durham Connects program demonstrated population-level impact by reducing infant emergency room visits and hospitalizations. This universal nurse home-visiting initiative achieved success through community partnerships and early intervention.
Area of Science:
- Public Health
- Pediatrics
- Health Services Research
Background:
- Previous home-visiting programs showed family-level but not population-level effectiveness.
- The Durham Connects (DC) initiative aimed to achieve population-level impact through community agency collaboration.
Purpose of the Study:
- To evaluate the population impact of the Durham Connects (DC) initiative, a universal postnatal nurse home-visiting program.
- To assess the effectiveness of a Preventive System Of Care model in achieving early-intervention goals.
Main Methods:
- A population randomized controlled trial involving all 4,777 births in Durham, NC, over 18 months.
- Universal, short-term, postnatal nurse home visits delivering brief interventions and needs assessments.
- Connecting families with community resources based on 12 assessed domains.
Main Results:
- The Durham Connects program achieved high penetration and fidelity.
- By 6 months of age, infants in the DC group had 18% fewer emergency room visits compared to controls.
- Infants in the DC group experienced 80% fewer hospital overnights than control families.
Conclusions:
- Population-level impact is achievable with well-designed and implemented programs.
- Key factors for success include community partnerships, universal reach, comprehensive assessment, and sustainable funding models.
- The Durham Connects initiative provides a model for effective population-level early intervention through nurse home visiting.
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