Intensive Nurse Home Visiting and Early Childhood Outcomes: A Randomized Clinical Trial

Area of Science:

• Public Health
• Pediatrics
• Health Services Research

Background:

• Home visiting programs are proposed to mitigate early childhood adversity and enhance child health.
• Evidence on the large-scale impact of these programs is still developing.

Purpose of the Study:

• To evaluate the effect of the Nurse-Family Partnership (NFP) home visiting program on children's health outcomes and healthcare utilization in the first two years of life.
• To assess the impact of NFP on adverse health outcomes, emergency department visits, and preventive care uptake among low-income families.

Main Methods:

• A randomized clinical trial involving 5670 Medicaid-eligible pregnant individuals in South Carolina, assigned to NFP or usual care.
• Data collected from 2016-2020, with analysis focusing on outcomes up to two years postpartum.
• Intent-to-treat analysis using linear regression to compare outcomes between groups.

Main Results:

• No statistically significant difference in the composite adverse outcome (child mortality, major injury, abuse/neglect concerns) between NFP and usual care groups (27.3% vs 26.8%).
• A non-significant reduction in emergency department utilization was observed in the NFP group (4% relative reduction), which lost statistical significance after adjustment.
• Assignment to NFP did not significantly affect the rate of well-child visits or preventive service uptake.

Conclusions:

• Intensive nurse home visiting services through NFP, when delivered at scale to a Medicaid population, did not reduce the incidence of adverse early childhood outcomes based on administrative data.
• Further research is recommended to explore the influence of scaled home visiting programs on other child health indicators, including long-term developmental trajectories.