Evaluation of an interagency home visiting program to reduce postneonatal mortality in disadvantaged communities

This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse-community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonparticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high-risk at birth.