Age 9 Follow-up of Preventive Intervention (Denver)

Study Overview
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Brief Summary
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To examine the impact of prenatal and infancy home visiting by paraprofessionals and by nurses from child age 2 through 9.

Detailed Description
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This project supports a 9-year follow-up of 650 children and their families who were enrolled in a randomized trial of prenatal and infancy home visiting by paraprofessionals and by nurses; participating families were assigned to control, paraprofessional-, or nurse-visited conditions. Earlier phases of assessment found significant benefits for nurse- and paraprofessional-visited families and children, although the nurse effects tended to be larger. The current phase of follow-up is designed to determine whether the effects of the nurse and paraprofessional programs endure and grow through the child age 9.5. The project is organized around seven questions: Do the programs of nurse and paraprofessional home-visiting produce enduring effects on: a) mothers' life-course; b) qualities of care parents provide to their children; c) children's early-onset behavior problems; d) children's incoherence and aggression/destruction in response to story stems; e) children's executive, language, and intellectual functioning and school achievement? To what extent are the beneficial effects of the programs on parental care-giving and children's development concentrated on those born to mothers with few psychological resources? To what extent are the benefits of the programs on mothers and children equivalent for Mexican- Americans and European-Americans? To what extent are the effects of the programs on antisocial behavior concentrated on boys? 5. To what extent are program effects moderated by school and neighborhood contexts? 6. To what extent are the effects of the programs on children's development explained by impacts of the programs on women's prenatal smoking, maternal life-course, qualities of parental caregiving, and children's earlier language development, executive functioning, and emotional regulation? 7. To what extent are the initial costs of the programs recovered in reduced expenditures for other government services during the first nine years of the first child's life?

Official Title
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Age 9 Follow-up of Preventive Intervention

Conditions
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Child Rearing, Risk Reduction Behavior, Reproductive Behavior

Intervention / Treatment
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* Behavioral: home visitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women from 21 antepartum clinics serving low-income women in Denver recruited if they had no previous live births and either qualified for Medicaid or had no private insurance.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>Control group | |
| Experimental: Paraprofessional home visits<br>home visitation by Paraprofessional | Behavioral: home visitation<br>* Home visits from mid-pregnancy until child age 2. Group 2 is visits by a paraprofessional; group 3 is visits by nurses.<br>|
| Experimental: Nurse home visits<br>home visitation by Nurse | Behavioral: home visitation<br>* Home visits from mid-pregnancy until child age 2. Group 2 is visits by a paraprofessional; group 3 is visits by nurses.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| fewer subsequent pregnancies |  | When first child is 9 | 
| increased interval between the birth of the first and second child |  | When first child is 9 | 
| reduced use of welfare |  | When first child is 9 | 
| increased participation in the work force |  | When first child is 9 | 
| reduced behavioral problems due to use of alcohol and drugs |  | When first child is 9 | 
| fewer arrests |  | When first child is 9 | 
| increased qualities of care parents provide to their children as reflected in fewer verified reports of child abuse and neglect and observations of coercive mother-child interaction. |  | When first child is 9 | 
| children's early-onset behavior problems (both externalizing and internalizing) reported by parents and teachers at home, at school, and with peers. |  | At child age 9 | 
| children's aggressive and destructive themes and narrative coherence in their responses to story stems. |  | At child age 9 | 
| executive functions and school achievement. |  | At child age 9 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nurse, paraprofessional, home visits, pregnancy, welfare, child development