Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial.
Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2021.16024
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发表时间：
2021-07-01
影响因子：
13.8
通讯作者：
O'Donnell K
中科院分区：
文献类型：
--
作者：
Goodman WB;Dodge KA;Bai Y;Murphy RA;O'Donnell K
What is the association of the Family Connects (FC) program, a universal newborn nurse home visiting program, with child maltreatment investigations and child emergency medical care use between birth and 5 years of age? In this randomized clinical trial, analyses of administrative records indicated that families assigned to FC had 39% fewer Child Protective Services investigations for suspected child abuse and neglect. Families assigned to FC also had a 33% decrease in total child emergency medical care use. These findings indicate that, when implemented with high quality and broad reach, the FC program can have positive long-term benefits for population rates of child well-being. The Family Connects (FC) program, a community-wide nurse home visiting program for newborns, has been shown to provide benefits for children and families through the first 2 years of life. Potential longer-term outcomes for child well-being remain unknown. To determine the effect of randomization to FC on child maltreatment investigations and emergency medical care through 5 years of age. In this randomized clinical trial, families of all 4777 resident births in Durham County, North Carolina, from July 1, 2009, to December 31, 2010, were randomly assigned to receive the FC program or treatment as usual. Impact evaluation was on an intent-to-treat basis and focused on a subsample of 549 families randomly selected from the full population and included review of hospital and Child Protective Services (CPS) administrative records. Statistical analysis was conducted from November 6, 2020, to April 25, 2021. The FC programs includes 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs, deliver education and intervention, and connect families with community resources matched to their needs. Ongoing program engagement with service professionals and an electronic resource directory facilitate effective family connections to the community. Two primary trial outcomes were CPS-recorded child maltreatment investigations and emergency medical care use based on hospital records. Of the 4777 randomized families, 2327 were allocated to the intervention, and 2440 were allocated to services as usual. Among the children in the full study population, 2380 (49.8%) were female, 2397 (50.2%) were male, and 3359 (70.3%) were from racial/ethnic minority groups; of the 531 children included in the impact evaluation follow-up, 284 (53.5%) were female, 247 (46.5%) were male, and 390 (73.4%) were from racial/ethnic minority groups. Negative binomial models indicated that families assigned to FC had 39% fewer CPS investigations for suspected child maltreatment through 5 years of age (95% CI, −0.80 to 0.06; 90% CI, −0.73 to −0.01; control = 44 total investigations per 100 children and intervention = 27 total investigations per 100 children); intervention effects did not differ across subgroups. Families assigned to FC also had 33% less total child emergency medical care use (95% CI, −0.59 to −0.14; 90% CI, −0.55 to −0.18; control = 338 visits and overnight hospital stays per 100 children and intervention = 227 visits and overnight hospital stays per 100 children). Positive effects held across birth risk, child health insurance, child sex, single-parent status, and racial/ethnic groups. Effects were larger for nonminority families compared with minority families. The findings of this randomized clinical trial suggest that, when implemented with high quality and broad reach, a brief postpartum nurse home visiting program can reduce population rates of child maltreatment and emergency medical care use in early childhood. ClinicalTrials.gov Identifier: NCT01406184 This randomized clinical trial examines the effect of randomization to the Family Connects program on child maltreatment investigations and emergency medical care through 5 years of age.
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影响因子：
7
作者：
Schafer, JL;Graham, JW
通讯作者：
Graham, JW
影响因子：
12.7
作者：
Glasgow, Russell E.;Vinson, Cynthia;Hunter, Christine
通讯作者：
Hunter, Christine
影响因子：
--
作者：
Dodge, Kenneth A.;Goodman, W. Benjamin
通讯作者：
Goodman, W. Benjamin
影响因子：
12.7
作者：
Dodge, Kenneth A.;Goodman, W. Benjamin;Guptill, Susan
通讯作者：
Guptill, Susan
影响因子：
3.3
作者：
Lawrence, C. Nicole;Rosanbalm, Katie D.;Dodge, Kenneth A.
通讯作者：
Dodge, Kenneth A.