Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial
Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial
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DOI：
10.1542/peds.2004-0961
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发表时间：
2004-12-01
期刊：
影响因子：
8
通讯作者：
Henderson, CR
中科院分区：
文献类型：
--
作者：
Olds, DL;Robinson, J;Henderson, CR
客观的。旨在检查由辅助专业人员和护士对 2 岁至 4 岁儿童进行产前和婴儿期家访的影响。方法。我们在科罗拉多州丹佛市的公共和私人护理机构中进行了一项随机对照试验，分为 3 个组，即对照组、专业人员辅助访视和护士访视。从怀孕到 2 岁都提供家访。我们连续邀请了 1178 名以前没有生育过的低收入孕妇参与，其中 735 名被随机分组； 85% 为未婚，47% 为墨西哥裔美国人，35% 为非墨西哥裔美国人，15% 为黑人，3% 为美洲印第安人/亚洲人。结果包括母亲对随后怀孕、参与教育和工作、福利使用、婚姻、同居、家庭暴力经历、心理健康、药物使用和掌控感的报告；母子互动和家庭环境的观察；儿童语言和执行功能测试；以及母亲对儿童外化行为问题的报告。结果。项目结束两年后，与对照组相比，接受辅助专业人员拜访的女性不太可能结婚（32.2% vs 44.0%），也不太可能与孩子的亲生父亲同住（32.7% vs 43.1%），但工作时间更长（15.13 个月 vs 13.38 个月），并报告有更强的掌控感和更好的心理健康（标准化分数[平均值 = 100，SD = 10]）共 101.25 分别为 99.31 和 101.21 与 99.16）。辅助专业人员就诊的妇女随后的流产率（6.6% vs 12.3%）和低出生体重新生儿（2.8% vs 7.7%）较少。与对照组相比，接受辅助专业人员拜访的母亲和儿童对彼此表现出更高的敏感性和反应性（标准化得分[平均值= 100，SD = 10]分别为100.92 vs 98.66），并且，如果母亲在登记时心理资源水平较低，则其家庭环境更有利于儿童的早期学习（得分为24.63 vs 23.35）。与对照组相比，接受护士探访的女性报告称，她们的第一个孩子和第二个孩子的出生间隔更长（24.51 个月 vs 20.39 个月），家庭暴力更少（6.9% vs 13.6%），而且她们的孩子入读学前班、启蒙计划或有执照的日托中心的频率也较低。与对照组相比，母亲在登记时心理资源水平较低的护士探访的儿童表现出更有利于儿童早期学习（得分为 24.61 比 23.35）、更高级的语言（得分为 91.39 比 86.73）、优越的执行功能（得分为 100.16 比 95.48）以及测试期间更好的行为适应（得分100.41 对比 96.66）。护士或辅助专业人员就诊对随后怀孕的次数、妇女的教育成就、物质的使用、福利的使用或儿童的外化行为问题没有统计学上的显着影响。结论。专业辅助人员访问的母亲在孩子 2 岁时项目结束后 2 年后开始从该项目中受益，但她们的第一个孩子与对照组的孩子在统计上没有区别。该计划结束两年后，护士探访的母亲和儿童继续受益于该计划。护士接生计划对儿童的影响主要集中在心理资源水平较低的母亲所生的孩子上。
Objective. To examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses from child age 2 through age 4 years.Methods. We conducted, in public and private care settings in Denver, Colorado, a randomized, controlled trial with 3 arms, ie, control, paraprofessional visits, and nurse visits. Home visits were provided from pregnancy through child age 2 years. We invited 1178 consecutive, low-income, pregnant women with no previous live births to participate, and we randomized 735; 85% were unmarried, 47% Mexican American, 35% white non-Mexican American, 15% black, and 3% American Indian/Asian. Outcomes consisted of maternal reports of subsequent pregnancies, participation in education and work, use of welfare, marriage, cohabitation, experience of domestic violence, mental health, substance use, and sense of mastery; observations of mother-child interaction and the home environment; tests of children's language and executive functioning; and mothers' reports of children's externalizing behavior problems.Results. Two years after the program ended, women who were visited by paraprofessionals, compared with control subjects, were less likely to be married (32.2% vs 44.0%) and to live with the biological father of the child (32.7% vs 43.1%) but worked more (15.13 months vs 13.38 months) and reported a greater sense of mastery and better mental health (standardized scores [mean = 100, SD = 10] of 101.25 vs 99.31 and 101.21 vs 99.16, respectively). Paraprofessional- visited women had fewer subsequent miscarriages (6.6% vs 12.3%) and low birth weight newborns (2.8% vs 7.7%). Mothers and children who were visited by paraprofessionals, compared with control subjects, displayed greater sensitivity and responsiveness toward one another (standardized score [mean = 100, SD = 10] of 100.92 vs 98.66) and, in cases in which the mothers had low levels of psychologic resources at registration, had home environments that were more supportive of children's early learning (score of 24.63 vs 23.35). Nurse-visited women reported greater intervals between the births of their first and second children (24.51 months vs 20.39 months) and less domestic violence (6.9% vs 13.6%) and enrolled their children less frequently in preschool, Head Start, or licensed day care than did control subjects. Nurse-visited children whose mothers had low levels of psychologic resources at registration, compared with control group counterparts, demonstrated home environments that were more supportive of children's early learning (score of 24.61 vs 23.35), more advanced language (score of 91.39 vs 86.73), superior executive functioning (score of 100.16 vs 95.48), and better behavioral adaptation during testing (score of 100.41 vs 96.66). There were no statistically significant effects of either nurse or paraprofessional visits on the number of subsequent pregnancies, women's educational achievement, use of substances, use of welfare, or children's externalizing behavior problems.Conclusions. Paraprofessional- visited mothers began to experience benefits from the program 2 years after the program ended at child age 2 years, but their first-born children were not statistically distinguishable from their control group counterparts. Nurse-visited mothers and children continued to benefit from the program 2 years after it ended. The impact of the nurse-delivered program on children was concentrated on children born to mothers with low levels of psychologic resources.