Nurse Family Partnership for Women With Previous Live Births
Study Details
Study Description
Brief Summary
The goal of this clinical trial is to test the Nurse Family Partnership (NFP) in mothers with previous live births (multiparous or multip individuals). The main aims are:
Specific Aim 1-Determine the effectiveness of NFP among multiparous women for reducing maternal morbidity and improving pregnancy outcomes.
Specific Aim 2-Determine the effectiveness of NFP among index children (child from pregnancy when mother was enrolled) of multiparous women for improving child outcomes.
Specific Aim 3 (Exploratory)-In preparation for a future study of the effects of preventive home-visiting programs on mother-index child-sibling triads, describe siblings (characteristics, role, influence) in the context of nurse home-visiting and evaluate the effectiveness of NFP on outcomes for prior-born siblings younger than 6 years old living in the home, including cognitive development, socioemotional development, and identification and referral to needed services.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
The proposed study will be conducted in partnership with two or more NFP sites in Columbus and Dayton, Ohio. Investigators will work with the prenatal care clinics and pregnancy resource referral centers to identify a process that fits into each site's flow for identifying and recruiting eligible multiparous pregnant women at 28 weeks EGA (estimated gestational age) or less to participate in the study. The study will recruit 800 women to participate. Half will be randomized to receive NFP and half will be randomized to receive any other community services available outside of NFP. Researchers will compare the intervention group with the control group to test the effects described in the Aims above (as outlined in the following hypotheses).
Hypothesis 1-Compared to multiparous women who receive usual care, women who receive NFP will have reductions in pregnancy-related hypertension and tobacco use.
Hypothesis 2-Compared to children of women who receive usual care, those whose mothers receive NFP will have improved language development.
Women will be asked to participate in seven data collection episodes at study enrollment/baseline, 36 to 40 weeks pregnancy, 6 to 8 weeks postpartum, and child ages 6, 12, 18, and 24 months.
Researchers will use the following data sources for this study: 1) data routinely collected by the NFP team to determine enrollment and engagement in the NFP program of study participants randomized to NFP; 2) self-administered and interview surveys of study participants collected by the research assistant; 3) formal observation-based assessment tools (such as the Bayley assessment of child development) administered by the research assistant; 4) videos of parent-child interactions recorded by the research assistant and coded by parenting experts; 5) saliva samples (mothers) collected by the research assistant or self-collected by the participant with guidance from the research assistant; 6) data from medical record review of mothers and their children; and 7) birth certificate data.
The research assistants will conduct all the primary data collection from mother-child dyads who have agreed to participate in the trial, and primary data collection will be separate from NFP program delivery which will be conducted by the NFP nurses. Primary data collection will occur at 7 time points as described above. Primary data collection will occur in the participants' homes or at another location where the participant and research assistant feel comfortable (such as a meeting room in a public library). The majority of measures could be collected in a variety of settings with the exception of the video-taped interactions between parents and children which would ideally occur in the child's natural environment. The postpartum and 12 month visits only involve maternal report measures and can be conducted by telephone/video using online surveys.
The research assistant will record where each data collection episode occurred. The research assistant will also record all attempts made to contact study participants for data collection and missed episodes of data collection (i.e., if a visit were arranged and the participant were not available). The research assistant will be trained regarding appropriate collection, transport, and storage procedures for biologic samples and will be trained to conduct the Bayley assessment of child development.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Intervention (NFP) In the standard NFP intervention, low-income pregnant women are recruited to voluntarily join the program through their 28th week of pregnancy. Enrolled women receive home visits from a nurse. The visits can occur in-person or via telehealth. In-person visits can occur in the client's home or in another community location agreed upon by the client and the nurse (such as a library or coffee shop). The typical schedule for visits is weekly during the first month after enrollment, every two weeks until the birth of the infant, weekly during the post-partum period, then every two to four weeks until child age two. |
Behavioral: Nurse Family Partnership
During NFP visits, the nurse: 1) engages in a therapeutic nurse-client relationship focused on promoting client abilities and behavior change to protect and promote her own health and child's health; 2) provides service coordination based on client's identified needs, referring to available community services; 3) follows NFP Visit Guidelines tailoring them to the strengths and challenges of each family; 4) works with client to support a healthy pregnancy by recognizing and reducing risk factors and promoting prenatal health care, healthy diet, exercise, and stress management; and 5) gathers data on program implementation and maternal and child health. The visits include content from six domains: personal health, environmental health, life-course, maternal role, family and friends, and health and human services. Nurses use educational materials to address the content from the six domains with their clients.
|
No Intervention: Control The control group will receive usual care for pregnant people, which may include home visiting services from another source other than NFP. Participants who are randomly selected to receive other services will be given information about other services for which they may qualify and information about how to access those services. |
Outcome Measures
Primary Outcome Measures
- Presence of Pregnancy-related hypertension [Birth of index child]
High Blood Pressure associated with pregnancy
- Change in maternal tobacco use by cotinine [Less than 28 weeks gestation and 36 weeks gestation]
Measured by cotinine level in saliva
- Change in self reported maternal tobacco use [Less than 28 weeks gestation, 36 weeks gestation, index child age 6 months, 12 months, and 24 months.]
Measured by self-report (yes/no)
- Index child language development measured by the Bayley IV language subscale [Index child age 24 months]
Scaled, age-adjusted score from 1-19 with 19 being best outcome
- Index child language development measured by the MacArthur Bates CDI (Communicative Development Inventories) [Index child age 24 months]
Percentage out of 100; 100 being best outcome
Secondary Outcome Measures
- Number of participants with infection during pregnancy based on medical record review [Index child age 1 month]
Receipt of screening for common infections; if positive, receipt of appropriate treatment
- Number of infants born with weight less than 2500 grams per medical record review [Index child age 1 month]
- Number of infants born less than 34 weeks gestation per medical record review [Index child age 1 month]
- Change in self-reported maternal substance use [Less than 28 weeks gestation, 36 weeks gestation, index child ages 6, 12, 18, 24 months]
Past month use per self-report (yes/no)
- Initiation and continuation of any breastfeeding per maternal report [Index child age 1 month, 6 months and 12 months]
- Percentage of well-child visits attended for index child per medical record review [Index child age 18-24 months]
Number out of 7 visits by 12 months
- Index child immunization use per medical record review [Record review at index child age 18-24 months]
Immunizations up-to-date for age at 18 months
- Index child emergency room visits for serious preventable injuries and sentinel injuries for child abuse. [Index child age birth to 24 months, collected at 24 months]
Visit rate and reason for visit per medical record review
- Index child hospitalization for injuries [Record review at index child age 24 months]
Number of days hospitalized for injury per medical record review
- Change in quality of home environment measured by the HOME (Home Observation Measurement of the Environment) Inventory short form [36 weeks gestation, index child age 18 months]
53 yes/no measures; score scaled based on child age, self-report and interviewer observation
- Change in quality of home environment measured by the CHAOS (Confusion, Hubbub and Order Scale) Scale [36 weeks gestation, index child age 24 months]
On a scale of 1-15, The higher the score the higher the level of environmental chaos in the home
- Mother-child interaction measured by the Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE) [Index child age 18 months]
Video recorded interactions are scored by trained research assistants, for each behavior the frequency and proportion of time spent is recorded.
- Child's developmental index measured by Bayley IV developmental assessment [Index child age 24 months]
Scaled, age-adjusted score from 1-19 with 19 being best outcome
- Index child's social and emotional development based on Bayley IV socio-emotional subscale [Index child age 24 months]
Scaled, age-adjusted score from 1-19 with 19 being best outcome
- Index child's social and emotional development measured by the Child Behavior Checklist (CBCL) (maternal report) [Index child age 24 months]
54 question scored on a scale of 0-2; lower scores are more emotionally regulated children
- Change in maternal perceived stress measured by Perceived Stress Scale (maternal report) [Less than 28 weeks gestation and index child age 6 months]
Scale of 0-40 based on 10 questions; 0-13 would be considered low stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
pregnant at 28 weeks EGA or less
-
history of previous live birth
-
covered by Medicaid or Medicaid-eligible
-
at least one of the following risks or adversities -age 19 or younger, no high school degree or equivalent, homeless (using a standardized definition), previous birth with low birth weight or prematurity, previous pregnancy with severe morbidity based on Centers for Disease Control definition, current pregnancy within 18 months of previous pregnancy, currently using tobacco or marijuana, history of substance use disorder, and self-identification as Black/African American (as a marker of facing the adversity of structural racism).
Exclusion Criteria:
-
unable converse and demonstrate adequate understanding to provide consent for study participation in English
-
are already enrolled in a home-visiting intervention with this pregnancy
-
have previously been enrolled in NFP
-
under the age of 16 years. Note that we propose to exclude those who don't speak English from our study because the community served by the two NFP delivery sites participating in our study is mostly English-speaking. However, those who don't speak English are not excluded from participation in NFP, and NFP routinely provides services to all eligible families regardless of language spoken using bilingual/multilingual nurses when available or using interpretation services. NFP materials for nurses to use with families, known as 'facilitators', are available in several languages. In the rare circumstance that a pregnant woman is excluded from participating in our study based on language, they will not be excluded from receiving NFP.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Nationwide Children's Hospital | Columbus | Ohio | United States | 43205 |
Sponsors and Collaborators
- University of Colorado, Denver
- Nationwide Children's Hospital
- University of Rochester
Investigators
- Principal Investigator: Mandy A Allison, MD, MSPH, University of Colorado School of Medicine
- Principal Investigator: Deena Chisolm, PhD, Nationwide Children's Hospital
Study Documents (Full-Text)
More Information
Additional Information:
- McIntosh K, Moss, E., Nunn, R., and Shambaugh, J. Examining the Black-white wealth gap. The Brookings Institute. https://www.brookings.edu/blog/up-front/2020/02/27/examining-the-black-white-wealth-gap/. Published 2020. Accessed2020.
- Darity Jr. W, Hamilton, D., Paul, M., Aja, A., Price, A., Moore, A., and Chiopris, C. What We Get Wrong About Closing the Racial Wealth Gap. Samuel DuBois Cook Center on Social Equality, Insight Center for Community Economic Development.
- Hart B, Risley TR. The early catastrophe. EDUCATION REVIEW-LONDON-. 2003;17(1):110-118.
- Ross CE, Wu C-l. The links between education and health. American sociological review. 1995:719-745.
- Nurse-Family Partnership: A nurse home visitation program for low-income, pregnant women. Social Programs that Work. Prenatal/Early Childhood. . https://evidencebasedprograms.org/policy_area/prenatal-earlychildhood/. Published 2019. Accessed 6/12/2019.
- Effectiveness HVEo. What is Home Visiting Evidence of Effectiveness? U.S. Department of Health and Human Serivces: Administration for Children and Families. https://homvee.acf.hhs.gov/. Published 2020. Accessed2020.
- Haskins R, Paxson, C., Brooks-Gunn, J. Social Science Rising: A Tale of Evidence Shaping Public Policy. Princeton, Brookings. ;2009.
Publications
- Alonso-Marsden S, Dodge KA, O'Donnell KJ, Murphy RA, Sato JM, Christopoulos C. Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment. Child Abuse Negl. 2013 Aug;37(8):555-65. doi: 10.1016/j.chiabu.2013.03.012. Epub 2013 May 6.
- Bor J, Cohen GH, Galea S. Population health in an era of rising income inequality: USA, 1980-2015. Lancet. 2017 Apr 8;389(10077):1475-1490. doi: 10.1016/S0140-6736(17)30571-8.
- Bowlby J. Attachment and loss: retrospect and prospect. Am J Orthopsychiatry. 1982 Oct;52(4):664-678. doi: 10.1111/j.1939-0025.1982.tb01456.x. No abstract available.
- Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol. 2002;53:371-99. doi: 10.1146/annurev.psych.53.100901.135233.
- Brito NH, Noble KG. Socioeconomic status and structural brain development. Front Neurosci. 2014 Sep 4;8:276. doi: 10.3389/fnins.2014.00276. eCollection 2014.
- Cheng TL, Johnson SB, Goodman E. Breaking the Intergenerational Cycle of Disadvantage: The Three Generation Approach. Pediatrics. 2016 Jun;137(6):e20152467. doi: 10.1542/peds.2015-2467. Epub 2016 May 9.
- Duggan A, Caldera D, Rodriguez K, Burrell L, Rohde C, Crowne SS. Impact of a statewide home visiting program to prevent child abuse. Child Abuse Negl. 2007 Aug;31(8):801-27. doi: 10.1016/j.chiabu.2006.06.011. Epub 2007 Sep 5.
- DuMont K, Mitchell-Herzfeld S, Greene R, Lee E, Lowenfels A, Rodriguez M, Dorabawila V. Healthy Families New York (HFNY) randomized trial: effects on early child abuse and neglect. Child Abuse Negl. 2008 Mar;32(3):295-315. doi: 10.1016/j.chiabu.2007.07.007.
- Duncan GJ, Dowsett CJ, Claessens A, Magnuson K, Huston AC, Klebanov P, Pagani LS, Feinstein L, Engel M, Brooks-Gunn J, Sexton H, Duckworth K, Japel C. School readiness and later achievement. Dev Psychol. 2007 Nov;43(6):1428-1446. doi: 10.1037/0012-1649.43.6.1428. Erratum In: Dev Psychol. 2008 Jan;44(1):232.
- Evans GW, Gonnella C, Marcynyszyn LA, Gentile L, Salpekar N. The role of chaos in poverty and children's socioemotional adjustment. Psychol Sci. 2005 Jul;16(7):560-5. doi: 10.1111/j.0956-7976.2005.01575.x.
- Falk-Rafael A. Advancing nursing theory through theory-guided practice: the emergence of a critical caring perspective. ANS Adv Nurs Sci. 2005 Jan-Mar;28(1):38-49. doi: 10.1097/00012272-200501000-00005.
- Fraser JA, Armstrong KL, Morris JP, Dadds MR. Home visiting intervention for vulnerable families with newborns: follow-up results of a randomized controlled trial. Child Abuse Negl. 2000 Nov;24(11):1399-429. doi: 10.1016/s0145-2134(00)00193-9.
- Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis. 2007 Oct;4(4):A107. Epub 2007 Sep 15.
- Kitzman H, Olds DL, Henderson CR Jr, Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, Shaver D, Engelhardt K, James D, Barnard K. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA. 1997 Aug 27;278(8):644-52.
- Kitzman H, Olds DL, Sidora K, Henderson CR Jr, Hanks C, Cole R, Luckey DW, Bondy J, Cole K, Glazner J. Enduring effects of nurse home visitation on maternal life course: a 3-year follow-up of a randomized trial. JAMA. 2000 Apr 19;283(15):1983-9. doi: 10.1001/jama.283.15.1983.
- Miller TR. Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996-2013, USA. Prev Sci. 2015 Aug;16(6):765-77. doi: 10.1007/s11121-015-0572-9.
- National Research Council (US) and Institute of Medicine (US) Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington (DC): National Academies Press (US); 2000. Available from http://www.ncbi.nlm.nih.gov/books/NBK225557/
- Noble KG, Engelhardt LE, Brito NH, Mack LJ, Nail EJ, Angal J, Barr R, Fifer WP, Elliott AJ; PASS Network. Socioeconomic disparities in neurocognitive development in the first two years of life. Dev Psychobiol. 2015 Jul;57(5):535-51. doi: 10.1002/dev.21303. Epub 2015 Mar 30.
- Noble KG, Houston SM, Brito NH, Bartsch H, Kan E, Kuperman JM, Akshoomoff N, Amaral DG, Bloss CS, Libiger O, Schork NJ, Murray SS, Casey BJ, Chang L, Ernst TM, Frazier JA, Gruen JR, Kennedy DN, Van Zijl P, Mostofsky S, Kaufmann WE, Kenet T, Dale AM, Jernigan TL, Sowell ER. Family income, parental education and brain structure in children and adolescents. Nat Neurosci. 2015 May;18(5):773-8. doi: 10.1038/nn.3983. Epub 2015 Mar 30.
- Olds D, Henderson CR Jr, Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L, Sidora K, Morris P, Powers J. Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. JAMA. 1998 Oct 14;280(14):1238-44. doi: 10.1001/jama.280.14.1238.
- Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA. 1997 Aug 27;278(8):637-43.
- Olds DL, Henderson CR Jr, Chamberlin R, Tatelbaum R. Preventing child abuse and neglect: a randomized trial of nurse home visitation. Pediatrics. 1986 Jul;78(1):65-78.
- Olds DL, Henderson CR Jr, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986 Jan;77(1):16-28. Erratum In: Pediatrics 1986 Jul;78(1):138.
- Olds DL, Henderson CR Jr, Tatelbaum R, Chamberlin R. Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation. Am J Public Health. 1988 Nov;78(11):1436-45. doi: 10.2105/ajph.78.11.1436.
- Olds DL, Holmberg JR, Donelan-McCall N, Luckey DW, Knudtson MD, Robinson J. Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatr. 2014 Feb;168(2):114-21. doi: 10.1001/jamapediatrics.2013.3817.
- Olds DL, Kitzman H, Cole R, Robinson J, Sidora K, Luckey DW, Henderson CR Jr, Hanks C, Bondy J, Holmberg J. Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial. Pediatrics. 2004 Dec;114(6):1550-9. doi: 10.1542/peds.2004-0962.
- Olds DL, Kitzman H, Hanks C, Cole R, Anson E, Sidora-Arcoleo K, Luckey DW, Henderson CR Jr, Holmberg J, Tutt RA, Stevenson AJ, Bondy J. Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial. Pediatrics. 2007 Oct;120(4):e832-45. doi: 10.1542/peds.2006-2111.
- Olds DL, Kitzman HJ, Cole RE, Hanks CA, Arcoleo KJ, Anson EA, Luckey DW, Knudtson MD, Henderson CR Jr, Bondy J, Stevenson AJ. Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med. 2010 May;164(5):419-24. doi: 10.1001/archpediatrics.2010.49.
- Olds DL, Robinson J, O'Brien R, Luckey DW, Pettitt LM, Henderson CR Jr, Ng RK, Sheff KL, Korfmacher J, Hiatt S, Talmi A. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics. 2002 Sep;110(3):486-96. doi: 10.1542/peds.110.3.486.
- Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K, Henderson CR Jr. Effects of home visits by paraprofessionals and by nurses: age 4 follow-up results of a randomized trial. Pediatrics. 2004 Dec;114(6):1560-8. doi: 10.1542/peds.2004-0961.
- Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM, Barfield W. Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019 May 10;68(18):423-429. doi: 10.15585/mmwr.mm6818e1.
- Swain JE, Kim P, Spicer J, Ho SS, Dayton CJ, Elmadih A, Abel KM. Approaching the biology of human parental attachment: brain imaging, oxytocin and coordinated assessments of mothers and fathers. Brain Res. 2014 Sep 11;1580:78-101. doi: 10.1016/j.brainres.2014.03.007. Epub 2014 Mar 15.
- Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006 Aug;29(4):377-87. doi: 10.1007/s10865-006-9056-5. Epub 2006 Jun 7.
- Wang E, Glazer KB, Howell EA, Janevic TM. Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review. Obstet Gynecol. 2020 Apr;135(4):896-915. doi: 10.1097/AOG.0000000000003762.
- 20-0470