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Guide
to Effective Programs
for Children and Youth |
CHILD HEALTH SUPERVISION
OVERVIEW
The Child Health Supervision program is a comprehensive home visiting program for new teen mothers and their babies. The program provides a variety of physical and emotional health services for teens and children until they are age 3. A randomized, experimental evaluation of this program found impacts in many areas including diet and feeding behaviors, positive behaviors, problem behaviors, parenting behaviors, and child development.
The Child Health Supervision program begins when the mother enters the seventh month of pregnancy. During this time, nurses begin visiting the family and giving them health information, physical examinations, general counseling, and referrals to local health services. In the first year of birth, new parents are visited nine times and less often in following years by a nurse and a pediatrician. Visits last one hour and at each visit the nurse tracks the child’s medical history, ensures that vaccinations are current, gives a physical exam, examines the child’s development, counsels the mother if she has concerns or questions, provides the parent with books and written information about child health and development, treats minor health problems or gives referrals for treatment. Pediatricians and nurses are on call if the mother has any questions or problems. Nurses also conduct cognitive stimulation visits an additional 18 times per year in the first year and less often in following years to help the child with physical and social development. During the first year, new mothers attend group sessions with other new mothers to help answer common questions and provide social support.
Gutelius, M. F., Kirsch, A. D., MacDonald, S., Brooks, M. R., & McErlean, T. (1977). Controlled study of Child Health Supervision: Behavioral results. Pediatrics, 60(3), 294-304.
Approach: Researchers identified all first-time teen mothers in a lower class district in Washington DC. To qualify for the study, mothers had to meet a set of criteria: be between 15 and 18 years old, be in the 7th month of pregnancy or earlier, score above 70 on the Peabody Picture Vocabulary test, have no chronic diseases, and not have major personality or emotional disorders. Additionally, children who were born under 2,500 grams, had birth abnormalities, and those children who died at birth were excluded from the study. After the initial screening, parents were randomly assigned to either the treatment Child Health Supervision program or a control group.
Parents in the control group were referred to prenatal clinics and were visited once after the birth to give parents information, a physical examination of the infant, and a referral to a local pediatrician’s office. At the yearly evaluations, children in the control group who had illnesses or physical problems were referred to a local hospital for treatment.
Parents in the treatment group were visited at the 7th month of the pregnancy by a project nurse. The nurse gave health information, physical examinations, and counseled mothers on postnatal needs. In the first year after birth, the parent and child were visited by a nurse and a pediatrician nine times. During the second and third years, each parent-child pair were visited six times and four times respectively. Each visit took one hour and at each visit the nurse wrote down medical history and made sure that immunization history was complete and the child was up to date, gave a physical exam, examined the child’s development, counseled the mother if she had concerns or questions, provided information about the child’s development like Spock’s Baby and Child Care, and either treated minor illnesses or physical problems or gave referrals for treatment. Mothers in the treatment group had the ability to call the nurse or pediatrician at any time with questions and also took part in group sessions in the first year with other mothers which provided them with information on child rearing and a social outlet. Additionally, infants in the treatment group were given an iron supplement for their first year.
The nurse also visited the child 18 times in the first year, 12 in the second, and 8 in the third to give the child additional cognitive stimulation. At these sessions, nurses interacted with the child on age-appropriate activities which targeted motor development, visual stimulation, and verbal development.
Nurses and pediatricians collected medical data for the evaluation and therefore were not blind to conditions. A psychologist who was blind to conditions collected information on behavioral variables. When the child was 6-months and at each birthday a physical examination was performed at a local hospital. Results will only be reported for the first 3 years because a higher level of attrition was found after this period.
Results: At random, assignment parent-child pairs in the treatment and control groups were equivalent on 63 sociodemographic and emotional measures. There were two variables in which the groups differed: more control mothers had lived in DC since birth and fewer control mothers took part in extracurricular activities at school. Pre-birth, the program did not have any impact on health of the mother, diet, weight gain during pregnancy, length or complications in delivery, and emotional reaction to their child. Likewise, the program did not have any impact on child physical characteristics at birth.
Diet and feeding: At their first birthday, children in the treatment group were more likely to drink an appropriate amount of milk daily (480-720ml) compared with children in the control group. At 6 months, more children in the treatment group were getting at least one serving of meat daily than children in the control group. At their second and third birthdays, children in the intervention group were more likely to have at least one serving of fruit daily compared with those in the control group. The program had no impact on children’s candy consumption. At 6 months and 3 years, more mothers in the treatment group reported that their child had a good appetite. At their second birthdays, children in the treatment condition were more likely to be feeding themselves compared with children in the control group. The program had no impacts on weeks of breast feeding, acceptance of strained and then table foods, colic, spitting up, amount of solid food taken, and use of a cup. Many differences between the groups approached significant difference but will not be discussed here.
Development: At 6 months, children in the treatment condition were less likely to be thumb-sucking than children in the control group, but children in the experimental condition were more likely to use a pacifier. At 1 year, children in the intervention condition were less likely to be waking up during the night compared with those in the control group. At their second birthdays, children in the treatment condition were more likely to be toilet trained (during the day period) than those in the control condition. The program did not have any impacts on toilet training at 3 years of age, constipation problems, pica disorder, problems with biting people, and number of toxic ingestions.
Behavior: When observed by a psychologist at 3 years, children in the treatment group were more likely to exhibit absorption in tasks, social confidence, self-confidence, assurance, positive reaction to failure, and ability to establish a relationship. The program had no impact on other behavioral variables like response to toys, attention span, cooperativeness, reactivity, happiness, endurance, temper tantrums, fears, discipline problems, general fussiness, ability to play alone, getting along with playmates, mild and severe accidents, school achievement, destructiveness, attention-seeking, stubbornness, shouting, jealousy, and cleaning up toys.
Parent: Parents in the treatment condition were more likely to take their children outdoors daily at 6 months. Parents in the intervention condition were also more likely to use crayons and storybooks in the home daily at 2 years. Parents in the experimental condition were more likely to have taken some type of schooling over the first three years after the birth of their child. Parents in the intervention condition were less likely than those in the control group to consider their children naughty or bad-tempered. Parents in the treatment condition were more likely to exhibit constructive reactions to hitting or kicking, praise the child daily, manage child’s fear of the dark, positively promote the child’s success in school. At three years he program had no impact on the mother’s style of housekeeping, time daily with the baby, free time away from the baby, and separations longer than 1 month.
Overall, of 300 behavioral variables, 32 significant impacts were found and all favored the experimental group, a highly statistically significant pattern.
As previously mentioned, one limitation of this study was the high level of attrition after the 3 year data collection. Also, because of the initial screening characteristics, the representativeness of the sample is limited to only those children which are born without problem and who are of normal weight.
For information on Pediatric and Child Health Supervision: http://www.brightfutures.org/
Gutelius, M. F., Kirsch, A. D., MacDonald, S., Brooks, M. R., & McErlean, T. (1977). Controlled study of Child Health Supervision: Behavioral results. Pediatrics, 60(3), 294-304.
Program categorized in this guide according to the following:
Evaluated participant ages: prenatal to 3 years and teens ages 15-18 years / Program age ranges in the Guide: prenatal, early childhood, youth
Program components: child care/early childhood education; clinic-based, provider-based, or miscellaneous; counseling/therapy; home visiting; parent or family component
Measured outcomes: education and cognitive development; social and emotional health and development; physical health; behavioral problems; teen pregnancy and reproductive health
Program information last updated 10/12/07
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© Child Trends 2003 |