Home-Based Nurse Intervention

HOME-BASED NURSE INTERVENTION (INT)

OVERVIEW

This intervention uses nurse specialists to visit mothers in their homes from the child’s birth until he or she turns 36 months of age. All children were exposed to drugs in utero. The nurses support the mothers and monitor the child’s health. The program was found to have no impacts on child behavior problems or parent stress when the children were two and three years of age, but children in the treatment group were less withdrawn than children in the control groups receiving standard care.

DESCRIPTION OF PROGRAM

Target Population: Children with in utero drug exposure

Between birth and 18 months, children receive 16 home visits, and there are more frequent visits during the first six months of age. Then, with every six months children are examined until age 36 months. Two pediatric nurse specialists visit the mother’s home. The pediatric nurse specialists are supervised by pediatric nurse practitioners who are available to them 24 hours a day.

The pediatric nurse specialists support the mothers emotionally, model positive parent-child interactions, monitor the infant’s health, provide parenting information, and teach the mother specific skills to increase the quality of the mother-child interaction. The materials for the mother are based on the Hawaii Early Learning Profile and the Carolina preschool curriculum.

EVALUATIONS OF PROGRAM

Butz, A. M., Pulsifer, M., Marano, N., Belcher, H., Lears, M. K., & Royall, R. (2001). Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure. Archives of Pediatrics and Adolescent Medicine, 155, 1029-1037.

Evaluated Population: Mothers were between 19 and 40 years old. Ninety-six percent of the children in the sample were 96 percent African American. On average, mothers had 11 years of education, 98 percent were single, and 68 percent of the mothers had custody of their children.

Approach: During pregnancy, mothers were assessed on self-reports of addiction severity, drug use, and drug use during pregnancy. Toxicology screens were used to detect drug use by the mother during pregnancy. Nursing staff collected specimens during labor from the mother and from the baby within 24 hours of birth. All child measures were taken every six months from birth to three years of age. Child behavior problems and parental stress were reported in this study. Parental stress was measured at child’s age two years and age four years, and is reported here as well.

Results: Impacts were not found for the child behavior problems measure. Specifically, no impacts were found for the internalizing and externalizing parts of the measure, as well as the anxiety-depression, sleep, somatization, aggression, and destruction subscales. However, in the subgroup of children who had clinically significant emotional/behavioral problems, significant impacts were found for externalizing, internalizing, and anxiety-depression. For the clinical problem group, no significant impacts were found for number of hospital visits (low number versus high number) or for continued maternal alcohol and other drug use.

The subgroup of parents who scored at the 90^th percentile or higher or at a standard score of 119 or higher on the parenting stress measure had no significant impacts. Parents with high parenting stress in the control group did not significantly differ from the treatment group on the number of hospital visits, continued maternal alcohol and other drug use, or parenting stress subscales.

The withdrawn subscale was significant, with the control group being significantly more withdrawn than the treatment group. No significant impacts were found for parenting stress (consisting of parent-child dysfunctional interaction, parental distress, and difficult child subscales).

SOURCES FOR MORE INFORMATION

References:

Program categorized in this guide according to the following:

Evaluated participant ages: Prenatal, Early Childhood (0-5).

Program components: Home-visiting.

Measured outcomes: Physical Health, Mental Health.

KEYWORDS: Infants (0-12 months), Toddlers (12-36 months), Home-based, Home Visitation, Parent/Family Component, Parent Training/Education, White or Caucasian, Black or African American, Aggression/Violence/Bullying, Depression/Mood Disorders, Anxiety Disorders/Symptoms, Tobacco Use, Alcohol Use, Marijuana/Illicit/Prescription Drugs, Other Substance Use, .

Last Updated on 3/24/10

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