Program

Oct 12, 2007

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.

DESCRIPTION OF
PROGRAM

Target population: The
program targets both teens ages 15-18 who are pregnant with their first child
and children from birth to age 3.

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.

EVALUATION(S) OF
PROGRAM

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.

Evaluated
population: Newborn children to age 3 born to first-time teen mothers
in Washington DC. Mothers were between 15 and 18 years of age in the late
1960s. The study sample consisted of 95 mother-child pairs.

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.

SOURCES FOR MORE
INFORMATION

For information on Pediatric and Child Health
Supervision:
http://www.brightfutures.org/

References

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.

KEYWORDS: Adolescents, Youth, Toddlers, Infants, Co-ed,  Aggression, Home-Based, Counseling/Therapy, Academic Achievement/Grades, Academic Motivation/Self-Concept Condom Use and Contraception, Family Structure/Marriage, Early Childhood Education, Health Status/Conditions, Home Visitation, Nutrition, Mathematics, Social Skills/Life Skills, Other Education, Other Behavior Problems, Other Social/Emotional Health, Other Civic Engagement

Program information last updated 10/12/07