Program

Jan 04, 2011

OVERVIEW

This home-visiting program attempted to improve the development and social skills of young children with failure-to-thrive, a condition in which a child experiences below expected weight gain, while lacking a biological explanation for the condition. Children were randomized to receive clinical services plus home visiting or, in the control group, clinical services only.  Out of two studies, only one impact has been found. When taking into account the mother’s education and the family’s receipt of public assistance, treatment children had higher scores on the “works hard” school behavior rated by teachers.

DESCRIPTION OF PROGRAM

Target Population: children age two or younger, born at appropriate gestation with appropriate birth weight who are later diagnosed with failure to thrive

The families receive services and information from a clinic on nutritional, medical, and behavioral topics as well as home visiting through a community-based group. In addition, non-professional home visitors come to the family for one hour, once a week, for one year. The home visitors, who received eight weeks of training, are supervised by a community health nurse. The visitors provide support, parenting advice, child development information, and help in using and obtaining resources. For example, they carried some mats and toys with them to visits in order to engage the parent in developmentally appropriate activities for the child.

EVALUATIONS OF PROGRAM

Hutcheson, J. J., Black, M. M., Talley, M., Dubowitz, H., Howard, J. B., Starr, R. H., et al. (1997). Risk status and home intervention among children with failure-to-thrive: Follow-up at age 4. Journal of Pediatric Psychology, 22(5), 651-668.

Evaluated Population: Inner-city children (N=116) were evaluated, with 74 children remaining in the follow-up at age four. They were born in a pediatric care clinic serving low-income families, born at greater than 36 weeks gestation, with appropriate birth weight, and diagnosed with failure-to-thrive. At baseline, children had to be fewer than 25 months of age with weight below the fifth percentile (weight for their particular age) or weight below the tenth percentile (weight for their particular height). Ninety percent of the families were African American, and few of the families had many financial resources. Eighty-two percent were receiving Medical Assistance and 74 percent were receiving Aid for Families with Dependent Children (AFDC). Mean age was 24 years. Mean education was 10.8 years, and 83 percent of the sample’s caregivers had never been married.

Approach: Families were all assigned to a clinic providing nutritional, medical, and behavioral resources. Half of the families were randomly assigned to also receive the home intervention treatment group (N=55). Fifty-six families were in the clinic-only group at posttest (12 months after baseline), 38 in the clinic-only group at child age four years (24 months after baseline). Fifty-five families were in the treatment group at posttest, 36 in the clinic-only group at the 24-month follow-up.

Development was measured with two tests, including two subscales each: mental development, psychomotor development, cognitive development, and motor development. Child behavior was measured by an observer, assessing competence and negative affect in particular during a ten-minute parent-child interaction. At the 24-month follow-up, a slightly different assessment was used for the parent-child interaction: task engagement, negative affect, and warmth. Demographic risk was included and compiled from six variables: maternal age under 18 years at the selected child’s birth; mother’s educational attainment is less than high school; living in a household with more than two people per bedroom; enrollment in AFDC or Medical Assistance; single parent status; and never been employed.

Results:  From baseline to posttest, there were no significant impacts from the program. At the 24-month follow-up, however, when the children were four, the intervention group had a higher score on motor development compared with the control group. When demographic risk was taken into account, there were no program impacts at either posttest or the 24-month follow-up.  Among children whose mothers reported low levels of negative affect at baseline, both cognitive development and behavior during play were also better at age four.

Black, M. M., Dubowitz, H., Krishnakumar, A., & Starr, R. H. (2007). Early intervention and recovery among children with failure to thrive: Follow-up at age 8. Pediatrics, 120(1), 59-69.

Evaluated Population: See above.

Approach: At age eight (six-year follow-up), about three-quarters of the sample was assessed by a trained nurse who measured the child’s growth, height and weight. Cognitive performance, academic performance, behavior at home, and behavior at school were assessed. Mothers reported on home behavior and teachers reported on school behavior.

Results: At the six-year follow-up, when the children were eight years old, wasting was less frequent, teacher-reported internalizing was lower, and children were more likely to be described as working hard for the home visiting group than for the control group.  No differences were found for behavior at home or for teacher-reported externalizing behavior.

SOURCES FOR MORE INFORMATION

References:

Black, M. M., Dubowitz, H., Krishnakumar, A., & Starr, R. H. (2007). Early intervention and recovery among children with failure to thrive: Follow-up at age 8. Pediatrics, 120(1), 59-69.

Hutcheson, J. J., Black, M. M., Talley, M., Dubowitz, H., Howard, J. B., Starr, R. H., et al. (1997). Risk status and home intervention among children with failure-to-thrive: Follow-up at age 4. Journal of Pediatric Psychology, 22(5), 651-668.

Program categorized in this guide according to the following:

Evaluated participant ages: Early Childhood (0-5), Mid. Childhood (6-11)

Program components: Home Visiting, Community/Media Campaign

Measured outcomes: Physical Health, Behavioral Problems, Education and Cognitive Development

KEYWORDS: Infants (0-12 months), Toddlers (12-36 months), Children (3-11), Males and Females (co-ed), Community-based, Home-based, Parent Training/Education, Home Visitation, Parent/Family Component, Urban, Other Behavioral Problems, Health Status/Conditions, Black/African American, Parent-child Relationship, Academic Motivation/Self-Concept/Expectations/Engagement, Other Education.

Last Updated on January 4, 2011