title: Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years.
abstract: OBJECTIVE
  The Nurse-Family Partnership delivered by nurses has been found to produce long-term effects on maternal and child health in replicated randomized trials. A persistent question is whether paraprofessional home visitors might produce comparable effects.
  
  
  OBJECTIVE
  To examine the impact of prenatal and infancy/toddler home visits by paraprofessionals and by nurses on child development at child ages 6 and 9 years.
  
  
  METHODS
  Randomized trial in public and private care settings in Denver, Colorado, of 735 low-income women and their first-born children (85% of the mothers were unmarried; 47% were Hispanic, 35% were non-Hispanic white, 15% were African American, and 3% were American Indian/Asian).
  
  
  METHODS
  Home visits provided from pregnancy through child age 2 years delivered in one group by paraprofessionals and in the other by nurses.
  
  
  METHODS
  Reports of children's internalizing, externalizing, and total emotional/behavioral problems, and tests of children's language, intelligence, attention, attention dysfunction, visual attention/task switching, working memory, and academic achievement. We hypothesized that program effects on cognitive-related outcomes would be more pronounced among children born to mothers with low psychological resources. We report paraprofessional-control and nurse-control differences with P < .10 given similar effects in a previous trial, earlier effects in this trial, and limited statistical power.
  
  
  RESULTS
  There were no significant paraprofessional effects on emotional/behavioral problems, but paraprofessional-visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years (effect size = -0.30, P = .08). There were no statistically significant paraprofessional effects on other primary outcomes. Nurse-visited children were less likely to be classified as having total emotional/behavioral problems at age 6 years (relative risk [RR] = 0.45, P = .08), internalizing problems at age 9 years (RR = 0.44, P = .08), and dysfunctional attention at age 9 years (RR = 0.34, P = .07). Nurse-visited children born to low-resource mothers compared with control-group counterparts had better receptive language averaged over ages 2, 4, and 6 years (effect size = 0.30, P = .01) and sustained attention averaged over ages 4, 6, and 9 years (effect size = 0.36, P = .006). There were no significant nurse effects on externalizing problems, intellectual functioning, and academic achievement.
  
  
  CONCLUSIONS
  Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching. Nurse-visited children showed improved behavioral functioning, and those born to low-resource mothers benefited in language and attention but did not improve in intellectual functioning and academic achievement.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00438282 and NCT00438594.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora.
authors.forename: David L
authors.initials: DL
authors.lastname: Olds
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora.
authors.forename: John R
authors.initials: JR
authors.lastname: Holmberg
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora.
authors.forename: Nancy
authors.initials: N
authors.lastname: Donelan-McCall
authors.affiliation: Department of Biostatistics and Informatics, Colorado Public School of Health, University of Colorado Denver, Aurora.
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Luckey
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Knudtson
authors.affiliation: Department of Human Development and Family Studies, University of Connecticut, Storrs.
authors.forename: Joann
authors.initials: J
authors.lastname: Robinson
mesh_terms: D002648:Child; D002657:Child Development; D002662:Child Health Services; D002669:Child Welfare; D003120:Colorado; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006792:House Calls; D006801:Humans; D017149:Private Sector; D017150:Public Sector; D000078329:Workforce