title: Kentucky Health Access Nurturing Development Services Home Visiting Program Improves Maternal and Child Health.
abstract: Home visitation programs are one of the numerous efforts to help reduce the rates of preterm birth and low birth weight as well as offering other improvements in maternal and child health and development. The Kentucky Health Access Nurturing Development Services (HANDS) is a voluntary, home visiting program serving first-time, high-risk mothers. This study's objective was to evaluate the impact of HANDS on maternal and child health outcomes.
  
  
  
  HANDS administrative data, live birth certificate records and data from the Division of Child Protection and Safety were used in these analyses. We analyzed 2253 mothers who were referred to HANDS between July 2011 and June 2012 and received a minimum of one prenatal home visit (mean number of prenatal visits = 12.9) compared to a demographically similar group of women (n = 2253) who did not receive a visit. Chi square statistics and conditional logistic regression models were used to evaluate the impact of HANDS.
  
  
  
  HANDS participants had lower rates of preterm delivery (OR 0.74, 95% CI 0.61-0.88) and low birth weight infants (OR 0.54, 95% CI 0.44-0.67). HANDS participants also were significantly less likely to have a substantiated report of child maltreatment compared to controls (OR 0.53, 95% CI 0.43-0.65). HANDS participants also had an increase in adequate prenatal care and a reduction in maternal complications during pregnancy. Of particular important, outcomes improved as the number of prenatal home visits increased: among women receiving 1-3 prenatal home visits was 12.1%, the rate among women receiving 4-6 prenatal home visits was 13.2%, while the rate of PTB among those receiving 7 or more prenatal home visits was 9.4%.
  
  
  
  HANDS program participation appears to result in significant improvements in maternal and child health outcomes, most specifically for those receiving seven or more prenatal home visits. As a state-wide, large scale home visiting program, this has significant implications for the continued improvement of maternal and child health outcomes in Kentucky.
authors.affiliation: Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA. corrine.williams@uky.edu.
authors.forename: Corrine M
authors.initials: CM
authors.lastname: Williams
authors.affiliation: Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cprek
authors.affiliation: Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA.
authors.forename: Ibitola
authors.initials: I
authors.lastname: Asaolu
authors.affiliation: Kentucky Department for Public Health, Frankfort, KY, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: English
authors.affiliation: Kentucky Department for Public Health, Frankfort, KY, USA.
authors.forename: Tracey
authors.initials: T
authors.lastname: Jewell
authors.affiliation: Kentucky Department for Public Health, Frankfort, KY, USA.
authors.forename: Kylen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Kentucky Department for Public Health, Frankfort, KY, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Robl
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002649:Child Abuse / Q000706:statistics & numerical data; D000067576:Child Health / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006792:House Calls; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007629:Kentucky / Q000453:epidemiology; D000068097:Maternal Health / Q000592:standards* / Q000706:statistics & numerical data; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control; D011295:Prenatal Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: Child health; Child maltreatment; Development; Home visiting; Low birth weight; Preterm birth