Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial

The Family Connects (FC) program, a community-wide nurse home visiting program for newborns, has been shown to provide benefits such as increased connections to community resources, higher-quality home environments and parenting during infancy, reduced postpartum mental health symptoms, and a 37% reduction in child emergency medical care use through 24 months of age. The current study aimed to use randomization to assess the effectiveness of the FC program on child maltreatment investigations and emergency medical care through 5 years of age. Discharge records for all county births at the 2 Durham County birthing hospitals were reviewed for possible inclusion in the study. In total, the families of all 4777 resident births were randomly assigned a priori to intervention or treatment based on infant birth date between July 1, 2009, and December 31, 2010. Families of all 2327 even-date births were assigned to receive the FC program and families of all 2450 odd-date births were assigned to receive treatment as usual. Control families were not offered the FC program but received all other services in the community. Independent of the RCT implementation, investigators selected a random subsample of 549 families from the full population of 4777 families to participate in an impact evaluation study beginning when the infant was 6 months of age and allowing study access to child hospital and maltreatment administrative records through 5 years of age. The FC programs include 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs and brief educational interventions for all families such as feeding practices using a high-inference approach combining parent self-report, direct observation, and nurse clinical judgment. The two primary trial outcomes used to assess effectiveness were CPS-recorded child maltreatment investigations and emergency medical care use based on hospital records. Of the 4777 randomized families, 2327 were allocated to the intervention, and 2440 were allocated to services as usual. Study results demonstrate that random assignment to receive short-term, universal postpartum home visits from a nurse is associated with reduced child maltreatment rates and emergency medical care use through 5 years of age. Random assignment to the FC program was associated with a 39% decrease in the mean number of CPS investigations for suspected maltreatment and a 33% decrease in the mean rate of emergency medical care use. The effect of randomization to the FC program held across every subgroup tested, including families with high and low child medical risk at birth, Medicaid or no health insurance and private insurance, single-parent and 2-parent families, racial/ethnic nonminority and minority status, and child sex.