New research from PolicyLab at The Children's Hospital of Philadelphia shows that one of the nation's largest programs providing home visitation support for at-risk mothers and children may not be as successful in reducing early childhood injuries as it was in earlier evaluations. The researchers evaluated the Nurse-Family Partnership (NFP) over seven years of widespread implementation in Pennsylvania and found that children served by the program had no fewer injuries than children in comparable families not enrolled in the program-and in some less serious cases, had higher injury rates. The results of the study are published in the current issue of Maternal Child Health Journal.
"A lot of evidence for the home visitation program had shown positive outcomes for mothers and children within the targeted geographic areas of randomized clinical trials," said David Rubin, MD, MSCE, co-director of PolicyLab and one of the study's authors. "Our research has previously reported on continued effectiveness for some of these outcomes as the service area grew larger, such as reducing rapid-succession second pregnancies and smoking among mothers. However, regrettably, this study failed to demonstrate the program's previous success in preventing child injuries."
The current peer-reviewed evaluation found that nearly one-third of the families served by NFP in Pennsylvania had emergency room visits for injuries to children from birth through the second birthday, a rate 12% greater than for families not enrolled in the program.
"We should not be surprised that there have been some bumps in the road as we increase the scale of home visiting programs. This research highlights the need to continue evaluating these programs after they have been implemented in communities," said the study's lead researcher Meredith Matone, MHS." Evaluation should focus on identifying local barriers that may be undermining a program's success. By identifying these barriers, we can foster smarter programs that are better equipped to serve families in diverse communities."
"This study points to an important lesson as states expand home visiting," said Libby Doggett, director of Pew's Home Visiting Campaign. "It's critical that programs monitor and evaluate, and use that data to constantly improve the services they provide."
The study authors stress that as programs like NFP achieve increased public funding, policymakers and program managers must allocate sufficient resources for effective program evaluation and quality improvement initiatives to ensure that programs respond quickly to challenges at the local level.
"This kind of study has its limitations, which the authors note in their paper. However, the PolicyLab findings were sufficiently important for us to take action to improve our implementation of the NFP as it is spread to new communities throughout the country," said NFP President and CEO Thomas R. Jenkins Jr. "The findings from PolicyLab's study over the past year have led us to add new training for nurses to enhance their effect on reducing serious childhood injuries among the families they serve. This adds to our ongoing continuous quality improvement work using thorough data collection and analysis. "