Professor of Pediatrics, Psychiatry, and Preventive Medicine

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David Olds, PhD

• Professor of Pediatrics, Psychiatry, and
  Preventive Medicine
• University of Colorado
• Health Sciences Center

November 20, 2004
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Baltimore, 1970
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NURSE FAMILY PARTNERSHIP

• Program with power
• Make sense to parents
• Solid clinical underpinnings
• Nurse home visits from pregnancy through child
  age two
• Rigorously tested

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FAMILIES SERVED

• Low income pregnant women
• Usually teens
• Usually unmarried
• First-time parents

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THREE GOALS

• Improve pregnancy outcomes
• Improve child health and development
• Improve parents economic self-sufficiency

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Prenatal Health-Related Behaviors
Child/Adolescent Functioning
Child Neurodevelopmental Impairment
Antisocial Behavior Substance Abuse
Dysfunctional Caregiving
Program
Emotional/Behavior Dysregulation
Cognitive Impairment
Maternal Life Course
Closely Spaced Unplanned Pregnancy
Negative Peers
Welfare Dependence
Substance Abuse
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TRIALS OF PROGRAM
Elmira, NY
Memphis, TN
Denver, CO
N 400
N 1,138
N 735

• Low-income whites
• Semi-rural

• Low-income
• blacks
• Urban

• Large portion of Hispanics
• Nurse versus paraprofessional visitors

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CONSISTENT RESULTS ACROSS TRIALS

• Improvements in womens prenatal health
• Reductions in childrens injuries
• Fewer subsequent pregnancies
• Greater intervals between births
• Increases in fathers involvement
• Increases in employment
• Reductions in welfare and food stamps
• Improvements in school readiness

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Elmira Maltreatment Injuries (0 - 2 Years)

• 80 Reduction in Child Maltreatment
• (Poor, Unmarried Teens)
• 56 Reduction in Emergency Room Visits (12-24
  Months)

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100
60
Simultaneous Region of Treatment Differences (p lt
.10)
50
Abuse / Neglect
40
30
20
Comparison
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Nurse
0
9
10
11
12
13
14
Maternal Sense of Control
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ELMIRA SUSTAINABLE RESULTS Mothers

LOW-INCOME, UNMARRIED 15-YEAR FOLLOW-UP
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ELMIRA SUSTAINABLE RESULTS Adolescents

15-YEAR OLDS BORN TO UNMARRIED, LOW-INCOME MOTHERS
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Memphis Design

• Urban Setting
• Sample (N 1139 for prenatal and N 743 for
  postnatal)
• 92 African American
• 98 Unmarried
• 85 lt Federal Poverty Index
• 64 lt 19 years at intake

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Memphis Program Effects on Childhood Injuries (0
- 2 Years)

• 23 Reduction in Health-Care Encounters for
  Injuries Ingestions
• 80 Reduction in Days Hospitalized for Injuries
  Ingestions

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1.5
Comparison
1.0
Simultaneous Region of Treatment Differences (p lt
.05)
No. Health Care Encounters with
Injuries/Ingestions
0.5
Nurse
0.0
60
70
80
90
100
110
120
130
Mothers Psychological Resources
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3.5
3.0
2.5
No. Days Hospitalized with Injuries/Ingestions
2.0
Comparison
1.5
Simultaneous Region of Treatment Differences (p lt
0.05)
1.0
0.5
Nurse
0.0
60
110
120
130
80
90
100
70
Mothers Psychological Resources
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Diagnosis for Hospitalization in which Injuries
and Ingestions Were Detected Nurse-Visited (n204)

• Age Length
• (in months) of Stay
• Burns (10 20 to face) 12.0 2
• Coin Ingestion 12.1 1
• Ingestion of Iron Medication 20.4 4

Kitzman, H., Olds, D.L., Henderson, Jr., C.R., et
al. JAMA 1997 278 644-652.
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Diagnosis for Hospitalization in which Injuries
and Ingestions Were Detected - Comparison (n453)

• Age Length
• (in months) of Stay
• Head Trauma 2.4 1
• Fractured Fibula/Congenital Syphilis 2.4
  12
• Strangulated Hemia with Delay in Seeking
• Care/ Burns (10 to lips) 3.5 15
• Bilateral Subdural Hemotoma 4.9 19
• Fractured Skull 5.2 5
• Bilateral Subdural Hemotoma (Unresolved)/
• Aseptic Meningitis - 2nd hospitalization
  5.3 4
• Fractured Skull 7.8 3
• Coin Ingestion 10.9 2
• Child Abuse Neglect Suspected 14.6 2
• Fractured Tibia 14.8 2
• Burns (20 face/neck) 15.1 5
• Burns (20 30 bilateral leg) 19.6 4
• Gastroenteritis/Head Trauma 20.0 3
• Burns (splinting/grafting) - 2nd
  hospitalization 20.1 6
• Finger Injury/Osteomyelitis 23.0 6

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Enduring Effects on Maternal Life-Course in
Memphis

• 31 Fewer Closely Spaced (lt6 months) Subsequent
  Pregnancies
• 50 Fewer Subsequent Therapeutic Abortions
• 30 Fewer Subsequent Admissions to Neonatal
  Intensive Care
• 3.64 Fewer Months of Welfare Use
• 32 Increase in Father Presence in Household
• 50 Increase in Marriage

Kitzman, Olds, Sidora, et al. Journal of the
American Medical Association, April 19, 2000
1983-1989.
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Growing Effects on Child Development Memphis
6-Year

• Higher IQs
• Better language development
• Fewer dysregulated incoherent narrations
• Fewer mental health problems

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Child Intellectual Functioning 6-Years (Low-Resour
ce Mothers)
P .03, ES .25
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Child Dysregulated Aggression 6-Years (Low-Resourc
e Mothers)
P .04, ES -.25
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Child Incoherent Stories () 6-Years (Low-Resource
Mothers)
P .03, ES .25
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Child Mental Health Total Problems
(Borderline/Clinical) 6-Years
P .04, OR .32
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Denver Maternal Characteristics
Married 13 Mexican American 46 African
American 17 European American (Non-Hispanic)
35 Monolingual Spanish Speakers
4 Cigarette Smokers 25
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Change in Cotinine From Intake to End of Pregnancy
100
Change In Cotinine
0
Control -36.6
Para -73.8
-100
-200
Nurse -235.6
-300
-400
P lt .05
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Infant Low Emotional Vitality Anger Stimuli -
6-Months (Low-Resource Mothers)
PC-P .21, ORC-P .63 PC-N .01, ORC-N .33
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Preschool Language Scale 21 months (Born to
Low-Resource Mothers)
PC-N .04
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Preschool Language 4 years (Low-Resource
Mothers)
PC-P .13, ESC-P .23 PC-N .04, ESC-N .31
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Child Executive Functioning Index
4-Years (Low-Resource Mothers)
Pc-p .06, ESC-P .29 Pc-n .000, ESC-N .47
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Benefits Minus Costs of Child Welfare Home
Visiting Programs

• Nurse Family Partnership
• Home Visiting for at-risk mothers/children
• Parent-child interaction therapy
• System of care/wrap around programs
• Family Preservation Services Programs
• Healthy Families America
• Comprehensive Child Development Program
• Infant Health and Development Program

• 17,180
• 6,197
• 3,427
• -1,914
• -2,531
• -4,569
• -37,397
• -49,021

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NATIONAL REPLICATION
Now operating in over 250 counties in 23 states,
serving over 12,000 families per year.
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FROM SCIENCE TO PRACTICE

• Nurturing Community, Organizational, and State
  Development
• Training and Technical Assistance
• Program Guidelines
• Clinical Information System
• Assessing Program Performance
• Continuous Improvement

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