Home nurse visits for disadvantaged mums improves child educational outcome

Home nurse visits for disadvantaged mothers is linked to improved cognitive functioning and academic performance in children in the US, according to new research from UCL, University of Colorado and University of Rochester, New York.

Two studies, published today in the journal Pediatrics , examine the effects of a free nurse home visiting programmes for first time mothers in an 18-year follow-up of a randomized clinical trial. Study one followed the children and study two examined the effects on the mothers.

Dr Gabriella Conti (UCL Economics and Social Sciences), co-author on the studies, said: "We now have evidence from the largest ever longitudinal evaluation of the US Nurse-Family Partnership, demonstrating that nurse home visits are clearly beneficial for young mothers and their children."

The two studies followed 742 low income first-time mothers, primarily African American, and their children, who were part of the Nurse-Family Partnership (NFP) programme in Memphis, Tennessee, from June 1990 through to September 2014.

Among those, 514 were provided free transportation for scheduled prenatal care plus developmental screening and referral for children at 6, 12, and 24 months of age, while the other 228 mothers were randomly assigned to receive the same services as the control group, plus nurse home visits up to age two.

Nurse-visited children had improved cognitive outcomes compared to children in the control group. These benefits were observed for children born to high-risk mothers with limited psychological resources to cope with poverty, that is, those with below average IQ, mental health and confidence in their ability to manage life challenges.

The child outcomes at age 18 included: improved math achievement scores, receptive language abilities, working memory, and ability to accurately read others’ emotions. In addition, the nurse-visited children were three times more likely to graduate from high school with honours compared to the control group. Also, at age 18, the proportion of nurse-visited children receiving supplemental security income for disability was 64.2% lower than that of the control group.

Nurse-visited female children born to all mothers participating in Nurse-Family Partnership had fewer convictions at age 18 than female children in the control group.

"It’s rare for studies of early invention programs to examine early-intervention effects over an 18-year period. This early intervention, Nurse-Family Partnership, produced long-term improvements in the cognitive functioning of 18-year-olds born to mothers who had limited personal resources to cope with the adversities of living in deep poverty. This new evidence shows promise that Nurse-Family Partnership’s effects may carry over into adulthood," said Professor David Olds (University of Colorado) and one of the lead investigators of the studies.

The mothers that participated in the nurse home visits programme found that when their first child was 18 years old, they had saved the government $17,310 (equivalent to approximately 13,468) in public benefits compared to women in the control group.

Dr Conti said: "There was less of a need for benefits like food stamps and Medicaid for mothers in the programme. This is because these women typically had fewer children and were more likely to be married. The mothers seem to take better care of themselves."

Nurse-visited mothers, when compared to the control group, were more likely to get married over the 18-year follow-up period and had higher rates of co-habitation. These mothers also had more confidence in their ability to manage life challenges. At the 18-year assessment, nurse-visited mothers had spouses who were employed 14 months more than those in the control group.

The NFP is a voluntary home-visiting programme for first-time mothers aged 18 and under. Mothers are partnered with a specially trained family nurse who visits them regularly, from early pregnancy until the child is two.

The programme is being delivered in England, Scotland, Northern Ireland, Norway, Bulgaria, Canada, and Australia (13 sites serving aboriginal families). In England, the Family Nurse Partnership (UK equivalent of the NFP) is commissioned through local authorities.


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