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David Olds, PhD

David Olds, PhD. Professor of Pediatrics, Psychiatry, and Preventive Medicine University of Colorado Health Sciences Center. November 20, 2004. Baltimore, 1970. NURSE FAMILY PARTNERSHIP. Program with power Make sense to parents Solid clinical underpinnings

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David Olds, PhD

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  1. David Olds, PhD Professor of Pediatrics, Psychiatry, and Preventive Medicine University of Colorado Health Sciences Center November 20, 2004

  2. Baltimore, 1970

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

  4. FAMILIES SERVED • Low income pregnant women • Usually teens • Usually unmarried • First-time parents

  5. THREE GOALS • Improve pregnancy outcomes • Improve child health and development • Improve parents’ economic self-sufficiency

  6. 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

  7. 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

  8. CONSISTENT RESULTS ACROSS TRIALS • Improvements in women’s prenatal health • Reductions in children’s 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

  9. Elmira Maltreatment & Injuries (0 - 2 Years) • 80% Reduction in Child Maltreatment (Poor, Unmarried Teens) • 56% Reduction in Emergency Room Visits (12-24 Months)

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

  11. Verified reports of child abuse and neglect 79% Behavioral problems due to drug or alcohol use 44% Arrests 69% ELMIRA SUSTAINABLE RESULTS: Mothers LOW-INCOME, UNMARRIED 15-YEAR FOLLOW-UP

  12. Arrests 54% Convictions 81% Sexual Partners 63% Number of days consuming alcohol 56% ELMIRA SUSTAINABLE RESULTS: Adolescents 15-YEAR OLDS BORN TO UNMARRIED, LOW-INCOME MOTHERS

  13. Memphis Design • Urban Setting • Sample (N = 1139 for prenatal and N = 743 for postnatal) • 92% African American • 98% Unmarried • 85% < Federal Poverty Index • 64% < 19 years at intake

  14. 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

  15. 1.5 Comparison 1.0 Simultaneous Region of Treatment Differences (p < .05) No. Health Care Encounters with Injuries/Ingestions 0.5 Nurse 0.0 60 70 80 90 100 110 120 130 Mothers’ Psychological Resources

  16. 3.5 3.0 2.5 No. Days Hospitalized with Injuries/Ingestions 2.0 Comparison 1.5 Simultaneous Region of Treatment Differences (p < 0.05) 1.0 0.5 Nurse 0.0 60 70 80 90 100 110 120 130 Mothers’ Psychological Resources

  17. Diagnosis for Hospitalization in which Injuries and Ingestions Were Detected Nurse-Visited (n=204) • 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.

  18. Diagnosis for Hospitalization in which Injuries and Ingestions Were Detected - Comparison (n=453) • 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

  19. Enduring Effects on Maternal Life-Course in Memphis • 31% Fewer Closely Spaced (<6 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.

  20. Growing Effects on Child Development Memphis 6-Year • Higher IQ’s • Better language development • Fewer dysregulated & incoherent narrations • Fewer mental health problems

  21. Child Intellectual Functioning 6-Years (Low-Resource Mothers) P = .03, ES = .25

  22. Child Dysregulated Aggression 6-Years (Low-Resource Mothers) P = .04, ES = -.25

  23. Child Incoherent Stories (%) 6-Years (Low-Resource Mothers) P = .03, ES = .25

  24. Child Mental Health % Total Problems (Borderline/Clinical) 6-Years P = .04, OR = .32

  25. Denver Maternal Characteristics Married 13% Mexican American 46% African American 17% European American (Non-Hispanic) 35% Monolingual Spanish Speakers 4% Cigarette Smokers 25%

  26. 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 < .05

  27. % Infant Low Emotional Vitality Anger Stimuli - 6-Months (Low-Resource Mothers) PC-P =.21, ORC-P = .63; PC-N = .01, ORC-N = .33

  28. Preschool Language Scale 21 months (Born to Low-Resource Mothers) PC-N = .04

  29. Preschool Language – 4 years (Low-Resource Mothers) PC-P = .13, ESC-P = .23; PC-N = .04, ESC-N = .31

  30. Child Executive Functioning Index 4-Years (Low-Resource Mothers) Pc-p = .06, ESC-P = .29; Pc-n = .000, ESC-N = .47

  31. 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 Benefits Minus Costs of Child Welfare & Home Visiting Programs

  32. NATIONAL REPLICATION Now operating in over 250 counties in 23 states, serving over 12,000 families per year.

  33. 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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