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

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1 David Olds, PhD Professor of Pediatrics, Psychiatry, and Preventive Medicine University of Colorado Health Sciences Center November 21, 2005 Centre of Excellence for Early Childhood Development Montreal, November 21, 2005

2 Baltimore, 1970

3 High-Risk Neighborhoods No sources of healthy food Unemployment No decent housing Unsafe play areas Crime

4 Research Team Cornell John Eckenrode Chuck Henderson Charlie Izzo Rochester Harriet Kitzman Bob Cole Kim Sidora Kathy Buckwell Beth Anson Baylor Carole Hanks Colorado David Olds Ruth O Brien JoAnn Robinson Lisa Pettitt Dennis Luckey John Holmberg Kathy Isacks Rosanna Ng Robin Tutt

5 NURSE FAMILY PARTNERSHIP Program with power Nurses visit families from pregnancy through child age two Makes sense to parents Solid empirical & theoretical underpinnings Focuses on parental behavior and context Rigorously tested

6 FAMILIES SERVED Low income pregnant women Usually teens Usually unmarried First-time parents

7 THREE GOALS 1. Improve pregnancy outcomes 2. Improve child health and development 3. Improve parents economic selfsufficiency

8 Prenatal Health-Related Behaviors Program Dysfunctional Caregiving Child Neurodevelopmental Impairment Emotional/Behavior Dysregulation Cognitive Impairment Child/Adolescent Functioning Antisocial Behavior Substance Abuse Maternal Life Course Closely Spaced Unplanned Pregnancy Welfare Dependence Negative Peers Substance Abuse

9 TRIALS OF PROGRAM Elmira, NY 1977 Memphis, TN 1987 Denver, CO 1994 N = 400 Low-income whites Semi-rural Low-income blacks Urban N = 1,138 N = 735 Large portion of Hispanics Nurse versus paraprofessional visitors

10 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

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

12 100 % Abuse / Neglect Simultaneous Region of Treatment Differences (p <.10) Comparison Nurse Centre of excellence for Early Childhood Development Maternal Sense of Control

13 Centre of excellence for Early Childhood Development

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

15 Maltreatment Reports Involving the Study Child by Treatment Status and Domestic Violence 2 Comparison Number of CPS Reports 1 Simultaneous Region of Treatment Differences (p <.05) NV Preg+Inf Domestic Violence Centre of excellence for Early Childhood Development

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

17 Memphis Design Urban Setting Sample (N = 1138 for prenatal and N = 743 for postnatal) 92% African American 98% Unmarried 85% < Federal Poverty Index 64% < 19 years at intake

18 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

19 Diagnosis for Hospitalization in which Injuries and Ingestions Were Detected Nurse-Visited (n=204) Age (in months) Length of Stay Burns (1 0 & 2 0 to face) Coin Ingestion Ingestion of Iron Medication Kitzman, H., Olds, D.L., Henderson, Jr., C.R., et al. JAMA 1997; 278:

20 Diagnosis for Hospitalization in which Injuries and Ingestions Were Detected - Comparison (n=453) Age Length (in months) of Stay Head Trauma Fractured Fibula/Congenital Syphilis Strangulated Hemia with Delay in Seeking Care/ Burns (1 0 to lips) Bilateral Subdural Hemotoma Fractured Skull Bilateral Subdural Hemotoma (Unresolved)/ Aseptic Meningitis - 2nd hospitalization Fractured Skull Coin Ingestion Child Abuse Neglect Suspected Fractured Tibia Burns (2 0 face/neck) Burns (2 0 & 3 0 bilateral leg) Gastroenteritis/Head Trauma Burns (splinting/grafting) - 2nd hospitalization Finger Injury/Osteomyelitis

21 No. Days Hospitalized with Injuries/Ingestions Comparison Nurse Simultaneous Region of Treatment Differences (p < 0.05) Centre of excellence for Early Childhood Development Mothers Psychological Resources

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

23 Maternal Characteristics Denver 46% Mexican American 17% African American 35% European American (Non-Hispanic) 4% Monolingual Spanish Speakers 87% Unmarried 25% Cigarette Smokers

24 Denver Design 735 Families Nurses N=236 Paraprofessionals N=244 Controls N=255

25 Pattern of Denver Program Effects Maternal and Child Functioning Comparison Para Nurse

26 100 Change in Cotinine From Intake to End of Pregnancy Change In 0 Cotinine -100 Control Para Nurse * -400 *Pc-n <.05

27 Preschool Language Scale 21 months (Born to Low-Resource Mothers) Comparison Para Nurse P C-N =.04, ES =.40

28 Executive Functioning Index - 4-Years (Born to Low-Resource Mothers) Comparison Para Nurse P c-p =.06, ES =.29; P c-n =.000, ES =.47

29 Preschool Language Scale - 4-Years (Born to Low-Resource Mothers) Comparison Para Nurse P c-n =.04, ES =.31

30 Washington State Institute for Public Policy Economic Analysis Focus on prevention and early intervention programs for children and youth Reduce crime Lower substance abuse Improve educational outcomes Decrease teen pregnancy Reduce suicide attempts Lower child abuse and neglect Reduce domestic violence

31 WSISP Methods Program must have rigorous evaluation Program must be capable of replication in real world Analyzed both specific programs and groups of program types Discounted programs tested with nonrandomized designs Discounted programs not tested in realworld settings Internally consistent analyses across programs

32 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

33 Benefits Minus Costs of Pre- Kindergarten Education Programs Early Childhood Education for Low- Income 3- & 4-Year Olds HIPPY (Home Instruction Program for Preschool Youngsters) Parents as Teachers Parent-Child Home Program Even Start Early Head Start $9,901 $1,476 $800 -$3,890 -$4,863 -$5,665

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

35 FROM SCIENCE TO PRACTICE Nurturing Community, Organizational, and State Development Training and Technical Assistance Program Guidelines Clinical Information System Assessing Program Performance Continuous Improvement

36

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