A fascinating study, recently released in Pediatrics (10.1542/peds.2020-049610), reports on 7-year maternal and child outcomes of a prenatal and infancy home visiting program for disadvantaged mothers in Germany. The authors, Drs. Kleim and Sandner, asked whether a home visiting program modelled on the Nurse Family Partnership (NFP) program would prove as helpful to mothers and children in their native Germany as it has been in the United States. While other European countries have performed randomized trials of NFP-modelled programs, none to date have documented school age outcomes.
Conducted in the German federal states of Bremen, Lower Saxony and Saxony, this study enrolled 755 expectant first-time mothers who had both economic and social risk factors and randomized 391 to a control group (CG) and 394 to an intervention group (IG). The IG began home visits during pregnancy (12th-28th week) and continued these till the index child was 2 years old. Like the NFP, home visits were structured and protocolized, although here conducted by midwives or social workers. IG mothers experienced a mean of 32.7 home visits lasting a mean of 82 minutes each, documenting good adherence to protocol; follow up of both groups included interviews and phone calls with trained study team members blinded to intervention received. Although at this 7-year time point nearly a third of each group (CG [29.1%] and IG [30.6%]) had dropped out (primarily due to loss of contact information), the authors describe transparently how missing data were managed so as not to jeopardize the validity and reliability of the results.
The outcomes are well organized and described – you may want to start with Table 1 which lists 8 hypotheses in the 3 main domains of (1) Child development and life satisfaction, (2) Adverse parenting, maternal abusive and neglectful parenting, and (3) Maternal mental health and life satisfaction. I don’t want to spoil your journey through the results, but certainly it is notable that IG mothers, as compared to CG mothers, reported fewer child Total Problem Behaviors (ES=0.21, 95% CI: 0.03 to 0.38; p=.02) and Internalizing Behaviors (ES=0.26, 95% CI: 0.08 to 0.44; p=.02), with a similar but nonsignificant trend for Externalizing Behaviors (ES=0.17, 95% CI: -0.01 to 0.34; p=.05). Not all results showed a benefit of the intervention, and some interesting differences by child sex are identified. For comparison you may enjoy a systematic review on the topic1, which found that each eligible study with sustained home visiting showed evidence of a statistically significant positive effect on at least one child or maternal outcome. While home visiting is not a panacea for all that ails, it seems to do a lot of good at many points in the life course, and the excellent 7-year outcome study discussed here demonstrates that these good outcomes happen “across the pond” too.
- Molloy C, Beatson R, Harrop C, Perini N, Goldfeld S. Systematic review: Effects of sustained nurse home visiting programs for disadvantaged mothers and children. J Adv Nurs. 2021 Jan;77(1):147-161. doi: 10.1111/jan.14576. Epub 2020 Oct 10. PMID: 33038049.