The nation's premier nurse home-visiting program for first-time mothers led to lower public spending and better cognitive outcomes for their children at the time they reached adulthood, according to a pair of new studies published in the journal Pediatrics.
As part of the Nurse-Family Partnership program, nurses visit women at home to teach them parenting skills and do health checkups, beginning early in pregnancy and continuing through their child's second birthday. The nonprofit – which seeks to improve pregnancy outcomes, child health and development, and families' economic self-sufficiency – operates in 41 states and has served more than 286,000 families since its widespread launch in 1996.
Previous research shows the model has yielded promising results, prompting other groups to develop their own home-visiting programs; meanwhile, the federal government has allocated $400 million annually for such initiatives. But new findings from one of the program's first sites in Memphis, Tennessee, estimating the program's long-term effects on mothers and their children, are the first to explore how families fared nearly two decades later.
"It's rare for studies of early invention programs to examine early-intervention effects over an 18-year period," David Olds, a pediatrics professor at the University of Colorado, one of the studies' lead authors and Nurse-Family Partnership's founder, said in a statement.
In the early 1990s, researchers enrolled 742 pregnant women and teens from"disadvantaged" neighborhoods in the Memphis area, most of whom were low-income and black and two-thirds of whom were under 18. All of the participants received free transportation to prenatal appointments, as well as screenings and child development referrals, while 228 also received home visits from nurses during pregnancy and through two years after giving birth.
By the time they turned 18, children of women who both received nurse visits and were considered "least capable of coping with the adversities that come with living in poverty" had better language abilities and math scores than mothers who didn't receive the visits. They also saw a lower level of Supplemental Security Income for disability, and were more likely to graduate high school with honors.
The findings indicate the home visits had a "profound effect in laying the foundation for moms to reduce the impact of poverty and build stronger families," Frank Daidone, Nurse-Family Partnership's president and CEO, said in a statement.
Yet researchers also found the program didn't affect the 18-year-olds' behavioral health in areas of substance use, mental health issues and risky sexual behavior. And while girls whose mothers had received visits from a nurse later had fewer criminal convictions, boys had higher conviction rates for interpersonal violence – a finding that surprised researchers.
Nurse-Family Parnership's "promotion of sensitive, responsive care and avoidance of harsh treatment may have decreased parents' attention to setting effective limits, especially among noncompliant males," researchers said.
Among mothers, the program similarly had no effect on rates of maternal substance abuse, depression or anxiety, or on the amount of time mothers worked in the years after having their first child. But those who received home visits were more likely to get married or to live with a partner, and to report more confidence in their ability to manage challenges in their lives.
After follow-up reviews of state records and interviews with 618 women whose children were 18, mothers who had been visited by nurses also incurred approximately $17,310 less in costs through public programs like Medicaid, the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families. Women who were considered more psychologically resourceful saw even greater savings, which researchers attributed to future pregnancy planning.
In all, Nurse-Family Partnership cost around $12,580 per family in 2009 dollars, resulting in net savings of about $4,730 per family over the 18-year period, researchers found.
"There's no better public investment than investing in building stronger families," Daidone said. "Not only does the government save money, but youth and families prosper and communities thrive."