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Home-Visiting Study Explores Long-Term Benefits From Early Intervention

nurse_mom_toddler.jpgSupporting mothers in the first years of a child's life has benefits to those children that ripple outward for years, particularly for boys.

Researchers led by Nobel Prize-winning economist James J. Heckman re-examined the data gathered on mothers and children who participated in the Nurse-Family Partnership, a home-visiting program that connects medical professionals and women in their first pregnancy. The nurses in the program offer prenatal counseling and then visit the families periodically until the children turn 2. The report was published online by the National Bureau of Economic Research. 

Among the findings: 

  • The program had a positive effect on birth weight in boys;
     
  • By age 2, researchers could see improvements in home environment, parenting attitudes, and maternal mental health for the parents of both boys and girls; 

  • By age 6, boys and girls both showed cognitive benefits, while girls showed early socio-emotional skills improvement;

  • By age 12, boys showed continuing cognitive benefits. For girls, the benefits were much weaker at this age. 

This study is one of the first to tease out some of the underlying reasons behind why the program helps children, said Maria Rosales-Rueda, one of the study's authors. "Mothers matter a lot," she said.

The interactions with the nurses helped mothers with their parenting skills and reduce maternal anxiety, the researchers found. The nurses also encouraged mothers to reduce smoking, drinking and illegal drug use, which may have led to the higher birth weights of boys who were studied. 

Policymakers' attention has been focused on expanding preschool and these findings, while focused on interventions earlier in a child's life, should be seen as complementing those efforts, said Rosales-Rueda, an assistant professor of education policy at the University of California-Irvine. 

"Preschool is super important, school is super important, because children spend a lot of time at school," she said. "But children spend a lot of time with their families and their parents as well." 

The analysis was based on more than 700 women in the Memphis area who were evaluated between 1990 and 1993. Almost all of the participants in this study were were black, unmarried, and low-income. About two-thirds were under the age of 18.

In addition to prenatal support and parenting skills, the nurses in the partnership also helped mothers establish goals about work, education, and future pregnancies. 

The fact that boys appeared to benefit more from the program matches other research in the field, including a 2016 study of a North Carolina early-intervention program. Boys are more susceptible to influences in utero, so improving the health of the mothers may account for the positive effects on boys. The fact that the effects lasted so long for boys is in contrast to some studies of preschool interventions, whose benefits have been shown to "fade out" over time. 

The release of this paper comes at a time when early-learning advocates are pushing to renew federal funding of the Maternal, Infant, and Early Childhood Home Visiting program. Originally funded through the Affordable Care Act, MIECHV provides money to states to help pay for home-visiting programs, and the Nurse-Family Partnership is one of several home-visiting models that are funded through the federal program. Other home-visiting programs use trained counselors who are not nurses. Some work with families until a child enters kindergarten, rather than stopping at age 2. But all have the goal of getting children and families off to a strong start by focusing on teaching parenting skills. 

"The findings from these studies show there is a huge amount of development that takes place in birth to age 2 and beyond," Rosales-Rueda said. "There's a window of opportunity for investment." 

Photo courtesy of the Nurse-Family Partnership


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