Has a community health worker home visiting randomized trial improved the health of newborn children?

Objectives: Infant health is a predictor of many subsequent outcomes, such as school enrollment, socioeconomic status, child and adult health, and labor market success. Low socioeconomic status of mothers is associated with relatively poor health outcomes of the infants. This study tests whether an enhanced home visiting program, a Nurse-CHW Team improved infant health compared to the usual Medicaid sponsored nurse home visits.

Materials and methods: Low income, Medicaid-eligible pregnant women were randomly assigned in a longitudinal, randomized controlled trial to either a Nurse-CHW team home visiting intervention or the usual nurse home visiting services and followed-up until the infant was one year of age. Infant health indicators, along with mother characteristics and behaviors, were surveyed at birth, at 6 months of age and at 12 months of age. Descriptive statistics will show preliminary evidence on whether the “treatment” group of infants had better health outcomes compared to the “control” group. To disentangle the effect of the intervention from potential differences between groups that might be correlated with infant health, I will perform treatment-effect multiple regression analysis, controlling for child and mother characteristics.

Principal findings: Compared to the standard home visits teams, the nurse-CHW teams reached a higher percentage of pregnant mothers, who also received more than twice the number of visits of the control group. All the infants in treatment group had at least 1 checkup, while three in the control group had no checkups by 6 months of age. A higher percentage of infants in the treatment group had no hospital stays by 6 months of age. The infants in the control group seem to have better overall mother-assessed health, both by 6 months of age and by 12 months. However, infants in the treatment group were less likely to have difficulties seeing or blindness, to have a serious condition such as Down syndrome or Turner's syndrome, or to have asthma problems by 6 months of age and between 6 and 12 months of age. Infants in the treatment group were also less likely to have heart problems by 6 months of age.

Conclusion: A nurse-CHW team home visiting approach better engaged low-income women with Medicaid insurance, and increased the intensity of services, when compared to a traditional community care that included nurse home visiting in a state sponsored Medicaid program. The intervention seems to have improved some infant health outcomes.