2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

335074
Improving child health with a home visitation program: A PATHS Equity Project


Wednesday, November 4, 2015 : 1:10 p.m. - 1:20 p.m.

Mariette Chartier, RN, PhD, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Nathan Nickel, MPH, PhD, Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Marni Brownell, PhD, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Dan Chateau, PhD, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Alan Katz, MBChB, MSc, CCFP, Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Elaine Burland, PhD, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Micahel Issac, MD, MPH, Northern Regional Health Authority, Winnipeg, MB, Canada
Joykrishna Sarkar, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Carole Taylor, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Chun Yan Goh, MSc, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
Audio (mp3) recording Recorded Presentation (mp4)
Background: The objective of this study was to evaluate the impact of a home visitation program – in existence in Manitoba since 1999 – on immunization rates, injury from maltreatment, and whether or not a child is apprehended by family services.

Methods: Program data – including screening data – were linked to administrative data in the Population Health Research Data Repository comprising de-identified data on all contacts with the heath system and social services for 99% of the population. Our sample included all children eligible for the program based on their screen: 4575 who received the program and 5185 eligible controls who did not participate. We used generalized linear models to estimate risk ratios (RR) to test whether the program was associated with improved outcomes. We used 30 variables from the administrative and screen data to generate propensity scores. Propensity scores were used to construct inverse probability of treatment weights to adjust for measured confounding.

Results:  After linking program and administrative data, we found that the program was associated with improvements in 2 year immunization (RR 1.10, p<0.05). The program was associated with reduced hospitalizations due to child maltreatment (RR 0.53, p<0.01). The program was associated with reduced child apprehensions into child and family services (RR 0.79, p<0.05). Sensitivity analyses showed that these associations were robust to modest levels of unmeasured confounding.

Conclusion: Home visiting programs – as implemented in Manitoba – may improve child health outcomes and reduce maltreatment and apprehension into care.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related nursing
Public health or related research

Learning Objectives:
Describe the benefits for using population-based administrative data for evaluating a home visitation program. Evaluate methodological approaches to adjust for confounding in evaluation research. Explain a sensitivity analysis to assess the sensitivity of findings to unmeasured confounding. Explain mechanisms by which a home visitation program can improve child health Describe the benefits of a paraprofessional home visitation program for improving child health.

Keyword(s): Child Health Promotion, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been principal investigator on nationally funded grants using administrative data to evaluate program/policy impact on health and health equity. I have published peer-review articles evaluating the impact of programs on health equity and child health. I teach graduate level courses in evaluation methods and health services research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5165.0: Infant & Child Health Oral Session 3