187 - Evaluation of an Australian randomized trial of nurse home visiting (right@home program): child outcomes in the first year of school

Poster Number: 187
Publication Number: 187.413

Anna Price, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Hannah Bryson, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Fiona K. Mensah, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Bridget Kenny, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Xiaofang Wang, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Francesca Orsini, MCRI, Melbourne, Victoria, Australia; Lisa Gold, Deakin University, Geelong, Victoria, Australia; Shalika Bohingamu Mudiyanselage, Deakin University, Burwood, 3125, Victoria, Australia; Lynn Kemp, Western Sydney University, Liverpool, New South Wales, Australia; Penny G. Dakin, n/a, Canberra, Australian Capital Territory, Australia; Tracey Bruce, Western Sydney University, Sydney, New South Wales, Australia; Maureen Makama, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Sharon Goldfeld, Murdoch Children's Research Institute, Melbourne, Victoria, Australia

Background: Nurse home visiting (NHV) is designed to redress the impacts of early adversity on family functioning and children’s developmental outcomes. In Australia, right@home (r@h) is the largest randomized controlled trial of NHV, embedded in the universal, well-child nursing service (the comparator), and delivered from pregnancy. When the program ended at children’s second birthdays, there were benefits to parent reported care, responsivity, and the home environment. Benefits to maternal mental health, family functioning, and child behavior emerged over ages 3-6 years. Notably, teacher assessment of children when they reach school is mostly absent from NHV trials.

Objective: To investigate impacts of the r@h program on children’s health, language, and learning in the first year of school.

Design/Methods: 722 pregnant women experiencing adversity were recruited from antenatal clinics across two states (Victoria, Tasmania) and randomized (363 program, 359 control). The r@h program offered 25 home visits focusing on promoting children’s learning and development via parenting and the home environment. In children’s first year of school (mean age 6.1 years) teachers completed the Strengths and Difficulties Questionnaire (SDQ), Social Skills Improvement System (SSIS), Childhood Executive Functioning Inventory (CHEXI), and reading and school adaptation items. Outcomes were compared between trial arms (intention to treat) using regression models accounting for stratification factors used during randomization, clustering (nurse/site-level), and pre-specified baseline variables. Missing data were handled using multiple imputation and inverse probability weighting techniques.

Results: Teachers assessed 327/722 (45%) children (173 intervention, 154 control). Estimated group differences on the SDQ, SSIS and CHEXI were consistently in favor of the r@h program with effect sizes (ES) ranging 0.03 to 0.2 (see Figure). There was statistical evidence of benefits for the CHEXI planning memory subscale (ES=0.20, 95%CI: 0.04; 0.37) and reading simple sentences (odds ratio=1.53, 95%CI: 1.03; 2.26).Conclusion(s): While benefits of r@h on child outcomes were small by the first year of school, effects were consistent across foundational skills necessary for school success. When considering the complexity of childhood inequities, NHV offers important, long-term protective benefits to children and families experiencing adversity.
Figure: Results of adjusted regression analyses comparing the two trial arms on continuous (top box) and categorical (bottom box) child outcomes, using multiply imputed and inverse probability weighted data.