New research from PolicyLab shows that one of the nation's largest programs providing home visitation support for at-risk mothers and children may not be as successful in reducing early childhood injuries as it was in earlier evaluations. The researchers evaluated the Nurse-Family Partnership (NFP) over seven years of widespread implementation in Pennsylvania and found that children served by the program had no fewer injuries than children in comparable families not enrolled in the program — and in some less serious cases, had higher injury rates.

The study was published in the current issue of Maternal Child Health Journal.

"A lot of evidence for the home visitation program had shown positive outcomes for mothers and children within the targeted geographic areas of randomized clinical trials," said David Rubin, MD, MSCE, co-director of PolicyLab and one of the study's authors.

"Our research has previously reported on continued effectiveness for some of these outcomes as the service area grew larger, such as reducing rapid-succession second pregnancies and smoking among mothers. However, regrettably, this study failed to demonstrate the program's previous success in preventing child injuries," Dr. Rubin added.

The evaluation found that nearly one-third of the families served by NFP in Pennsylvania had emergency room visits for injuries to children from birth through the second birthday, a rate 12 percent greater than for families not enrolled in the program.

"We should not be surprised that there have been some bumps in the road as we increase the scale of home visiting programs. This research highlights the need to continue evaluating these programs after they have been implemented in communities," said the study's lead researcher Meredith Matone, MHS. "Evaluation should focus on identifying local barriers that may be undermining a program's success. By identifying these barriers, we can foster smarter programs that are better equipped to serve families in diverse communities."

The study authors stress that as programs like NFP achieve increased public funding, policymakers and program managers must allocate sufficient resources for effective program evaluation and quality improvement initiatives to ensure that programs respond quickly to challenges at the local level.