Quasinatural Experiment of Postnatal Home Visiting: An Independent Impact Study of Family Connects


      Family Connects (FC) is a postnatal nurse home visiting program that has scale-up potential because it is brief, inexpensive, and universal. Three investigations have linked Family Connects to improved maternal and family outcomes, but no independent impact studies have been conducted to date.


      This study investigates a FC program in Racine County, WI that was implemented by a multimunicipal health department in partnership with a local hospital. The sampling frame included all women who gave birth at the hospital from July 1, 2018 to August 31, 2019 (N=1,511). A quasinatural experiment resulted from systematically restricting FC recruitment to weekdays. All eligible women whose birth records and addresses were obtained from a vital records office were mailed a 6-month postpartum survey. Data collected from 489 respondents (32.4%) were analyzed in February 2022 to estimate the impact of FC on maternal health, infant health and development, and parenting behavior outcomes under intent-to-treat and per protocol assumptions.


      No significant differences were observed between study groups at baseline. Despite evidence that the FC program in Racine met many model standards for implementation fidelity, null effects were observed at 6 months after delivery for most outcomes. Results suggested that parents from eligible households reported more frequent infant emergency medical episodes than parents who were not offered the program.


      This study found few significant effects associated with FC participation. Further investigation is needed to identify the populations with and conditions under which the program produces its intended effects.
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        • Adirim T
        • Supplee L.
        Overview of the federal home visiting program.
        Pediatrics. 2013; 132: S59-S64
        • Sweet MA
        • Appelbaum MI.
        Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children.
        Child Dev. 2004; 75: 1435-1456
        • Filene JH
        • Kaminski JW
        • Valle LA
        • Cachat P.
        Components associated with home visiting program outcomes: a meta-analysis.
        Pediatrics. 2013; 132: S100-S109
        • Molloy C
        • Beatson R
        • Harrop C
        • Perini N
        • Goldfeld S.
        Systematic review: effects of sustained nurse home visiting programs for disadvantaged mothers and children.
        J Adv Nurs. 2021; 77: 147-161
        • Peacock S
        • Konrad S
        • Watson E
        • Nickel D
        • Muhajarine N.
        Effectiveness of home visiting programs on child outcomes: a systematic review.
        BMC Public Health. 2013; 13: 17
        • HHS
        • Administration for Children & Families
        Impacts on family outcomes of evidence-based early childhood home visiting: results from the Mother and Infant Home Visiting Program Evaluation. 2019; (Published January 18, Accessed December 27, 2021)
        • Duffee JH
        • Mendelsohn AL
        • Kuo AA
        • et al.
        Early childhood home visiting.
        Pediatrics. 2017; 140e20172150
        • Condon EM
        Maternal, Infant, and Early Childhood Home Visiting: A call for a paradigm shift in states’ approaches to funding.
        Policy Polit Nurs Pract. 2019; 20: 28-40
        • Dodge KA.
        Toward population impact from early childhood psychological interventions.
        Am Psychol. 2018; 73: 1117-1129
        • ASTHO
        State home visiting approaches improve early childhood outcomes and systems.
        ASTHO, Arlington, VA2018 (Accessed December 27, 2021)
        • May A
        • Poppe J.
        Early childhood home visiting: what legislators need to know.
        in: National Conference of State Legislatures, Washington, DC2019 (Accessed December 27, 2021)
      1. S690 State of New Jersey, 219th Legislatures. Updated July 29, 2021. Accessed December 27, 2021.

      2. S526. State of Oregon, 80th Legislative Assembly, 2019. Updated July 23, 2019. Accessed December 27, 2021.

        • Dodge KA
        • Goodman WB
        • Murphy RA
        • O'Donnell K
        • Sato J
        • Guptill S
        Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting.
        Am J Public Health. 2014; 104: S136-S143
        • Dodge KA
        • Goodman WB
        • Murphy RA
        • O'Donnell K
        • Sato J
        Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care.
        Pediatrics. 2013; 132: S140-S146
        • Goodman WB
        • Dodge KA
        • Bai Y
        • Murphy RA
        • O'Donnell K
        Effect of a universal postpartum nurse home visiting program on child maltreatment and emergency medical care at 5 years of age: a randomized clinical trial.
        JAMA Netw Open. 2021; 4e2116024
        • Goodman WB
        • Dodge KA
        • Bai Y
        • O'Donnell KJ
        • Murphy RA
        Randomized controlled trial of Family Connects: effects on child emergency medical care from birth to 24 months.
        Dev Psychopathol. 2019; 31: 1863-1872
        • Dodge KA
        • Goodman WB.
        Universal reach at birth: Family Connects.
        Future Child. 2019; 29: 41-60
        • Alonso-Marsden S
        • Dodge KA
        • O'Donnell KJ
        • Murphy RA
        • Sato JM
        • Christopoulos C
        Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment.
        Child Abuse Negl. 2013; 37: 555-565
        • Mersky JP
        • Choi C
        • Langlieb J
        • Lee CP
        • Chang P.
        Increasing equitable access to home visiting: an independent implementation study of Family Connects.
        J Soc Soc Work Res. 2022; (In press. Online February 2)
        • Hays RD
        • Bjorner JB
        • Revicki DA
        • Spritzer KL
        • Cella D.
        Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items.
        Qual Life Res. 2009; 18: 873-880
        • Yu L
        • Buysse DJ
        • Germain A
        • et al.
        Development of short forms from the PROMISTM sleep disturbance and sleep-related impairment item banks.
        Behav Sleep Med. 2011; 10: 6-24
        • Kroenke K
        • Spitzer RL
        • Williams JBW
        • Monahan PO
        • Löwe B.
        Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.
        Ann Intern Med. 2007; 146: 317-325
      3. Survey Description. National Health Interview Survey. 2018. Updated June 2019. Accessed December 27, 2021.

        • Glascoe FP.
        Parents’ Evaluation of Developmental Status: how well do parents’ concerns identify children with behavioral and emotional problems?.
        Clin Pediatr. 2003; 42: 133-138
        • Buuren S.
        Flexible Imputation of Missing Data.
        2nd ed. Chapman & Hall/CRC, Boca Raton, FL2018
        Date: Accessed December 27, 2021
        • Benjamini Y
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J R Stat Soc B. 1995; 57: 289-300
        • Evers AWM
        • Colloca L
        • Blease C
        • et al.
        Implications of placebo and nocebo effects for clinical practice: expert consensus.
        Psychother Psychosom. 2018; 87: 204-210
        • Kirsch I.
        Placebo effect in the treatment of depression and anxiety.
        Front Psychiatry. 2019; 10: 407
        • Benedetti F.
        Placebo Effects.
        Oxford University Press, Oxford, United Kingdom2020
        • Goodman WB
        • Dodge KA
        • Bai Y
        • Murphy RA
        • O'Donnell K
        Evaluation of a Family Connects dissemination to four high-poverty rural counties.
        Matern Child Health J. 2022; 26: 1067-1076
        • Goyal NK
        • Brown CM
        • Folger AT
        • Hall ES
        • Van Ginkel JB
        • Ammerman RT.
        Adherence to well-child care and home visiting enrollment associated with increased emergency department utilization.
        Matern Child Health J. 2020; 24: 73-81
        • Ruiz S
        • Snyder LP
        • Rotondo C
        • Cross-Barnet C
        • Colligan EM
        • Giuriceo K.
        Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use.
        Health Aff (Millwood). 2017; 36: 425-432
        • Lewandowsky S
        • Oberauer K.
        Low replicability can support robust and efficient science.
        Nat Commun. 2020; 11: 358
        • Shrout PE
        • Rodgers JL.
        Psychology, science, and knowledge construction: broadening perspectives from the replication crisis.
        Annu Rev Psychol. 2018; 69: 487-510
        • Gubbels J
        • van der Put CE
        • Stams G-JJM
        • Prinzie PJ
        • Assink M.
        Components associated with the effect of home visiting programs on child maltreatment: a meta-analytic review.
        Child Abuse Negl. 2021; 114104981
        • Snowden JM
        • Kozhimannil KB
        • Muoto I
        • Caughey AB
        • McConnell KJ.
        A “busy day” effect on perinatal complications of delivery on weekends: a retrospective cohort study.
        BMJ Qual Saf. 2017; 26: e1
        • Palmer WL
        • Bottle A
        • Aylin P.
        Association between day of delivery and obstetric outcomes: observational study.
        BMJ. 2015; 351: h5774
        • Miles M
        • Ryman TK
        • Dietz V
        • Zell E
        • Luman ET.
        Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature.
        Vaccine. 2013; 31: 1560-1568
        • Galea S
        • Tracy M.
        Participation rates in epidemiologic studies.
        Ann Epidemiol. 2007; 17: 643-653