Randomized Controlled Trial (RCT) of...
Nurse-Family Partnership in South Carolina – Home Visiting for Low-Income, First-Time Mothers
Reviewed
JAMA Pediatrics (June 2025) published a large RCT of the Nurse-Family Partnership – a nurse home visiting program for low-income, first-time mothers – as implemented in South Carolina. This high-quality RCT found no impact on its primary child health-related outcome – likelihood of injury, abuse, or neglect during the first two years of life.
Relevant Excerpt from the Published Abstract:
Intervention The treatment group was offered NFP home visits during pregnancy and 2 years postpartum, while the control group received usual care.
Main Outcomes and Measures The primary outcome was a composite measure that included child mortality and claims related to major injury or concern for abuse or neglect within the first 2 years of life. Secondary outcomes included emergency department utilization and preventive health care measures, such as well-child visits and their components, including screenings for cognitive development, blood lead levels, fluoride varnish application, and dental health. We used an intent-to-treat approach with a linear regression model to estimate the treatment effect of NFP on early childhood outcomes by comparing participants assigned to the control and treatment group, regardless of whether they used NFP services.
Results Among enrolled participants, 4932 individuals were tracked to a live birth (3295 in the intervention group and 1637 in the control group) and were analyzed for child health and utilization outcomes once their child turned 2 years old. Mean (SD) participant age was 22.5 (4.7) years. The incidence of the composite adverse outcome was 27.3% and 26.8% in the intervention and control groups, respectively (adjusted between-group difference, 0.4 percentage points; 95% CI, −2.3 to 3.0), with no statistically significant differences between elements of the composite primary outcome. Among participants assigned to receive NFP, their children were less likely to use the emergency department by 2.9 percentage points (95% CI, −5.5 to −0.3), a 4% reduction relative to the rate of 72.8% in the control group. Once we adjusted for multiple hypothesis testing, this outcome was no longer statistically significant. Assignment to NFP did not significantly impact the likelihood of receiving the guideline number of well-child visits or preventive services.
Conclusions and Relevance In this randomized clinical trial, assignment to intensive nurse home visiting services did not reduce the likelihood of adverse outcomes in early childhood measured through administrative data. More evidence is needed to understand whether delivering intensive home visiting services at scale to a Medicaid population influences other child outcomes, including longer-term developmental outcomes.
We have no suggested revisions to the study abstract.
No-Spin’s Study Overview
High-quality RCT of the Nurse Family Partnership (NFP) home visiting program for low-income, first-time mothers, conducted in South Carolina, finds no impact on the study’s primary child health-related outcome – likelihood of injury, abuse, or neglect during the first two years of life.
Program:
- NFP is an established nurse home visiting program for first-time mothers – mostly low-income and single. Nurses visit the women biweekly or monthly during pregnancy and the first two years of their child’s life, providing education, assessments, and goal-setting related to prenatal health, child health and development, and maternal life course.
Study Design:
- The study randomized 5,670 pregnant, Medicaid-eligible women without previous children in South Carolina to NFP (treatment) or services as usual (control). Sample members averaged 22.5 years of age. 55% were Black and 6% were Hispanic.
- Based on careful review, this was a high-quality RCT (e.g., baseline balance, low attrition, successful program implementation, preregistered analyses).
Findings:
- The study found no effect on its primary, composite outcome related to child health: likelihood of a healthcare encounter or mortality associated with major injury or suspected abuse or neglect during the first two years of life. 27.3% of treatment families experienced this outcome vs. 26.8% of control families – a difference that was not statistically significant.
- In addition, the study found no discernible effect on this outcome for the primary subgroup of interest – socially-vulnerable women, defined as those who at baseline were younger than 19, had not finished high school, or had challenges with mental health.
Comment:
- As reported in previous papers (1,2), the study also found no discernible effects on its two other preregistered primary outcomes: rate of adverse birth outcomes, and mothers’ rate of subsequent births within 21 months.
- Arnold Ventures, which funds No-Spin Evidence Review, helped fund the NFP South Carolina RCT.
Click or tap a highlight to see No-Spin’s comment