Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Continuity of Care (Caseload), Midwifery, Home Visit (caregiver),

Intervention Description: A model pilot program was established in South Australia to address the ongoing closure of regional maternity services and bring sustainable birthing services to the area with the aim of keeping birthing as close to home as safely possible. This Midwifery Caseload Model of Care (MMoC) model was an all-risk model or care whereby 12.9 full-time equivalent midwives were employed to work in collaboration with general practitioners (GP)/obstetricians across five birthing sites (Port Pirie, Crystal Brook, Wallaroo, Clare and Jamestown). In the MMoC all pregnant women in the region could be referred to the program and allocated to a known midwife once pregnancy had been confirmed. Care was then provided by the MMoC midwife and an obstetric GP or obstetrician. The service delivery model prioritized choice and interdisciplinary care. An anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period.

Intervention Results: Most women (97%) received a postnatal visit from a MMoC midwife and 84.1% reported the MMoC midwives were their main postpartum care provider. Shared care GP/MMoC midwives accounted for 8.9% (n = 17) and 6.9% (n = 13) indicated they had “other” postnatal care such as child and family health nurse, midwives and nurses at the birth hospital, and midwives at referral hospital due to baby’s prematurity. Overall women had an average of four postnatal visits. Close to a third of women (32.5%) had six or more visits. Most women (77%) reported receiving their visit in their home or a combination of home and not at home (20%). Only 3.2% of visits were not conducted at home. In addition to midwifery visits, most women (approximately 80%) also used community supports, the most frequently being child and family health nurses.

Conclusion: In this regional/rural MMoC, women were able to receive quality continuity and components of care as have been previously benchmarked against the QMNC Framework. Women embraced the new MMoC, established strong relationships with their midwives and were able to maintain good collaborative arrangements with their local GPs. The generalisability of these results should be considered for other regions which offer maternity services and have GP obstetrician support. These findings are consistent with existing evidence that supports midwifery continuity of care for women and adds to the growing body of evidence for midwifery caseload outside of metropolitan areas

Study Design: Mixed methods design using qualitative and quantitative methodologies

Setting: Five birthing sites in South Australia (Port Pirie, Crystal Brook, Wallaroo, Clare and Jamestown).

Population of Focus: Pregnant women in regional/rural areas

Sample Size: 205

Age Range: 16-42 years

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Patient-Centered Medical Home, CAREGIVER, Home Visit (caregiver), PATIENT/CONSUMER, Home Visits, Outreach (caregiver), Nurse/Nurse Practitioner, Enabling Services

Intervention Description: (1) To improve connections to the medical home for infants from one low-income neighborhood (2) To increase the number of families enrolled in a local home visiting program, and (3) To improve communication between medical staff and home visitors.

Intervention Results: Outcomes were timeliness of well child care and enrollment in home visiting. Time series analyses compared patients from the intervention neighborhood with a demographically similar neighborhood. Mean age at newborn visit decreased from 14.4 to 10.1 days of age. Attendance at 2- and 4-month well child visits increased from 68 to 79% and 35 to 59 %, respectively. Rates did not improve for infants from the comparison neighborhood. Confirmed enrollment in home visiting increased. After spread to 2 more clinics, 43 % of infants in the neighborhood were reached.

Conclusion: Neighborhood-based newborn registries, proactive nursing outreach, and collaboration with a home visiting agency aligned multiple clinics in a low-income neighborhood to improve access to health-promoting services.

Study Design: Quasi-experimental: Nonequivalent control group

Setting: Primary care clinics and a home visiting program in a neighborhood defined by two zip codes

Population of Focus: All children born in the intervention and comparison neighborhoods

Data Source: Data from the local children’s hospital’s Emergency Department was used to identify the most common primary medical providers for children from the study zip codes • Newborn registry data (maintained manually with a Microsoft Excel spreadsheet) • Electronic health record data (with an automated newborn registry) • Manual chart review • Automated report of appointment data • Outcome measures using clinic data • Process measures using clinic and home visiting agency data

Sample Size: n=237 (cumulative number of babies on a registry); n=30 (cumulative number of families enrolled in home visiting)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, CAREGIVER, Education/Training (caregiver), PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Motivational Interviewing, Motivational Interviewing/Counseling

Intervention Description: Intervention (INT) was a home-based asthma follow-up after ED visit and two visits for an environmental control educational program delivered by trained nurses and nurse practitioners to the child and caregiver. For caregivers of children with positive cotinine results, brief motivational interviewing sessions were conducted to implement total home smoking ban.

Intervention Results: Over half of children in the study tested positive for SHS. Targeting SHS exposure was major component of the intervention [but] no significant reduction in cotinine exposures was associated with the intervention at 12 months.

Conclusion: In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.

Study Design: Prospective randomized controlled trial

Setting: Home-based (following ED visit)

Population of Focus: Children with physician diagnosed persistent asthma, having two or more ED asthma visits or more than one hospitalization over the past 12 months and residing in the Baltimore metropolitan area

Data Source: For SHS exposure, child saliva samples collected during the ED visit and at 6- and 12-month follow up visits.

Sample Size: 222 inner city children ages 3-12

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Home Visit (caregiver), PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Home Visit (caregiver)

Intervention Description: This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. Conducted as part of the initiative by Cradle Kalamazoo initiative to decrease racial disparities in infant mortality, home visitors attended a 2-day training that incorporated MI skills, cultural sensitivity, and safe sleep information. The MI training was conducted by a licensed Ph.D.-level psychologist as well as a second-year doctoral student in clinical psychology with 1 year of experience conducting clinical work. Home visitor outcomes were assessed using a pre-post design that included self reporting (based on a 16-question safe sleep knowledge questionnaire) and an observational rating by a paid “community mother.” When assessing client outcomes, a quasi-experimental design was used to examine changes in knowledge, attitudes, and safe sleep practices (Fig. 1). The home visitors administered the safe sleep survey to two different groups. The intervention group included 31 clients of home visitors who completed the training. The control group included 44 clients of home visitors who had not completed the training.

Intervention Results: Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior.

Conclusion: MI may be an effective technique for home visitors to help increase families' safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families' safe sleep behavior.

Setting: Cradle Kalamazoo initiative in Kalamazoo, Michigan

Population of Focus: Home visitors and their clients

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, CAREGIVER, Home Visit (caregiver)

Intervention Description: A health education program was evaluated which used child development specialists as home visitors and served a population of first-time mothers living in rural communities.

Intervention Results: Significant group differences were found on health and safety outcomes. As compared with controls, the intervention mothers (i) had safer homes; (ii) were more likely to use birth control, thus had fewer pregnancies since birth of their first child; (iii) reported smoking fewer cigarettes; (iv) knew more about effects of smoking on their child’s health and (v) were more likely to use health department services.

Conclusion: It is highly recommended that a program such as this be implemented as part of health delivery program with new mothers and infants.

Study Design: Quasi-experimental Design

Setting: Community (home)

Population of Focus: Pregnant women who smoked

Data Source: Mother’s self-report.

Sample Size: 355 pregnant women

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Training (Parent/Family), , PARENT_FAMILY, PROFESSIONAL_CAREGIVER

Intervention Description: This evaluation examined the rates of safe infant sleep practices and associated factors among 1985 participants enrolled in Florida Maternal, Infant, and Early Childhood Home Visiting (FL MIECHV) programs during 2017-2019.

Intervention Results: Most caregivers (70%) reported always placing their babies to sleep on their back, alone, and without soft bedding. Factors such as primary language, race, education, housing situation, and year the Safe Baby™ curriculum implemented were significantly associated with safe infant sleep practices.

Conclusion: Bearing this in mind, FL MIECHV can tailor safe sleep education, messaging, and strategies to support participants at highest risk. Recent adoption of the Safe Baby™ curriculum, and associated staff training, was an important factor influencing parents' infant sleep practices.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Adult-led Support/Counseling/Remediation, Educational Material, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER, YOUTH

Intervention Description: This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners.

Intervention Results: On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim;

Conclusion: these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing

Intervention Description: The aim of this study is to evaluate effects of the counseling method “Smoke-free children” that focuses on protection of infants.

Intervention Results: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine.

Conclusion: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

Study Design: RCT

Setting: Child health centers

Population of Focus: Swedish mothers who had given birth to a healthy child

Data Source: Self-reporting of smoking; cotinine levels of mothers’ saliva

Sample Size: 26 mothers in the intervention group and 15 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Telephone Support, CAREGIVER, Home Visit (caregiver), Assessment (caregiver), Attestation (caregiver), Motivational Interviewing/Counseling

Intervention Description: This pilot study evaluated the effectiveness of a nurse-delivered home-visiting program during the postpartum period that included a low-intensity smoking relapse-prevention intervention.

Intervention Results: Although both groups showed significant relapse from being smoke free, the intervention group was twice as likely to be smoke free at 3 and 6 months, and three times as likely to be smoke free at both times. The cotinine verification revealed a misclassification rate of 37% at the 6-month follow-up (i.e., participants self-reported as abstinent but shown by cotinine not to be abstinent).

Conclusion: The effectiveness of this brief, low-cost, and potentially replicable intervention in improving the rate of persistent postpartum smoke-free status for women who quit smoking during pregnancy is encouraging. A randomized trial of the approach is warranted.

Study Design: Pilot study; Prospective two-group design

Setting: Birthing hospital plus home visit

Population of Focus: English-speaking women who delivered healthy babies, resided in Franklin County, Ohio, and reported quitting smoking during pregnancy and at least 7 days before delivery

Data Source: Questionnaire that included smoking history and attitudes and intent to stay smoke free administered at baseline. Saliva sample for maternal cotinine analysis collected at baseline and 3 and 6 months for all participants who self-reported abstinence (defined as no smoking for the previous 7 days)

Sample Size: 97 in the baseline group and 122 in the intervention group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Home Visits, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Home Visit (caregiver)

Intervention Description: We conducted a randomized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness.

Intervention Results: 1) A significant difference in the amount of exposure to tobacco smoke—5.9 fewer cigarettes per day at 12 months; (2) no difference in infant cotinine excretion; (3) lower prevalence of persistent lower respiratory symptoms among intervention-group infants of smoking mothers whose head of household had no education beyond high school (14.6% versus 34.0%).

Conclusion: The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school: intervention group, 14.6%; and controls, 34.0%.

Study Design: RCT

Setting: In the home

Population of Focus: Infants weighing at least 2000 g at birth, free of significant postnatal medical problems, and residing in Alamance or Chatham County in central North Carolina

Data Source: Urine collection from the infants; self-report about smoking and smoke exposure from the mother and other questions designed to identify maternal and family characteristics that might modify the effect of the intervention and to identify risk factors for infant lower respiratory disease.

Sample Size: 933 total started the study, 659 completed it; 168 infants in the reduced data collection groups

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Adult-led Support/Counseling/Remediation, CAREGIVER, Home Visit (caregiver), Motivational Interviewing/Counseling, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Description: To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.

Intervention Results: The primary outcome was the number of symptom-free days during 2 weeks averaged across the pea asthma season (November-February). Children in the treatment group experienced more symptom-free days and better results on several other asthma-related measures. Full-year outcomes also showed a significant treatment effect. When comparing outcomes separately for children without and with smoke exposure in the home, results suggest an effect of the intervention for both groups of children. Primary findings were independent of any change in the child’s cotinine level, suggesting that the school-based care component alone is effective in reducing symptoms.

Conclusion: The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.

Study Design: Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-base care group or a usual care group

Setting: School, with intervention in the home

Population of Focus: Children aged 3 to 10 years with persistent, physician-diagnosed asthma in the Rochester City School District, with consent of the child’s primary care provider to participate in the study

Data Source: All families were given diaries to track their child’s symptoms, and outcomes were assessed by monthly telephone interviews. Saliva samples were collected from the child at the beginning and end of the study to determine the child’s level of cotinine. Medical records were reviewed for 10% of the sample to confirm office and emergency department visits and hospitalizations.

Sample Size: 530 children from 67 schools and preschools

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Home Visits, Other Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: Illinois develped an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. They serve as specialized home visitors, providing home-based education and support during the last half of pregnancy and for 6 weeks postpartum. The doula worked with the mother more intensively during pregnancy and the first weeks postpartum, while the home visitor became the primary provider by 6 weeks postpartum. The goal of this randomized controlled trial is to examine whether young, low-income families receiving doula-home visiting services, compared to families receiving lower-intensity case management services, have improved maternal and child health outcomes during the period between birth and 3 months of age.

Intervention Results: Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05).

Conclusion: The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

Study Design: RCT

Setting: Doula-home visiting programs in high-poverty IL communities

Population of Focus: Women under 26 years of age, less than 34 weeks gestation, living in the program geographic catchment area

Sample Size: 312 young, pregannt woman across four communities

Age Range: Pregnant women under 26 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Training (Parent/Family), CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Motivational Interviewing/Counseling

Intervention Description: This study tested the efficacy of coaching to reduce environmental tobacco smoke ETS exposure among asthmatic Latino children.

Intervention Results: Intervention parents reported their children exposed to significantly fewer cigarettes than control parents by 4 months (post-coaching). Reported prevalence of exposed children decreased to 52% for intervention families but only 69% for controls. By month 4, cotinine levels decreased from 54% to 40% among intervention and increased from 43% to 49% among control children. However, cotinine levels decreased among controls to same level achieved by intervention families by the 13-month follow-up.

Conclusion: Asthma management education plus coaching can reduce ETS exposure more than expected from education alone, and decreases in the coached condition may be sustained for about a year. The delayed decrease in cotinine among controls is discussed.

Study Design: RCT

Setting: Community (home)

Population of Focus: Latino or Hispanic families with an asthmatic child who lived in a home with a smoker and was exposed to at least 6 cigarettes in the past week

Data Source: Reported ETS exposure, children’s urine cotinine, air nicotine monitors, and parent’s saliva cotinine were measured

Sample Size: 204 Latino children ages 3-17 years with asthma

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Training (Parent/Family), CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Pharmacotherapy (Nicotine), Home Visits, Educational Material, Motivational Interviewing, Peer Counselor, Telephone Support

Intervention Description: We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking.

Intervention Results: Parents’ reports of their smoking and children’s exposure showed moderate and significant correlation with children’s urine cotinine levels and home air nicotine. 13 intervention group mothers and 4 controls reported quitting smoking for 7 days prior to 1 or more study measurements without biochemical contradiction. Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers’ smoking in the counseled group compared with controls. Reported indoor smoking and children’s urine cotinine decreased, yet group differences for changes were not significant.

Conclusion: Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.

Study Design: Two-group, repeated measures RCT

Setting: Community (home)

Population of Focus: WIC clients in San Diego, California

Data Source: 3 weekly baseline child urine cotinine measures collected before trial randomization then reported and urine cotinine measures at 3 (midintervention), 6 (post-intervention), 12, and 18 months

Sample Size: 150 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, Training (Parent/Family), Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Home Visit (caregiver)

Intervention Description: A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures.

Intervention Results: There were no significant differences in medical visits, theophylline levels, or records of asthma symptomsOne year after discontinuing the intervention, a marked "washout" effect was observed.

Conclusion: Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.

Study Design: RCT

Setting: Homes and well-child clinics

Population of Focus: Patients admitted to the Izaak Walton Killam Children’s Hospital with a diagnosis of asthma in the preceding 5 years

Data Source: Medical personnel

Sample Size: 95 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Training (Parent/Family), CAREGIVER, Home Visit (caregiver), Motivational Interviewing/Counseling

Intervention Description: We tested the effectiveness of a program consisting of motivational interviewing (MI) and feedback of urine cotinine to stop passive smoking (PS) in children at risk for asthma.

Intervention Results: After 6 months, a significant group difference was observed for the unverified parental report of stopping PS in children: 27% of parents in the intervention group versus 7% in the control group. For the verified parental report, the difference was similar (23% versus 7%) but was not statistically significant.

Conclusion: Despite a limited sample size, the results suggest that the intervention program is probably an effective strategy to stop PS in children. A program longer than 6 months might be necessary for a longer lasting intervention effect.

Study Design: RCT

Setting: Home-based (6 sessions)

Population of Focus: Families with children ages 0-13 with a high risk of asthma and passive smoking exposure

Data Source: Parental self-report, urine cotinine in children

Sample Size: 58 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Education/Training (caregiver), Home Visit (caregiver)

Intervention Description: To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke.

Intervention Results: Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval (−0.86 to 0.48). Overall, 98% of parents in both groups still smoked at follow up. However, there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking.

Conclusion: A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children’s exposure to environmental tobacco smoke. The intervention may have made some parents less inclined to stop smoking. If a clinician believes that a child’s health is being affected by parental smoking, the parent’s smoking needs to be addressed as a separate issue from the child’s health.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families with an asthmatic child aged 2-12 years living with a parent who smoked

Data Source: Salivary cotinine concentrations in children, and parent self-report.

Sample Size: 501 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Collaboration with Local Agencies (Health Care Provider/Practice), Continuity of Care (Caseload), HEALTH_CARE_PROVIDER_PRACTICE, PROFESSIONAL_CAREGIVER

Intervention Description: This report describes priority populations for home visiting programs, the capacity of programs to enroll more families, common sources of referrals to home visiting, and sources from which programs want to receive more referrals.

Intervention Results: Programs prioritized enrollment of pregnant women; parents with mental health, substance abuse or intimate partner violence concerns; teen parents; and children with developmental delays or child welfare involvement. Most respondents reported capacity to enroll more families in their programs. Few reported receiving any referrals from pediatric providers, child welfare, early care and education, or TANF/other social services. Most desired more referrals, especially from healthcare providers, WIC, and TANF/other social services.

Conclusion: Given that most programs have the capacity to serve more families, this study provides insights regarding providers with whom home visiting programs might strengthen their referral systems.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Motivational Interviewing/Counseling, Provider Training/Education,

Intervention Description: Identified in this article are 5 pillars for implementing CBPPC care in cases involving ethical considerations: (1) identification of biases, (2) utilization of a culturally safe approach, (3) communication, (4) assessment and support, and (5) knowledge of community resources.

Intervention Results: successful intervention

Conclusion: By facilitating the communication of patient and family needs and goals and by connecting patients and families with community resources to improve quality of life, CBPPC and hospice nurses play an essential role in decreasing stressors and suffering. The implementation of palliative care improves patient outcomes, enhances interprofessional and family communication, and reduces end-of-life cost burdens both to families and to health care systems; however, the time it takes a nurse to develop trusting relationships, consider family-centered education needs, connect families with accessible specialists, and address their own needs and possible biases is not easily coded for compensation in the current health care system. Without substantial CBPPC nurse involvement in this case, the outcome might have been far less satisfactory for the family. It is recommended that nurses and interprofessional teams implement the 5 crucial pillars discussed for providing ethical and safe palliative care.

Study Design: case review

Setting: CMC: community-based palliative care - a case study involving a family with a child who has a life-limiting genetic disease and the community-based pediatric palliative care (CBPPC) team that provided care in the family's home.

Population of Focus: CMC - healthcare professionals, particularly those involved in community-based pediatric palliative care.

Sample Size: 1 family

Age Range: children

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Community Health Workers (CHWs), PATIENT/CONSUMER, Home Visits, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers.

Intervention Results: The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721.

Conclusion: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families in low-income households with children with asthma

Data Source: In-home interviewing, dust sample and standardized home inspection

Sample Size: 274 randomized participants

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Home Visit (caregiver), Audit/Attestation

Intervention Description: The Maternal Infant Health Outreach Worker (MIHOW) program is an early-childhood home visiting program that uses community health workers (CHWs) to improve health outcomes in underserved communities. To be a MIHOW home visitor, women must be from the target community, be of the same culture and/or language group of families served, have completed all MIHOW training, and use the MIHOW curriculum. This randomized clinical trial evaluated the impact of MIHOW’s use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. All study participants received the minimal education intervention (MEI), which consisted of printed educational materials about health and child development, compared to the intervention group that also received MIHOW home visitation services. Data was collected during interviews conducted by trained data collectors who were fluent in Spanish, also spoke English, and were from the same community.

Intervention Results: Enrolled women (N = 132) were randomly assigned, with 110 women completing the study (MEI = 53; MIHOW = 57). Positive and statistically significant (p < .01) effects of MIHOW were observed on breastfeeding duration, safe sleep practices, stress levels, depressive symptoms, emotional support, referral follow through, parental confidence, and infant stimulation in the home.

Conclusion: Findings provided strong evidence of the effectiveness of MIHOW for improving health outcomes in this sample. Using trained CHWs makes programs such as MIHOW a viable option for providing services to immigrant and underserved families.

Population of Focus: Pregnant Hispanic women living in middle Tennessee

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, CAREGIVER, Home Visit (caregiver)

Intervention Description: To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population.

Intervention Results: Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum.

Conclusion: Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Professional Support, Educational Material (caregiver),

Intervention Description: The Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program.

Intervention Results: In the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2-20.7) higher than those managed in the program.

Conclusion: A goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.

Study Design: Cross-sectional prospective quasi-experimental study

Setting: Following Baby Back Home program in Arkansas

Population of Focus: Children enrolled in the Following Baby Back Home program in Arkansas from January 2013 to December 2017

Sample Size: 498 children

Age Range: Infants in the first year of life

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Home Visit (caregiver), PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: The Team for Infants Exposed to Substance abuse (TIES) Program provides a holistic, multi-disciplinary, community-based model to address the complex needs of families with young children affected by maternal substance use.

Intervention Results: A multi-year implementation study of the model yielded results that indicate the effectiveness of this home-based family support intervention. The model focuses on reducing maternal alcohol and other drug use, increasing positive parenting, promoting child and maternal health, and improving family income and family housing. A key component of the model is establishing a mutual, trusting relationship between the home visiting specialists and the family. Foundational to the TIES model is a family-centered, culturally competent, trauma-informed approach that includes formal interagency community partnerships

Conclusion: This article describes elements of the model that lead to high retention and completion rates and family goal attainment for this unique population.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Enabling Services, Outreach (Provider), PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, PROFESSIONAL_CAREGIVER

Intervention Description: The purpose of this study was to describe how each practice operationalized clinical–community linkage strategies that best suited their setting and to determine if efforts resulted in improved MIHP participation and other service use.

Intervention Results: When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1–10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4–14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3–5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3–14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed.

Conclusion: Clinical–community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical–community linkages.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Educational Material, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Home Visit (caregiver), Educational Material (caregiver)

Intervention Description: Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed.

Intervention Results: Post-intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM2.5 was significantly decreased (P < 0.001). Salivary cotinine was significantly decreased for non-smoking women (P < 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6).

Conclusion: Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM2.5 and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.

Study Design: A single arm, unmasked clinical trial

Setting: Home-based (4 home-visits during the 5 week study)

Population of Focus: Women > 18 years of age and either pregnant nonsmokers or post-partum (any smoking status) with an infant age 0-12 months

Data Source: Air quality assessment, salivary cotinine

Sample Size: 50 women, 32 had infants and 18 were pregnant at time of enrollment

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Home Visits, Other Education, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.

Intervention Results: Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation.

Conclusion: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families’ medication administration practices and anticipate social needs after paediatric discharge.

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Counseling (Parent/Family), CAREGIVER, Motivational Interviewing/Counseling, Home Visit (caregiver), PATIENT/CONSUMER, Home Visits, Motivational Interviewing

Intervention Description: Secondhand smoke (SHS) is a significant cause of acute respiratory illness (ARI) and 5 times more common in indigenous children. A single-blind randomized trial was undertaken to determine the efficacy of a family centered SHS intervention to reduce ARI in indigenous infants in Australia and New Zealand.

Intervention Results: Two hundred and ninety-three mother/infant dyads were randomized and followed up. Three quarters of mothers smoked during pregnancy and two thirds were smoking at baseline (as were their partners), with no change for more than 12 months. Reported infant exposure to SHS was low (≥95% had smoke-free homes/cars). Infant CCRs were higher if one or both parents were smokers and if mothers breast fed their infants. There was no effect of the intervention on ARI events [471 intervention vs. 438 usual care (reference); incidence rate ratio = 1.10, 95% confidence intervals (CI) = 0.88–1.37, p = .40].

Conclusion: Despite reporting smoke-free homes/cars, mothers and their partners continue to smoke in the first year of infants’ lives, exposing them to SHS. Emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal.

Study Design: Single-blind randomized trial

Setting: Community (homes)

Population of Focus: Indigenous mothers/infants from homes with more than one smoker

Data Source: Baseline data at home visit; Baseline, 2 month, and 3 month quantitative and qualitative process evaluation indicators; outcome data from face-toface home visits and urine samples

Sample Size: 293 mother/infant dyads

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Home Visit (caregiver), Continuity of Care (Caseload), STATE, PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study examined state-level supports and barriers for coordination of home visiting with other entities within the early childhood system of care.

Intervention Results: Forty-two (75%) of the MIECHV administrators participated in the survey. States and territories varied widely within and across the 5 domains of support for coordination. MIECHV leadership was an area of relative strength, whereas data systems and finance showed the most room for improvement. State leadership and shared goals were associated with stronger perceptions of state-level coordination.

Conclusion: The findings indicate opportunities for shared learning among states to enhance coordination infrastructure. Such efforts should include multiple stakeholder perspectives and consideration of local and organizational contexts. This work could be facilitated using the service coordination toolkit developed as part of this project.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Outreach (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PROFESSIONAL_CAREGIVER

Intervention Description: To assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity.

Intervention Results: Relational coordination scores, which are relative measures, ranged from 1 to 5; highest with supplemental nutrition for Women, Infants & Children (M = 3.77) and early intervention (M = 3.44); and lowest with housing (M = 2.55). The greatest sharing of resources was with supplemental nutrition (sum = 12.95) and mental health providers (sum = 11.81), and least with housing (sum = 7.26); with a range of 1–30 where higher scores indicated greater resource-sharing.

Conclusion: Home visiting nurses collaborate with interprofessional providers with variation in the degree of collaboration between agencies and by provider type within an agency. Collaboration was a function of two interrelated domains: interpersonal relationships supported by organizational and contextual factors at the systems-level.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), Telephone Support, Motivational Interviewing, CAREGIVER, Motivational Interviewing/Counseling, Outreach (caregiver), Home Visit (caregiver)

Intervention Description: The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce children’s environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention.

Intervention Results: The levels of cotinine in the intensive intervention and minimal intervention groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group. This increase was statistically significant. The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home. The decrease in cotinine levels was higher in the intensive intervention group than the minimal intervention group but the difference was not statistically significant.

Conclusion: The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home.

Study Design: RCT

Setting: Community (home and hospital)

Population of Focus: Mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked

Data Source: Urinary cotinine samples and forms

Sample Size: 80 mothers with 40 in the intensive intervention group and 40 in the minimal intervention group

Age Range: Not specified