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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1491-1494

Home Visiting

Neil B. Guterman, PhD, MSW*
Elizabeth Anisfeld, PhD{ddagger}
Mary McCord, MD, MPH{ddagger},§
* Department of Social Work
{ddagger} Department of Pediatrics
§ Department of Public Health
Columbia University
New York, NY 10025, USA

The first 300 words of the full text of this article appear below.

To the Editor.—

We read with great interest the article by Olds et al1 on home visiting by paraprofessionals and nurses. Many of us across the disciplines are indebted to Dr Olds for the seminal work he and his colleagues have conducted over the last several decades demonstrating the efficacy of his nurse home visitation program in preventing a broad array of detrimental maternal health, life course, and child developmental outcomes. Dr Olds’ work has been especially instrumental in the field of child abuse and neglect prevention, helping to spur the development of hundreds of preventive home visitation programs across the United States.

The findings reported in Pediatrics in September 2002 extend his earlier work by again demonstrating a wide array of positive benefits for mother-child pairs as a result of nurse home visitation, now across 3 different community settings: Elmira, New York, Memphis, Tennessee, and Denver, Colorado. We would like to caution the readers, however, concerning the conclusions they might be tempted to draw from this most recent study, which, on the face of it, appears as if Dr Olds has directly demonstrated the relative efficacy of nurses versus paraprofessionals as home visitors, in a way generalizable to other contexts. Dr Olds and colleagues, themselves, directly caution us, "Because of constraints of sample size and cost, the study was not designed to make direct comparisons between paraprofessionals and nurses."1

Olds and colleagues attempted to statistically control post hoc for some of the observed nonequivalencies across nurse and paraprofessional home visitor groups occurring during the study’s implementation, most notably in the substantially greater turnover that occurred among the paraprofessional . . . [Full Text of this Article]