Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months

Abstract

One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.

Trial registration: ClinicalTrials.gov NCT01406184.

Keywords: home visiting; population health; prevention; system of care.

Conflict of interest statement

Conflict of Interest. The authors acknowledge participation in Family Connects model dissemination and report no other conflict of interest in the study reported here.

Figures

Figure 1.

CONSORT 2010 flow diagram for Family Connects RCT implementation and evaluation.

Figure 2.

Mean cumulative number of emergency medical care episodes from birth to 24 months, by intervention group (n = 531).