Redefining the Science and Policy of Early Childhood Intervention Programs

Abstract

* Abbreviation:\n NFP — : Nurse-Family Partnership\n\nDavid Olds and his team are to be applauded for creating the Nurse-Family Partnership (NFP) home-visiting program and for steadfastly following up with the participants in the Memphis randomized controlled trial. In 2 new “child”1 and “mother”2 articles, they report the impacts of NFP on children and mothers, respectively, when the children reach age 18.\n\nAll too often in the field of home-visiting, observers want to decide that a program either “works” or does not work. If 1 trial, 1 outcome variable, or 1 subgroup shows a null or adverse effect, there may be a rush to declare that the program failed and should be defunded. If 1 evaluation shows a positive impact for a targeted subgroup, there may be support for at least modest funding, but it is not clear that the population benefits or public health is served. This field is not like drug trials or the Food and Drug Administration,3 for which the stark goal is to “separate the relative handful of discoveries which prove to be true advances from a legion of false leads and unverifiable clinical impressions”; instead, home-visiting programs have multiple goals for the mother and child, are implemented with different subgroups in different contexts at different times, assess outcomes in diverse domains across different ages in child development, and use diverse methods of data analysis (eg, covariance, moderation, and mediation) to understand mechanisms. To have a population impact, they must be embedded in a broader system of care for families. To contextualize my comments with full disclosure, I note that I lead and study a public health approach to home-visiting that connects families with community resources, including targeted home-visiting programs similar to NFP.\n\nThe scientific question in these articles is not whether the NFP program works but how it … \n\nAddress correspondence to Kenneth A. Dodge, PhD, Center for Child and Family Policy, Duke University, 302 Towerview Dr, Durham, NC 27708. E-mail: dodge{at}duke.edu