Nurse home visitors follow detailed visit-by-visit program protocols that focus on five domains of functioning: personal health, maternal role development, environmental health, maternal life-course development, and family and friend support. The content of the protocols is organized developmentally to reflect those challenges that women are likely to confront at different stages of pregnancy and during the first 2 years of the child’s life. Within each of the five domains, specific assessments are made of maternal, child, and family functioning, and specific educational content and psychosocial interventions are implemented depending upon the nature and degree of vulnerability revealed in the assessment.

During home visits, nurses carry out three major activities: 1) promoting adaptive change in behavior that affects the outcomes of pregnancy, the health and development of the child, and maternal life course; 2) helping women build supportive relationships with family members and friends; and 3) linking family members with other health and human services. In carrying out these activities, emphasis is placed on the importance of building on parents’ strengths and promoting parental competence and control over life circumstances.

Memphis: (N=1135). Primarily (92%) African-American families. Participants had to have one of the following risk conditions: 1) unmarried, 2) less than 12 years of education, or 3) unemployed. Randomly assigned to Treatment groups 1, 2 ,3 or 4. Families in Treatment 1 (n=166) were provided transportation to prenatal care but no postnatal visits or screening. Families in Treatment 2 (n=515) were provided transportation to prenatal care, screening, and referral services until 24 months after birth. Families in Treatment 3 (n=230) were provided transportation, screening, and nurse home visits during pregnancy, once at the hospital, and once at home after birth. Families in Treatment 4 (n=228) were provided same services as Treatment 3 plus received home visits until child’s 2nd birthday. Program began June 1990 and ended August 1991.

Denver: (N=735). Including 331 (40%) Mexican-American families. Random assignment to Treatment groups 1, 2, or 3. Families in Treatment 1 (n=255) received screening for children at ages 1 and 2 years and referral to services if needed. Families in Treatment 2 (n=235) received developmental screening and referral plus nurse home visits through pregnancy through child’s 2nd year. Families in Treatment 3 (n=245) received screening and referral plus paraprofessional home visitation from pregnancy through child’s 2nd year.