Quasinatural Experiment of Postnatal Home Visiting: An Independent Impact Study of Family Connects.

Abstract

Family Connects (FC) is a postnatal nurse home visiting program that has scale-up potential because it is brief, inexpensive, and universal. Three investigations have linked Family Connects to improved maternal and family outcomes, but no independent impact studies have been conducted to date. This study investigates a FC program in Racine County, WI that was implemented by a multimunicipal health department in partnership with a local hospital. The sampling frame included all women who gave birth at the hospital from July 1, 2018 to August 31, 2019 (N=1,511). A quasinatural experiment resulted from systematically restricting FC recruitment to weekdays. All eligible women whose birth records and addresses were obtained from a vital records office were mailed a 6-month postpartum survey. Data collected from 489 respondents (32.4%) were analyzed in February 2022 to estimate the impact of FC on maternal health, infant health and development, and parenting behavior outcomes under intent-to-treat and per protocol assumptions. No significant differences were observed between study groups at baseline. Despite evidence that the FC program in Racine met many model standards for implementation fidelity, null effects were observed at 6 months after delivery for most outcomes. Results suggested that parents from eligible households reported more frequent infant emergency medical episodes than parents who were not offered the program. This study found few significant effects associated with FC participation. Further investigation is needed to identify the populations with and conditions under which the program produces its intended effects.