Durham Connects Evaluation

• Child Emergency Room (ER) Presentation Rates [ Time Frame: 0 - 66 Months of Child Age ] [ Designated as safety issue: Yes ]
  Lifetime child emergency department visit reported in hospital records for an injury with a maltreatment-related diagnostic code.
• Pediatric Well-Care Visit and Child Immunization Compliance Rates [ Time Frame: 0 - 66 Months of Child Age ] [ Designated as safety issue: Yes ]
  Lifetime rates of compliance with well-care pediatric visits and immunizations as reported in pediatric records; lifetime child injuries reported in pediatric records.
• Child Social-Emotional Competence and Behavior Problems [ Time Frame: 24 - 66 Months of Child Age ] [ Designated as safety issue: No ]
  Mothers complete the Head Start Competence Scale (Domitrovich et al., 2001), measuring child social and emotional skills central to interpersonal relationships and emotion regulation. Mothers also complete the ages 1.5-5 version of the Child Behavior Checklist (CBCL 1.5-5; Achenbach & Rescorla, 2001), a standardized measure assessing DSM-oriented emotional and behavioral problems, including: 1) affective problems; 2) anxiety problems; 3) pervasive developmental problems; 4) Attention Deficit/Hyperactivity problems; and 5) Oppositional Defiant problems.

The aim of this randomized controlled trial (RCT) is to evaluate the impact and mechanisms of the Durham Connects (DC) brief universal nurse home-visiting program to prevent child maltreatment and improve child well-being. It is the first-ever RCT of a home-visiting program that is designed to prevent child maltreatment in an entire community population.

Evaluation of program impact will test three hypotheses: 1) Random assignment to the Durham Connects Program will be associated with lower rates of child maltreatment and emergency department maltreatment-related injuries, better pediatric care, better parental functioning, and better child well-being than assignment as control; 2) Intervention effect sizes will be larger for higher-risk groups; and 3) Community resource use and enhanced family functioning will mediate the positive impact of Durham Connects on outcomes.

The Durham Connects Program is an innovative, community based, universal nurse home-visiting program that aims to lower the population rate of child maltreatment and improve child well-being. The Durham Connects Program is implemented jointly by the Durham County (North Carolina) Department of Health and Duke University. It is designed to be brief and inexpensive per family so that communities can afford its costs. Its goals are consistent with those of more intensive nurse home-visiting programs: 1) to connect with the mother in order to enhance maternal skills and self-efficacy; and 2) to connect the mother with needed community services such as health care, child care, mental health care, and financial and social support; so that 3) the mother can connect with her child.

From July 1, 2009, through December 31, 2010, all 4,782 residential births in Durham County, North Carolina, were randomly assigned according to birthdate, with even-birth-dates assigned to receive DC. Odd-birth-dates were assigned to receive services-as-usual and served as the control group. Program implementation was evaluated for all 2,330 even-birth-date families.

Durham Connects begins with a visit during the birthing hospital stay, followed by 1-3 nurse home visits between 4-12 weeks of infant age, and then a follow-up contact one month later. During the visits, the nurse engages with the mother and completes a health and psychosocial assessment, during which she systematically assesses risk and family needs in 12 important empirically-derived domains of family functioning. For each domain found to be at risk, the nurse intervenes directly to support the mother or connects the mother with ongoing evidence-based interventions in the community. Although Durham Connects is implemented universally, it focuses on triaging families according to assessed risk and then connecting them with ongoing collaborating community resources that can "carry the family's baton" after the nurse home-visitor leaves the family.

• Unspecified Child Maltreatment, Suspected
• Unspecified Child Maltreatment, Confirmed

• Experimental: Durham Connects Eligible Group
  From July 1, 2009 - December 31, 2010, all even-birth-date residential births in Durham County, North Carolina were randomly assigned to receive the Durham Connects nurse home visiting program.
  Intervention: Other: Durham Connects
• No Intervention: Control Group
  From July 1, 2009 - December 31, 2010, all odd-birth-date residential births in Durham County, North Carolina were randomly assigned to a control group condition. These families were assigned to receive services as usual and served as the randomized comparison group for evaluating Durham Connects program impact.

Inclusion Criteria:

• Infant born between July 1, 2009 and December 31, 2010
• Infant born at Durham County, NC hospital (Duke or Durham Regional)
• Family of infant resides in Durham County, NC

Exclusion Criteria:

• Infant born before July 1, 2009 or after December 31, 2010
• Infant not born at Durham County, NC hospital
• Family of infant resides outside of Durham County, NC

• The Duke Endowment
• The Pew Charitable Trusts
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)