Family Connects is an evidence-based model that supports all families of newborns. Two randomized controlled trials of Family Connects were conducted in Durham, NC, when the model was formerly called Durham Connects. We continue to engage in high quality research to drive data-driven improvement of the Family Connects Model.
An ongoing randomized controlled trial of Family Connects began in 2009. Results have shown:
- Emergency room visits and hospital overnight stays were reduced by 50% in the first year of life; these results were sustained but did not increase through the second year of life.
- Mothers were 28% less likely to report possible postpartum clinical anxiety.
- Mothers reported significantly more positive parenting behaviors, like hugging, comforting and reading to their infants; no significant differences were found in negative parenting behaviors.
- Mothers expressed increased responsivity to, and acceptance of, their infants.
- Home environments were improved — homes were safer and had more learning materials to support infant development.
- Community connections increased by 15%.
- When using out of home childcare, families used higher quality care.
A second randomized controlled trial took place in 2014. Results from this trial have shown:
- Families had 44% lower rates of Child Protective Services investigations for suspected child abuse or neglect through child age 2; 39% lower investigation rates through child age 5.
- Community connections increased by 13%.
- Mothers were 30% less likely to experience possible postpartum depression or anxiety.
- Families were more likely to use out-of-home childcare.
- As the number of birth risks increased, infants experienced fewer emergency department visits but more hospital overnights.
- Mothers were more likely to complete their 6-week postpartum health check, but also had more emergency department visits.
Results from research on the Family Connects model have been published in a number of journals, including Pediatrics, American Journal of Public Health, and JAMA Network Open.
STUDIES
Kristine Zimmermann, Lisa S. Haen, Allissa Desloge, and Arden Handler – Published Online: 23 Oct 2023 https://doi.org/10.1089/heq.2023.0104. Download PDF.
“Racial and ethnic inequities persist among birthing families in urban U.S. communities, despite public health efforts to improve outcomes. To address these inequities, in 2020, the Chicago Department of Public Health (CDPH) launched Family Connects Chicago (FCC), an evidence-based, universal, postpartum home visiting program. We examine CDPH’s transition from “high risk” to universal home visiting to determine whether and how this change represent an explicit commitment to advancing maternal and child health equity.”
WHO recommendations on maternal and newborn care for a positive postnatal experience. Geneva: World Health Organization; 2022. License: CC BY-NC-SA 3.0 IGO.
“The WHO postnatal care model places the woman–newborn dyad at the centre of care (see Fig. 4.1). The foundation of this postnatal care model is Recommendation 44, which supports a minimum of four postnatal care contacts. The first contact refers to continued care in the health facility for at least the first 24 hours after birth or a first postnatal contact within the first 24 hours for a home birth. At least three additional postnatal care contacts occur between 48 and 72 hours, between 7 and 14 days, and during week six after birth. The overarching aim is to provide women, newborns, parents and caregivers with respectful, individualized, person-centred care at every contact. This includes the provision of effective clinical practices (assessments, referrals and management), relevant and timely information, and psychosocial and emotional support, by kind, competent and motivated health workers who are working within a well-functioning health system.”
Rybińska, A., Best, D. L., Goodman, W. B., Bai, Y., & Dodge, K. A. (2022). Transitioning to virtual interaction during the COVID-19 Pandemic: Impact on the family connects postpartum home visiting program activity. Infant Mental Health Journal, 43, 159– 172. https://doi.org/10.1002/imhj.21953
“We conclude that post-pandemic onset virtual delivery rates of FC declined but are high enough to merit continued implementation during a period when some families will decline in-person visits. When in-person visits are deemed safe per public health guidelines, the findings suggest a hybrid approach that could maximize program outreach by prioritizing in-person contact and offering virtual delivery as a second choice.”
Dodge KA, Goodman WB, Bai Y, Best DL, Rehder P, Hill S. Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomized controlled trials and a field quasi-experiment. Lancet Reg Health Am. 2022 Aug 23;15:100356. doi: 10.1016/j.lana.2022.100356. PMID: 36778074; PMCID: PMC9904066.
Findings:
1) In the absence of intervention, large and statistically significant differences between Black families and Non-Hispanic White families were found in maternal anxiety, maternal depression, father non-support, child emergency medical care, and child maltreatment investigations. Few differences were found between Non-Hispanic White families and Hispanic families.
2) High rates of participation in treatment were found for each race group.
3) Across studies, assignment to FC was associated with statistically significant reductions in 7 of 12 disparities, in maternal anxiety and depression, father non-support, infant emergency medical care, and child maltreatment investigations.”
Goodman WB, Dodge KA, Bai Y, Murphy RA, O’Donnell K. Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(7):e2116024. doi:10.1001/jamanetworkopen.2021.16024
“In this randomized clinical trial, analyses of administrative records indicated that families assigned to FC had 39% fewer Child Protective Services investigations for suspected child abuse and neglect. Families assigned to FC also had a 33% decrease in total child emergency medical care use.”
Dodge KA, Goodman WB, Bai Y, O’Donnell K, Murphy RA. Effect of a Community Agency–Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(11):e1914522. doi:10.1001/jamanetworkopen.2019.14522
“This community-based randomized clinical trial found that the visitation program was implemented with 76% penetration and 90% adherence to the protocol, leading nurses to address minor problems for 52% of families and connect an additional 42% to community resources. Analyses of interviews and administrative records indicated that families assigned to the intervention had more community connections, fewer cases of maternal anxiety or depression, and fewer investigations for child abuse.”
- Universal Reach at Birth: Family Connects (2019) – Peer reviewed published report
Dodge, K. A., & Goodman, W. B. (2019). Universal Reach at Birth: Family Connects. The Future of Children, 29(1), 41–60. https://www.jstor.org/stable/26639555
“How do we screen all families in a population at a single time point, identify family-specific risks, and connect each family with evidence-based community resources that can help them overcome those risks—an approach known as targeted universalism? In this article, Kenneth A. Dodge and W. Benjamin Goodman describe Family Connects, a program designed to do exactly that.”
- Universal Reach at Birth: Family Connects (2019) – Peer reviewed published report
Goodman WB, Dodge KA, Bai Y, O’Donnell KJ, Murphy RA. Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months. Dev Psychopathol. 2019 Dec;31(5):1863-1872. doi: 10.1017/S0954579419000889. PMID: 31477190; PMCID: PMC7061922.
“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.”
Number 736 May 2018
Presidential Task Force on Redefining the Postpartum Visit
Committee on Obstetric Practice
“The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs. It is recommended that all women have contact with their obstetrician–gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth.”
- Moving Beyond Program to Population Impact: Toward a Universal Early Childhood System of Care (2018)
Goodman WB, O’Donnell K, Murphy RA, Dodge KA; Duke University. Moving Beyond Program to Population Impact: Toward a Universal Early Childhood System of Care. J Fam Theory Rev. 2019 Mar;11(1):112-126. doi: 10.1111/jftr.12302. Epub 2018 Nov 15. PMID: 30923572; PMCID: PMC6433400.
“Results from this randomized trial evaluation of Family Connects suggest that universal home visiting by newborn nurses can be successful both in serving as an initial portal of entry into a broader early childhood system of care and in addressing numerous barriers to effectively scaling intervention services for children and families for population impact.”
Dodge KA, Goodman WB, Murphy RA, O’Donnell K, Sato J, Guptill S. Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. Am J Public Health. 2014 Feb;104 Suppl 1(Suppl 1):S136-43. doi: 10.2105/AJPH.2013.301361. Epub 2013 Dec 19. PMID: 24354833; PMCID: PMC4011097.
“Of all families, 80% initiated participation; adherence was 84%. Hospital records indicated that Durham Connects infants had 59% fewer infant emergency medical care episodes than did control infants. Durham Connects mothers reported fewer infant emergency care episodes and more community connections, more positive parenting behaviors, participation in higher quality out-of-home child care, and lower rates of anxiety than control mothers. Blinded observers reported higher quality home environments for Durham Connects than for control families.”
Dodge KA, Goodman WB, Murphy RA, O’Donnell K, Sato J. Randomized controlled trial of universal postnatal nurse home visiting: impact on emergency care. Pediatrics. 2013 Nov;132 Suppl 2(Suppl 2):S140-6. doi: 10.1542/peds.2013-1021M. PMID: 24187116; PMCID: PMC3943376.
“After demographic factors (i.e., birth risk, Medicaid status, ethnicity, and single parenthood) were covaried, relative to control families, families assigned to intervention had 50% less total emergency medical care us (mean [M] emergency department visits and hospital overnights) (Mintervention = 0.78 and Mcontrol = 1.57; P < .001, effect size = 0.28) across the first 12 months of life.
This brief, universal, postnatal nurse home visiting program improves population-level infant health care outcomes for the first 12 months of life. Nurse home visiting can be implemented universally at high fidelity with positive impacts on infant emergency health care that are similar to those of longer, more intensive home visiting programs. This approach offers a novel solution to the paradox of targeting by offering individually tailored intervention while achieving population-level impact.”
Alonso-Marsden S, Dodge KA, O’Donnell KJ, Murphy RA, Sato JM, Christopoulos C. Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment. Child Abuse Negl. 2013 Aug;37(8):555-65. doi: 10.1016/j.chiabu.2013.03.012. Epub 2013 May 6. PMID: 23660409; PMCID: PMC3760480.
“Findings suggest that while higher demographic risk increases families’ initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.”