M. Rebecca Kilburn

Drawing on previous studies and the collective experience of conducting rigorous evaluations as part of the Tribal Maternal, Infant, and Early Childhood Home Visiting grants, we outline methodological considerations that will inform future research in tribal communities, particularly in the area of home visiting. The methodological issues we discuss are study design choices, measurement and data collection, and including community members in all aspects of the research.

BACKGROUND AND OBJECTIVES: Evaluations of home visiting models have shown that they can reduce children’s health care use in the first year of life. Models that exclusively use nurses as home visitors may cost more and be infeasible given nursing shortages in some locations. The goal of this study was to test whether a universal home visiting model employing a nurse–parent educator team as home visitors reduces health care use in the first year of life.METHODS: This study was a randomized controlled clinical trial of an intensive home visiting program delivered in homes of primary caregivers and their first-born children in Santa Fe, New Mexico. Intention-to-treat and contamination-adjusted intention-to-treat models were estimated, and 244 primary caregivers participated in the survey.RESULTS: In their first year of life, treatment group children were one-third less likely to visit the emergency department (control group mean, MC = 0.42, treatment group mean, MT = 0.28, P = .02) and were also 41% less likely to have visited a primary care provider ≥9 times (MC = 0.49, MT = 0.29, P < .001). We found no differences between the treatment and control groups for hospitalizations or injuries requiring medical attention. The universal program reduced infant health care use for high-risk and lower-risk families.CONCLUSIONS: Children in families randomly assigned to the program had less health care use in their first year, demonstrating that a universal prevention home visiting model delivered by a nurse–parent educator team can reduce infant health care use.

Growth in federal, state and private funding is fueling the initiation of home visiting programs around the country. As communities expand home visiting programs, they need information about how they can successfully start up new sites. This paper proposes measures of successful home visiting program implementation and identifies factors that promote successful implementation or serve as barriers to program initiation. It focuses on lessons learned from the replication of the First Born® Program in six counties in New Mexico. Specifically, it examines how well sites met staffing, family referral and enrollment, program fidelity, and financing goals in the first year of providing services. Data come from semi-structured interviews with senior program staff and program documentation. The findings are likely to be valuable to a wide spectrum of communities starting or expanding home visiting services, as well as to public and private funders of programs.

The theoretical and empirical literature on parental investment focuses on whether child-specific parental investments reinforce or compensate for a child's initial endowments. However, many parental investments, such as neighborhood quality and family size and structure, are shared wholly or in part among all children in a household. The empirical results of this paper imply that such household parental investments compensate for low endowments, as proxied by low birth weight.

This paper tests whether parents reinforce or compensate for child endowments. The authors employ birth weight as a proxy for endowments and estimate how the difference in birth weight across siblings impacts specific parental investments, including breastfeeding initiation and duration, well-baby visits, immunizations, preschool attendance, and kindergarten entry age. They also examine whether parental investment in a child is impacted by her siblings' endowments. Their results indicate that heavier birth weight children receive higher levels of most parental investment than their lower birth weight siblings suggesting that parental investments in infancy and early childhood reinforce differences in endowments. In one exception, they find weak evidence that lower birth weight children enter kindergarten slightly later than their normal birth weight siblings, which could be interpreted as a compensating parental investment. Presence of a low birth weight sibling in the household increases the likelihood of investments such as well-baby visits and immunizations.

This paper explores how observed and unobserved parental investments compensate for low birth weight. Controlling for family fixed effects, which encompass unobserved parental investment, we find birth weight positively correlates with math and reading scores and these estimates are considerably larger in magnitude than estimates derived from models that do not control for family fixed effects. Additionally, we examine how three specific parental investments - kindergarten entrance age, maternal labor supply, and family size - interact with birth weight in models of child test scores. Of these investments, only smaller family size conveys particular advantage to low birth weight children.

While the use of child care and mothers' labor force participation are often described as being related to the availability of center-based child care, there is little empirical evidence documenting this relationship. This paper examines the role of center availability in child care use and mother's participation in wage labor using the China Health and Nutrition Survey. Our difference-in-difference estimates suggest that the availability of child care centers in China is associated with sizeable increases in both child care utilization and women's wage labor in urban areas. Our results also demonstrate the importance for non-random center availability.