Lorraine Klerman

Professor, University of Alabama at Birmingham

Differences In Population

• Enrollment (voluntary/mandatory)

• Age at enrollment (% of teenagers)

• Race/ethnicity (% Caucasian, African-American, Hispanic)

• Timing of first contact (during pregnancy/ already had infant or toddler)

• Welfare status at enrollment (all/some)

Differences Between Programs Overall

• Auspices (public health/welfare)

• Principal contact (nurse/case manager)

• Size of caseload (20-25 families/50-60 clients

• Usual place of contact (home/case manager’s office)

• Involvement of others (much/some)

• Focus (health & maternal life course/move from welfare)

• Approach (behavioral change/information & education

• Financial incentives (no/yes)

Differences in Family Planning Components

• Importance of family planning component (central/peripheral)

• Integration with rest of program (high/low)

• Family planning education (by nurse / in workshop)

• Family planning counseling (directive / not directive)

Differences In Result

• Elmira site follow-up- fewer pregnancies and births among home visited women at 46 month and 15 year

• Memphis site - fewer pregnancies and births among home visited women at 24 month follow-up

• Camden site - fewer pregnancies among case managed women at 29 month follow-up (but more births)

• Newark and Chicago sites - more pregnancies and births among case managed women at 29 month follow-up

• Elmira site - intervals between births longer among home visited women at 46 month and 15 year follow-up

Reasons For Greater Impact of
Home Visiting Program

• Less difficult population (?)

• Overall program approach

-- use of nurse
-- focus on home
-- attention to social supports
-- timing of first contact

• Family planning component

-- an element in planning for the future
-- taught by same person in same places
-- directive approach