TY - JOUR A1 - Schepan, Marie Lisanne A1 - Sandner, Malte A1 - Conti, Gabriella A1 - Kliem, Sören A1 - Brand, Tilman T1 - Maternal and Child Health Following 2 Home Visiting Interventions vs Control BT - Five-Year Follow-Up of a Randomized Clinical Trial JF - JAMA Pediatrics N2 - ImportanceHome-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes.ObjectiveTo assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes.Design, Setting, and ParticipantsThe baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up.InterventionsBased on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services.Main Outcomes and MeasuresAverage treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction.ResultsThe mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, −5.49 to −0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, −4.00; 95% CI, −6.82 to −1.18), parenting stress (ATE, −0.13; 95% CI, −0.20 to −0.06), and maternal mental health burden (ATE, −3.63; 95% CI, −6.03 to −1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group.Conclusions and RelevanceBoth staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families.Trial RegistrationGerman Clinical Trials Register Identifier: DRKS00007554 Y1 - 2025 U6 - https://doi.org/10.1001/jamapediatrics.2024.5929 SN - 2168-6203 PB - American Medical Association (AMA) ER - TY - JOUR A1 - Conti, Gabriella A1 - Kliem, Sören A1 - Sandner, Malte T1 - Early Home Visiting Delivery Model and Maternal and Child Mental Health at Primary School Age JF - AEA Papers and Proceedings N2 - We study the impacts of a prenatal and infancy home visiting program targeting disadvantaged families on mental health outcomes, assessed through diagnostic interviews. The program significantly reduced the prevalence of mental health conditions for both mothers and children, measured at primary-school age, and broke the intergenerational association of these conditions. The impacts are predominantly associated with a particular delivery model, wherein a single home visitor interacts with the family, as opposed to a model involving two home visitors. Y1 - 2024 U6 - https://doi.org/10.1257/pandp.20241087 SN - 2574-0768 VL - 114 SP - 401 EP - 406 PB - American Economic Association ER - TY - JOUR A1 - Conti, Gabriella A1 - Poupakis, Stavros A1 - Sandner, Malte A1 - Kliem, Sören T1 - The effects of home visiting on mother-child interactions BT - Evidence from a randomized trial using dynamic micro-level data JF - Child Abuse & Neglect N2 - Home visiting programs constitute an important policy to support vulnerable families with young children. One of their principal aims is to improve infant-parent relationships, so a key measure of their effectiveness is based on observational measures of parent-children interactions. In the present study we provide novel evidence on the effectiveness of home visiting programs in improving mother-child interactions within a randomized controlled trial (RCT) of the Pro Kind program. A major goal of the Pro Kind program is to promote child development by strengthening the intuitive parenting skills of mothers. On this basis, the following research question is addressed in this paper: What is the impact of the Pro Kind home visitation program on the quality of mother-child interaction? Y1 - 2021 U6 - https://doi.org/10.1016/j.chiabu.2021.105021 SN - 0145-2134 VL - 115 PB - Elsevier BV ER - TY - JOUR A1 - Conti, Gabriella A1 - Sandner, Malte A1 - Brand, Tilman A1 - Kliem, Sören T1 - Efficacy of delivery models in early intervention: Findings from Germany's nurse-family partnership on family and child welfare services and pediatric medical incidents in high-risk families JF - Child Abuse & Neglect N2 - This study evaluates the effectiveness of two delivery models of the ProKind intervention—a German adaptation of the Nurse-Family Partnership (NFP)—in supporting high-risk families. The continuous model (CM) involves home visits exclusively conducted by NFP-trained midwives, while the tandem model (TM) combines visits by a midwife during pregnancy with follow-up visits by a social worker postnatally. A total of 755 disadvantaged pregnant women were randomly assigned to intervention (n = 394) or control groups (n = 361). Outcomes include child protection service (CPS) surveillance, foster care placements, and pediatric hospital visits. The study is based on a longitudinal, multicenter randomized controlled trial (RCT) with two follow-up phases: Phase I (birth to 36 months) and Phase II (around the child’s 7th birthday). Average treatment effects were estimated using augmented inverse probability weighting (AIPW) combined with lasso variable selection. The CM significantly reduced pediatric hospital visits in both follow-up phases. In Phase II, there were also suggestive trends toward reduced CPS surveillance and fewer foster care placements. No significant effects were found for the TM on any outcome. Full-sample analyses confirmed significant reductions in hospital visits during Phase II. These results underscore the relevance of delivery models in home-visitation programs and suggest that sustained, midwife-led interventions can yield long-term benefits for vulnerable families. Y1 - 2025 U6 - https://doi.org/10.1016/j.chiabu.2025.107513 SN - 0145-2134 VL - 166 PB - Elsevier BV ER - TY - JOUR A1 - Kliem, Sören A1 - Sandner, Malte A1 - Brand, Tilman A1 - Fischer, Sebastian A1 - Lohmann, Anna A1 - Schepan, Marie Lisanne A1 - Conti, Gabriella A1 - Baier, Dirk T1 - Follow-up study on the long-term effectiveness of the home-visiting program “ProKind”: study protocol for a randomized controlled trial JF - Frontiers in Pediatrics N2 - BackgroundThe Nurse-Family Partnership (NFP) is an evidence-based home visiting program shown to improve maternal and child outcomes. Pro Kind is the first German adaptation of NFP, implemented between 2006 and 2012. While earlier evaluations demonstrated short- and medium-term benefits, no European trial has yet assessed long-term effects into adolescence. ObjectivesThis study protocol outlines the third phase of the Pro Kind randomized controlled trial (RCT), designed to evaluate the program’s effectiveness 14–16 years post-intervention. Primary aims are to assess adolescent and maternal outcomes related to mental health, parenting, risk behaviors, and life satisfaction, as well as potential long-term economic effects.MethodsThe original RCT enrolled 755 pregnant women with psychosocial risk factors, randomly assigned to an intervention (n = 394) or control group (n = 361). The intervention comprised structured home visits from midwives or tandem teams (midwife + social worker) from pregnancy until the child’s second birthday. The 15-year follow-up combines self-report data (via online interviews and questionnaires) and administrative records on employment, social benefits, and criminal justice involvement. Discussion: This study represents the first long-term follow-up of an NFP adaptation in Europe. While U.S. trials of NFP provide evidence of the program’s effectiveness, these results cannot be generalized to European welfare contexts. This underscores the need for long-term evaluations of NFP adaptations in Europe to generate evidence that can inform policy and ensure evidence-based decision making. Y1 - 2025 U6 - https://doi.org/10.3389/fped.2025.1606749 SN - 2296-2360 VL - 13 PB - Frontiers Media SA ER -