Building the Evidence Base for Family Connects

At St. David’s Foundation, we believe supported families and connected communities play a key role in early childhood outcomes. Central to our Resilient Children strategy is investing in programs that create the conditions to promote strong, healthy early relationships. Family Connects, a universal nurse home visiting program for families of newborns, is a key example of the effectiveness of this strategy with a robust evidence base demonstrating the short and long-term impacts of the model.

New research published in the July 7, 2021 issue of JAMA Network Open further confirms the positive effects of Family Connects. This most recent evaluation finds that the Family Connects intervention is associated with 39% fewer investigations for child maltreatment and a 33% decrease of emergency medical care use in total per child, with effects continuing to the child’s fifth birthday[i].

This study follows previously reported findings from a random control trial, which found positive impacts on child health, parenting, and lower child welfare investigations through two years of age[ii]. The significance of this recent research is to document that key positive effects of the Family Connects intervention continue at least until the child’s fifth birthday. These findings lend important information for funders and policy makers who must decide where to allocate limited resources. In some early childhood programs, the initial positive effects wane over time, reducing the long-term value of the intervention. This research demonstrates that two of the most prominent effects (and those with high, quantifiable costs to society) of the Family Connects intervention, persist, lasting at least through age five.

The outcomes are particularly relevant to funders and policy makers who supported bringing the Family Connects model to Texas, which since 2018 has rolled out in phases in five Texas communities, including Austin and Bastrop. Additional data demonstrating the long-term value of the program makes an even stronger case for using Family Connects to improve overall child well-being and reduce the number of children entering the child welfare system.

“This newest study shows that the positive benefits of Family Connects persist at least until children reach age five,” says Kim McPherson, MPAff, Senior Program Officer, St. David’s Foundation. “As we seek to create the community conditions that allow all children to reach their potential, it’s now even clearer that Family Connects should be universally available as the first layer of a thoughtfully designed system of supports. The effects aren’t just good—they last.”

Download the article here.

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[i] 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

[ii] 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.

About Family Connects

The model:

• Family Connects provides one to three home visits from a registered nurse shortly after the birth of a child that include infant and postpartum health checks as well as tailored referrals to resources within the community.
• The program also includes a comprehensive community alignment process that seeks to better match real time need against available resources, allowing for more effective local decision making.
• Because home visits are offered to all families, no stigma is attached to participation, helping to increase community acceptance and achieve population level impacts at a relatively modest cost ($500-700 per birth). The program is voluntary and offered to all families free of charge.

Central Texas Implementation:

• In 2018, the program was launched in five Texas communities, including Austin and Bastrop, with funding from public and private sources. The program has since been recognized by the Prenatal-to-3 Policy Impact Center for its ability to provide comprehensive screening and referral to improve child outcomes. More information about Family Connects in Central Texas can be found here (no longer available).
• Family Connects is in various stages of planning and implementation in 17 states.

About the Evidence Base:

• The evidence on the effects of Family Connects comes from a randomized controlled trial (RCT), the gold standard in research. In order to evaluate and isolate the effects of Family Connects intervention on child health and wellbeing, the evaluation design randomly assigned all 4,777 resident births in Durham, North Carolina during an 18-month period, (July 1, 2009 to December 31, 2010) to receive either the Family Connects intervention or treatment as usual.
• The findings are based on analysis of hospital and Child Protective Services records in ensuing years as well as later observations and interviews with families. The initial cohort of both intervention and control groups continues to be followed to determine whether the effects found in earlier analyses persist as the children age. Read more about the growing evidence base here.