Public Health Nurse Tailored Home Visiting and Parenting Behavior for Families at Risk for Referral to Child Welfare Services, Colorado: 2018-2019

Abstract

Objectives. To examine public health nurse (PHN) intervention tailoring through the Colorado Nurse Support Program (NSP). Our 2 specific aims were to describe the NSP program and its outcomes and to determine the effects of modifying interventions on short- and long-term outcomes among NSP clients. Methods. In our retrospective causal investigation of 150 families in Colorado in 2018-2019, intervention effects were modeled via longitudinal modified treatment policy analyses. Results. Families served by PHNs improved in terms of knowledge, behavior, and status outcomes after receiving multidimensional, tailored home visiting interventions. Case management interventions provided in the first month of PHN home visits had lasting effects on behavior outcomes, and 2 additional case management interventions in the first month were estimated to have even more of an impact. Conclusions. Modern causal inference methods and real-world PHN data revealed a nuanced, fine-grained understanding of the real impact of tailored PHN interventions. Public Health Implications PHN programs such as the NSP and use of the Omaha System should be supported and extended to advance evaluations of intervention effectiveness and knowledge discovery and improve population health. (Am J Public Health. 2022;112(S3):S306-S313. https://doi.org/10.2105/AJPH.2022.306792).

FIGURE 1—

Time-Dependent Confounding, Interventions, Baseline Information, and Knowledge, Behavior, and Status Outcomes for Clients: Colorado, 2018–2019 Note. B = behavior; K = knowledge; S = status. The diagram illustrates how previous outcomes and interventions can affect future interventions and shows the causal ordering of data required for a longitudinal modified treatment policy analysis. Each arrow represents a relationship among variables and the direction of the relationship.

FIGURE 2—

Expected Changes in Knowledge, Behavior, and Status Outcomes Under Hypothetical (a) Decreases by 2 and (b) Increases by 2 in the Number of Case Management Interventions: Colorado, 2018–2019 Note. IM = intervention modification. When interventions are modified in a given month, they are held fixed in all other months. A positive change means that outcomes improve with a given hypothetical modification in interventions. Error bars represent 95% confidence intervals.