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Effectiveness of a Home Intervention for Perceived Child Behavioral Problems and Parenting Stress in Children With In Utero Drug Exposure
Arlene M. Butz, RN, ScD;
Margaret Pulsifer, PhD;
Nicole Marano, BS;
Harolyn Belcher, MD;
Mary Kathleen Lears, MPH, MSN;
Richard Royall, PhD
Arch Pediatr Adolesc Med. 2001;155:1029-1037.
Objective To determine if a home-based nurse intervention (INT), focusing on parenting
education/skills and caregiver emotional support, reduces child behavioral
problems and parenting stress in caregivers of in utero drug-exposed children.
Design Randomized clinical trial of a home-based INT.
Settings Two urban hospital newborn nurseries; homes of infants (the term infant
is used interchangeably in this study with the term child to denote those
from birth to the age of 36 months); and a research clinic in Baltimore, Md.
Participants In utero drug-exposed children and their caregivers (N = 100) were examined
when the child was between the ages of 2 and 3 years. Two groups were studied:
standard care (SC) (n = 51) and INT (n = 49).
Intervention A home nurse INT consisting of 16 home visits from birth to the age
of 18 months to provide caregivers with emotional support and parenting education
and to provide health monitoring for the infant.
Main Outcome Measures Scores on the Child Behavior Checklist and the Parenting Stress Index.
Results Significantly more drug-exposed children in the SC group earned t scores indicative of significant emotional or behavioral
problems than did children in the INT group on the Child Behavior Checklist
Total (16 [31%] vs 7 [14%]; P = .04), Externalizing
(19 [37%] vs 8 [16%]; P = .02), and Internalizing
(14 [27%] vs 6 [12%]; P = .05) scales and on the
anxiety-depression subscale (16 [31%] vs 5 [10%]; P
= .009). There was a trend (P = .06) in more caregivers
of children in the SC group reporting higher parenting distress than caregivers
of children in the INT group.
Conclusions In utero drug-exposed children receiving a home-based nurse INT had
significantly fewer behavioral problems than did in utero drug-exposed children
receiving SC (P = .04). Furthermore, those caregivers
receiving the home-based INT reported a trend toward lower total parenting
distress compared with caregivers of children who received SC with no home
visits.
From the Departments of Pediatrics (Drs Butz and Belcher) and Psychiatry
(Dr Pulsifer), The Johns Hopkins University School of Medicine, Institutional
Research Department, Loyola College, Baltimore (Ms Marano), The Kennedy Krieger
Institute, Baltimore (Dr Belcher), and the Schools of Nursing (Ms Lears) and
Public Health (Dr Royall), The Johns Hopkins University, Baltimore, Md.
Corresponding author and reprints: Arlene M. Butz, RN, ScD, Department
of Pediatrics, The Johns Hopkins University School of Medicine, 600 N Wolfe
St, Room CMSC-144, Baltimore, MD 21287-3144 (e-mail: abutz{at}jhmi.edu).
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