Durham Connects RCT Evaluation II

The Durham Connects program is an innovative, community-based, universal nurse home-visiting
program that aims to lower the population rate of child maltreatment and improve child and
family health and well-being. The Durham Connects Program is implemented jointly by the
Durham County (North Carolina) Health Department, the Center for Child & Family Health, and
Duke University. It is designed to be brief and inexpensive per family so that communities
can afford its costs. Its goals are consistent with those of more intensive nurse
home-visiting programs: 1) to connect with the mother in order to enhance maternal skills and
self-efficacy; and 2) to connect the mother with needed community services such as health
care, child care, mental health care, and financial and social support; so that 3) the mother
can connect with her child.

DC achieves population reach by engaging all families within the community, rapidly triaging
families based on identified risk to concentrate resources to families with greater needs,
and connecting those families with significant nurse-identified risk to matched community
programs and services to provide long-term support and a first step into the community system
of care. The program consists of 4-7 manualized intervention contacts, including 1) a
hospital birthing visit when a staff member communicates the importance of community support
for parenting and schedules an initial home visit; 2) 1-3 nurse home visits between 3-12
weeks of infant age to provide physical assessments for infant and mother, intervention and
education, assessment of family-specific needs, and for families with significant
nurse-identified risk, connections to matched community resources to provide longer-term
support; 3) 1-2 nurse contacts with community service providers to facilitate successful
connections; and 4) a telephone follow-up one month after case closure to review consumer
satisfaction and community connection outcomes. With family consent, letters from the program
reporting on the visit are also provided to also connect families to maternal and infant
healthcare providers for ongoing support.

During home visits, the nurse engages the mother (and father, when possible) to provide brief
educational interventions for all families (e.g., safe sleep) and utilizes a high-inference
approach to assess family needs across 12 empirically-derived factors linked to child health
and well-being: Healthcare: parent health, infant health, health care plans;
Parenting/childcare: childcare plans, parent-infant relationship, management of infant
crying; Family violence/safety: material supports, family violence, maltreatment history; and
Parent well-being: depression/anxiety, substance abuse, social/emotional support.

The nurse scores each of the 12 factors and intervenes accordingly. A score of 1 (low risk)
receives no subsequent intervention. A score of 2 (moderate risk) receives short-term,
nurse-delivered intervention over 1-2 sessions. For a score of 3 (high risk) the nurse
connects the family to matched community resources tailored to address that particular risk
(such as, treatment for postpartum depression, a DSS social worker exclusively serving Durham
Connects families for enrollment in Medicaid or food stamps, a multi-year home visiting
program for long-term parent support). The nurse also provides follow up to make sure that
each connection "sticks," requiring additional contacts with the family or community agency.
A score of 4 (imminent risk) receives emergency intervention (<1% of cases). A final contact
four weeks after case closure ascertains community connection outcomes and whether further
problem solving is needed to address new or existing needs.

From January 1, 2014, through June 30, 2014, all residential births in Durham County, North
Carolina (~1600) will randomly assigned according to birthdate, with odd-birth-dates assigned
to receive DC. Even-birth-dates will be assigned to receive services-as-usual and serve as
the randomized control group. All eligible families (i.e., families living in Durham County
giving birth at one of the two county hospitals) were included with experimental rigor, and
without exception, but with ethical care for confidentiality. Hospital discharge records were
utilized to confirm eligibility for all RCT families. Program implementation will be
evaluated for all odd-birth-date families. The Duke University Health System Institutional
Review Board approved all RCT implementation and evaluation procedures.

Completely independent of program implementation, all RCT families were contacted and invited
to participate in an independent evaluation of DC short-term impact at infant age 6 months
(interviews completed between infant ages 6-8 months). Eligible RCT families were identified
using short-form public birth records (i.e., resident Durham County births at one of the two
county birthing hospitals) without consideration for intervention participation or adherence.
RCT families were contacted and invited to participate in a descriptive research study about
family community service use and child development. Families were blind to study goals, and
home interviewers were blind to family DC participation status.

Inclusion Criteria:

- Infant born between January 1, 2014 and June 30, 2014

- Infant born at a Durham County, North Carolina (NC) hospital (Duke or Durham Regional)

- Family of infant resides in Durham County, NC

Exclusion Criteria:

- Infant born before January 1, 2014 or after June 30, 2014

- Infant not born at a Durham County, NC hospital (Duke or Durham Regional)

- Family of infant resides outside of Durham County, NC