Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure

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.