Pushing the Envelope: Child Health Services Research in Communities
Improving Children's Health
Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research
was explored, including public and private funding opportunities, networks for
conducting research, and uses of research in policy and practice. The meeting
was co-sponsored by the National Association of Children's Hospitals and Related
Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR),
the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the
Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data
Dr. Olds discussed the need for clear
evidence to translate research into practice. He emphasized the need to understand
practice changes before their adoption and implementation through policy.
To illustrate the importance of this
recommendation, he described the history of home visiting research and the adoption
of home visiting programs. Many policymakers implemented home visiting programs
without sufficient knowledge of the conditions required for their success. His
research demonstrated that nurse-delivered services, provided to well-targeted
populations, and well grounded in social behavioral theory, are most effective:
- Olds D, Henderson CR, Cole R,
et al. Long-term effects of nurse home visitation on children's criminal and
antisocial behavior: 15-year follow-up of a randomized trial. The Journal
of the American Medical Association. 1998; 280(14): 1238-1244.
- Olds D, Eckenrode J, Henderson
C, et al. Long-term effects of home visitation on maternal life course and
child abuse and neglect: 15-year follow-up of a randomized trail. Journal
of The American Medical Association. 1997; 278: 637-643.
As the success of home visiting became
widely known, similar programs were implemented by many organizations to promote
improvements in child health outcomes. Unfortunately, they were modified without
the benefit of the research knowledge gained from earlier studies. This is reflected
in a recent review of home visiting programs that found the effects of many
programs were small and had significant problems retaining participants:
- Olds DL, Henderson C, Kitzman
H, et al. Prenatal and infancy home visitation by nurses: recent findings.
The Future of Children. 1999; 9(1): 44-65.
Dr. Olds is currently funded by the
U.S. Department of Justice and the Department of Health and Human Services to
study how nurse home visiting programs can be brought to scale, with a focus
on the fidelity of new programs. Both past and future research should be used
to guide policymakers and providers as they implement, change, and evaluate
the impact of interventions to improve the health of children.
Olds D. Pushing the Envelope:
Child Health Services Research in Communities. Presentation Summary, Improving
Children's Health Through Health Services Research, Chicago, June 26, 1999.