Improving Children's Health Through Health Services Research

David Olds, Ph.D.

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 Harbor, Inc.

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.