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early-childhood programs
The operative claimNurse home-visiting programs — notably the Nurse-Family Partnership — produced lasting benefits in replicated randomized trials, especially for higher-risk subgroups (such as children of mothers with low psychological resources and reduced offending among girls), but several large-scale and international replications found null effects on their primary outcomes, so at-scale effectiveness is more modest and uneven.
Established that the foundational NFP trials produced lasting benefits for higher-risk families; contested whether those benefits replicate at scale, where recent large RCTs found null primary outcomes.
The foundational US trials (Elmira, Memphis, Denver) are randomized with follow-up into late adolescence and show benefits concentrated in the highest-risk subgroups: better child language/attention and math for children of mothers with limited psychological resources, and reduced arrests/convictions among girls. But a pragmatic English RCT (Building Blocks) found no short-term benefit on primary outcomes, and a large at-scale South Carolina RCT found a null primary composite (mortality/injury/maltreatment). Benefits are real but targeted, larger for higher-risk families and as delivered with fidelity, and weaker on primary outcomes when scaled.
Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Cole, R., Kitzman, H., et al (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of Pediatrics & Adolescent Medicine, 164(1), 9-15.
Experimental · N = 400 · followed to age 19
At 19-year follow-up of the Elmira Nurse-Family Partnership RCT, girls in the nurse-visited group were markedly less likely to have been arrested (10% vs 30%) and convicted, with the largest effects for children of high-risk mothers; few program effects appeared for boys.
Bearing on this claim: Elmira 19-year RCT follow-up: reduced arrests/convictions among nurse-visited girls, largest for high-risk mothers.
doi.org/10.1001/archpediatrics.2009.240Kitzman, H. J., Olds, D. L., Knudtson, M. D., Cole, R., Anson, E., Smith, J. A., et al (2019). Prenatal and infancy nurse home visiting and 18-year outcomes of a randomized trial. Pediatrics, 144(6), e20183876.
Experimental · N = 742 · followed to age 18
At 18 years, youth born to mothers with limited psychological resources who received nurse visits had better receptive language and math achievement than controls, and nurse-visited females showed a trend toward fewer convictions; there were no effects on other behaviors — benefits concentrated in the highest-risk subgroup.
Bearing on this claim: Memphis 18-year RCT: better language and math for children of low-psychological-resource mothers.
doi.org/10.1542/peds.2018-3876Olds, D. L., Holmberg, J. R., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J (2014). Effects of home visits by paraprofessionals and by nurses on children: Age-six and nine follow-up of a randomized trial. JAMA Pediatrics, 168(2), 114-121.
Counter-authority (2). Studies an adversary may cite — surfaced deliberately so the grade is honest about its limits.
Robling, M., Bekkers, M.-J., Bell, K., Butler, C. C., Cannings-John, R., Channon, S., et al (2016). Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. The Lancet, 387(10014), 146-155.
Experimental · N = 1,645 · to 24 months postpartum
In a pragmatic English RCT, adding the Family Nurse Partnership to usual care produced no additional short-term benefit on its primary outcomes (prenatal smoking, birthweight, second pregnancy, infant ED/hospital use); the authors concluded continuation was not justified on short-term evidence.
Bearing on this claim: England Building Blocks RCT: no short-term benefit on primary outcomes; continuation not justified on short-term evidence.
doi.org/10.1016/s0140-6736(15)00392-x3 supporting · 2 counter verified sources
Benefits are subgroup-specific (higher-risk mothers, girls) and outcome-specific, not universal; recent at-scale and international RCTs found null primary outcomes; effects depend on fidelity and the counterfactual services available; and paraprofessional delivery underperforms nurse delivery. The rating is of targeted foundational-trial benefits, not guaranteed at-scale effectiveness.
Last reviewed June 26, 2026
Experimental · N = 735 · ages 6 and 9
Nurse-visited children showed better behavioral functioning, and those born to low-resource mothers had better receptive language and sustained attention than controls; there were no significant nurse effects on intellectual functioning or academic achievement, and paraprofessional effects were smaller.
Bearing on this claim: Denver RCT (ages 6/9): better behavior; language/attention gains for low-resource subgroup; nurses > paraprofessionals.
Swanson, K., McConnell, M., Williams, M., et al (2025). Intensive nurse home visiting and early childhood outcomes: A randomized clinical trial. JAMA Pediatrics.
Experimental · N = 5,670 · to age 2
In a large at-scale South Carolina RCT, assignment to intensive nurse home visiting did not reduce the primary composite of child mortality/major injury/abuse-neglect by age 2; a small reduction in ED use lost significance after multiple-testing adjustment — at-scale primary effects were null.
Bearing on this claim: Large South Carolina at-scale RCT: null primary composite (mortality/injury/maltreatment) by age 2.
doi.org/10.1001/jamapediatrics.2025.1600