***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Home visitation to families with young children has been promoted as an effective way to prevent child maltreatment , but few studies have examined the conditions under which such programs meet this goal . OBJECTIVE To investigate whether the presence of domestic violence limits the effects of nurse home visitation interventions in reducing substantiated reports of child abuse and neglect . DESIGN Fifteen-year follow-up study of a r and omized trial . SETTING Semirural community in upstate New York . PARTICIPANTS Of 400 socially disadvantaged pregnant women with no previous live births enrolled consecutively between April 1978 and September 1980 , 324 mothers and their children participated in the follow-up study . INTERVENTIONS Families were r and omly assigned to receive routine perinatal care ( control group ; n = 184 participated in follow-up ) , routine care plus nurse home visits during pregnancy only ( n = 100 ) , or routine care plus nurse home visits during pregnancy and through the child 's second birthday ( n = 116 ) . MAIN OUTCOME MEASURES Number of substantiated reports over the entire 15-year period involving the study child as subject regardless of the identity of the perpetrator or involving the mother as perpetrator regardless of the identity of the child abstract ed from state records and analyzed by treatment group and level of domestic violence in the home as measured by the Conflict Tactics Scale . RESULTS Families receiving home visitation during pregnancy and infancy had significantly fewer child maltreatment reports involving the mother as perpetrator ( P = . 01 ) or the study child as subject ( P = .04 ) than families not receiving home visitation . The number of maltreatment reports for mothers who received home visitation during pregnancy only was not different from the control group . For mothers who received visits through the child 's second birthday , the treatment effect decreased as the level of domestic violence increased . Of women who reported 28 or fewer incidents of domestic violence ( 79 % of sample ) , home-visited mothers had significantly fewer child maltreatment reports during the 15-year period than mothers not receiving the longer-term intervention ( P = .01 ) . However , this intervention did not significantly reduce child maltreatment among mothers reporting more than 28 incidents of domestic violence ( 21 % of sample ) . CONCLUSIONS The presence of domestic violence may limit the effectiveness of interventions to reduce incidence of child abuse and neglect . JAMA . 2000;284:1385 - 1391 CONTEXT Home-visitation services have been promoted as a means of improving maternal and child health and functioning . However , long-term effects have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women 's life course and child abuse and neglect . DESIGN R and omized trial . SETTING Semirural community in New York . PARTICIPANTS Of 400 consecutive pregnant women with no previous live births enrolled , 324 participated in a follow-up study when their children were 15 years old . INTERVENTION Families received a mean of 9 home visits during pregnancy and 23 home visits from the child 's birth through the second birthday . DATA SOURCES AND MEASURES : Women 's use of welfare and number of subsequent children were based on self-report ; their arrests and convictions were based on self-report and archived data from New York State . Verified reports of child abuse and neglect were abstract ed from state records . MAIN RESULTS During the 15-year period after the birth of their first child , in contrast to women in the comparison group , women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports ( P<.001 ) . Among women who were unmarried and from households of low socioeconomic status at initial enrollment , in contrast to those in the comparison group , nurse-visited women had 1.3 vs 1.6 subsequent births ( P=.02 ) , 65 vs 37 months between the birth of the first and a second child ( P=.001 ) , 60 vs 90 months ' receiving Aid to Families With Dependent Children ( P=.005 ) , 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs ( P=.03 ) , 0.18 vs 0.58 arrests by self-report ( P<.001 ) , and 0.16 vs 0.90 arrests disclosed by New York State records ( P<.001 ) . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies , the use of welfare , child abuse and neglect , and criminal behavior on the part of low-income , unmarried mothers for up to 15 years after the birth of the first child The  Parents as Teachers ( PAT ) program is a parent-education program that includes home visiting and is design ed to begin prenatally or at birth . Through home visits , visitors called parent educators help parents to strengthen their parenting skills and knowledge of child development and to prepare young children for school . This article describes the PAT program and reports the results of evaluations of two r and omized trials of PAT  : ( 1 ) the Northern California ( Salinas Valley ) Parents as Teachers Demonstration , which served primarily Latino parents in the Salinas Valley of California 's Monterey County ; and ( 2 ) the Teen Parents as Teachers Demonstration , which served adolescent parents in four counties in Southern California . The two evaluations revealed small and inconsistent positive effects on parent knowledge , attitudes , and behavior , and no gains in child development or health , when analyses compared the experimental and control groups overall . However , subgroup analyses in the Salinas Valley program indicated that children in primarily Spanish-speaking Latino families benefitted more than either non-Latino or English-speaking Latino families , with significant gains in cognitive , communication , social , and self-help development . Subgroup analyses in the Teen PAT Demonstration indicated that families that received both PAT services and comprehensive case management services design ed to help mothers improve their life course benefitted most . Subgroup analyses in the Salinas Valley study suggested that children in families that received more intensive services benefitted more than children whose families received less intensive services . Results from that study suggested that home visits produced about a one-month developmental advantage per 10 visits for participating children Evaluation of high-risk cases treated via a tri-agency , interdisciplinary , early-intervention program suggests that a better outcome was achieved in the treatment program than in a control group of similar high-risk families receiving st and ard care . The number of treated cases requiring child protection services decreased during treatment , and confirmed episodes of child abuse were fewer in the treated group than in the control group Perinatal child abuse prevention projects are rarely rigorously evaluated . Women were referred to the Child Parent Enrichment Project ( CPEP ) project during or just after pregnancy if identified as at-risk of engaging in child abuse by community professionals . Clients were r and omly assigned to CPEP services ( n = 97 ) or traditional community services ( n = 94 ) .  CPEP services are based on ecological theory and involve six months of home visiting by paraprofessional women and linkage to other formal and informal community re sources . No advantages on self-report measures for the CPEP group were measured at posttest , and follow-up reports of child abuse were similar for both groups . Consumer satisfaction indicates that clients highly valued the program . Some indication of greater success with families with less serious problems was observed . The results argue for caution regarding the capacities of perinatal child abuse prevention services to serve the high-risk clientele they often receive Effects of early and extended postpartum contact and paraprofessional home visits on maternal attachment , reports of child abuse and neglect , and health care utilization were determined by r and om assignment of 321 low-income women to intervention or control groups immediately after delivery . Observations of maternal attachment were made at four months and 12 months . Hospital , health and welfare agency records , and interviews were used to determine reports of child abuse and neglect and health care utilization . After establishing a control for maternal background variables , early and extended contact explained statistically significant but small amounts of variance in several of the attachment measures . There were no statistically significant effects of the home visit interventions on maternal attachment , and neither intervention was related to reports of child abuse and neglect and health care utilization . Although the study supported earlier findings that early and extended contact has a significant effect , additional interventions are needed to support mother-infant attachment CONTEXT A program of home visitation by nurses has been shown to affect the rates of maternal welfare dependence , criminality , problems due to use of substances , and child abuse and neglect . However , the long-term effects of this program on children 's antisocial behavior have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on children 's antisocial behavior . DESIGN Fifteen-year follow-up of a r and omized trial . Interviews were conducted with the adolescents and their biological mothers or custodial parents . SETTING Semirural community in New York . PARTICIPANTS Between April 1978 and September 1980 , 500 consecutive pregnant women with no previous live births were recruited , and 400 were enrolled . A total of 315 adolescent offspring participated in a follow-up study when they were 15 years old ; 280 ( 89 % ) were born to white mothers , 195 ( 62 % ) to unmarried mothers , 151 ( 48 % ) to mothers younger than 19 years , and 186 ( 59 % ) to mothers from households of low socioeconomic status at the time of registration during pregnancy . INTERVENTION Families in the groups that received home visits had an average of 9 ( range , 0 - 16 ) home visits during pregnancy and 23 ( range , 0 - 59 ) home visits from birth through the child 's second birthday . The control groups received st and ard prenatal and well-child care in a clinic . MAIN OUTCOME MEASURES Children 's self-reports of running away , arrests , convictions , being sentenced to youth corrections , initiation of sexual intercourse , number of sex partners , and use of illegal substances ; school records of suspensions ; teachers ' reports of children 's disruptive behavior in school ; and parents ' reports of the children 's arrests and behavioral problems related to the children 's use of alcohol and other drugs . RESULTS Adolescents born to women who received nurse visits during pregnancy and postnatally and who were unmarried and from households of low socioeconomic status ( risk factors for antisocial behavior ) , in contrast with those in the comparison groups , reported fewer instances ( incidence ) of running away ( 0.24 vs 0.60 ; P = .003 ) , fewer arrests ( 0.20 vs 0.45 ; P = .03 ) , fewer convictions and violations of probation ( 0.09 vs 0.47 ; P<.001 ) , fewer lifetime sex partners ( 0.92 vs 2.48 ; P= .003 ) , fewer cigarettes smoked per day ( 1.50 vs 2.50 ; P= .10 ) , and fewer days having consumed alcohol in the last 6 months ( 1.09 vs 2.49 ; P = .03 ) . Parents of nurse-visited children reported that their children had fewer behavioral problems related to use of alcohol and other drugs ( 0.15 vs 0.34 ; P = .08 ) . There were no program effects on other behavioral problems . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce reported serious antisocial behavior and emergent use of substances on the part of adolescents born into high-risk families This study is a controlled evaluation of the efficacy of home visits design ed to promote better child health and development for infants of working class families . Each of the 115 mother-infant pairs meeting the study criteria was assigned to one of three comparable groups : group A received home visits starting prenatally ; group B received visits from six weeks post partum ; and group C received no visits . Home observations were completed by an independent evaluator at 6 weeks , 6 , 12 , and 18 months of age . Significant differences favoring group A over groups B and C were found at each evaluation period . These included : ( 1 ) a reduced accident rate ; ( 2 ) higher scores on assessment s of home environment and maternal behavior ; and ( 3 ) a lower prevalence of mother-infant interaction or feeding problems and of nonparticipant fathers . Aside from a reduction in the accident rate , group B did not benefit from the home visits when compared to control infants . The results support the efficacy of home visits , but only if a prenatal visit is included . These findings suggest that a unique relationship is created between the mother and home visitor and this relationship is sensitive to the timing of the initial encounter A study was design ed to assess the effect and cost of providing parenting and child care education in the home to inner-city mothers of poor infants receiving comprehensive health care in a large federal Children and Youth Program . R and omly selected , healthy neonates weighing more than 2000 gm and born to black women aged 18 years and older ( n = 131 ) and to comparable control subjects ( n = 132 ) were followed for a mean of 23.4 and 22.9 months , respectively . A community woman , with educational , social service , and medical backup support from the Children and Youth Program , made home visits 7 to 10 days after the birth and between regularly scheduled well-child-care visits . Improved compliance with well-child care , fewer illness visits , and sharp reductions in hospitalization and in neglect or abuse were found in the visited group compared with the control group , and substantial cost was a 
    Output:
    
The Task Force found insufficient evidence to determine the effectiveness of early childhood home visitation in preventing violence by visited children , violence by visited parents ( other than child abuse and neglect ) , or intimate partner violence in visited families .