Children who receive home visits are healthier, achieve more in school and have better social and emotional skills, according to a new study, released Monday by James J. Heckman, a Nobel laureate economist at the University of Chicago. Mothers have better prenatal and mental health and parenting skills.
“We show that parenting matters,” wrote Mr. Heckman, along with co-researchers in economics, education, medicine and nursing.
The effects are particularly strong and lasting for boys, the study found. That fits with previous research that has found that boys are more sensitive than girls to both disadvantage and intervention.
“I think what’s been forgotten in this whole political discussion is boys are really very vulnerable and girls are more resilient,” Mr. Heckman said. “There is a boy problem in this country, especially for disadvantaged boys, and working with the mothers changing their environment seems to have an effect on their well-being.”
Home visiting programs have received federal funding under administrations of both parties. The Trump budget proposed maintaining funding at $400 million a year. Congress has not yet reauthorized it. Advocates of home visiting programs say they cover only 3 percent of families who need them, and propose increasing the funding.
The Nurse-Family Partnership, one of the biggest of the home visiting programs, was started in the late 1970s by a doctor named David Olds. Mothers who received the visits smoked less, and they had fewer preterm births and fewer incidents of abuse or neglect. Children were healthier, safer and more prepared for school. Over the next decade and a half, Dr. Olds tested it in three very different communities, with similar results. The program now serves 33,000 families in 42 states.
A variety of subsequent research on home visitation programs has found they are one of the most effective ways to help disadvantaged families, as long as the visits are by highly trained registered nurses; they’re frequent; and they cover a broad curriculum, said Maya Rossin-Slater, an assistant professor of health research and policy at Stanford and a co-author of a literature review on early childhood policies.
The new analysis drew on data from one of Dr. Olds’s randomized controlled trials, in Memphis. It included 700 predominantly African-American single mothers, and followed children through age 12. Unlike in other analyses, the researchers tested each outcome separately, which confirmed many of the positive outcomes but found that some were not statistically significant.
The biggest example was the effects on girls versus boys. Boys whose mothers were part of the home visit program were healthier at birth, but the health of newborn girls was not significantly different from that of the control group, the study found. The cognitive effects were larger for boys than for girls, but the social and emotional effects were stronger for girls.
Also, the effects for boys lasted through age 12 — at which point they outperformed the control group in reading and math, and their mothers had lower participation in welfare programs — but they seemed to wear off for girls by 12. Mr. Heckman said he did not know why, but speculated that adolescent girls in low-income families might have more responsibilities placed on them, causing stress.
The researchers also zeroed in on which factors caused positive results. Improvements within the home at age 2 — elements like parental involvement, role modeling and developmentally appropriate toys — led to cognitive gains in boys at age 6. That led to higher achievement scores at age 12, the research found.
Boys whose mothers received the visits were born almost a week later than those who did not, and weighed an average 7 ounces more at birth. That was found to explain 14 percent of their cognitive achievement.
In girls, improvements within the home caused cognitive gains, the study showed, and also led to an increase in their warmth and empathy and a decrease in aggression. Lower maternal anxiety caused both cognitive gains and a decrease in behavior problems.
“The mechanism you find is basically igniting the mother-child relationship, building attachment,” Mr. Heckman said. “The parental interaction is, I think, the whole story.”
Ms. Arneson, who was not raised by her mother and grew up with various caregivers, said the nurse visits gave her the confidence to be a mother. She and Aisaya, now 3, read books every night, a habit the nurse started.
“She loves to learn and she’s happy and healthy,” Ms. Arneson said. “It’s having your nurse encouraging you and letting you know that you can be that mom. It’s breaking the cycle with mothers.”