September 2008

Grant Results

SUMMARY

Starting in 2001, researchers at The Children's Hospital of Philadelphia conducted the MOM Program to determine whether providing mothers with support could improve their children's development and behavior. The MOM Program, a five-year randomized controlled trial, started immediately postpartum with mothers in the hospital.

Mothers in the control group received a packet of information about child development and local programs for women and children. Mothers in the intervention group received the same information as well as regular home visits and reminder phone calls focused on preparing for upcoming pediatric care visits, the child's development and participation in early intervention services and Head Start.

Starting in 2006, researchers evaluated MOM Program effects on the children at age 5. The evaluation included 254 mothers and children (128 in the intervention group, who received support and 126 in the control group, who did not).

Key Findings

  • Children in the intervention group were less aggressive physically than those in the control group.
  • Twice as many children in the intervention group as in the control group enrolled in Head Start.
  • The intervention had a significant impact on participation in early intervention services for 0- to 3-year-olds.

Funding
The Robert Wood Johnson Foundation (RWJF) provided partial support for the evaluation with a grant of $134,400 from October 2006 through May 2007. The William Penn Foundation supported the MOM study and partially supported the evaluation.

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THE PROBLEM

Many children from low-income urban communities face obstacles to their intellectual and behavioral development. These obstacles can be particularly formidable when the children's mothers have limited cognitive ability — such as being able to problem-solve around life issues — difficulty reading and difficulty understanding what they need to do to access services for themselves or their children, according to the project director. Finding effective ways to engage low-income urban mothers — especially those with limited cognitive ability — to seek medical and developmental care for their children remains challenging to health care providers.

The MOM Program: A Study to Determine Whether Supporting Mothers Improves Children's Outcomes

In 2001, researchers at The Children's Hospital of Philadelphia (the largest provider of pediatric care services in the greater Philadelphia region) began a five-year randomized controlled trial, called the MOM Program, to determine whether providing mothers with support could improve their children's development and behavior. The study focused on improving the use of pediatric primary care services for the children and supporting children's participation in early intervention services and Head Start.

Early intervention services and Head Start seek to prevent or lessen the effects of problems affecting development. Early intervention services range from identification (through hospital or school screening and referral services) to diagnostic and direct intervention programs. Head Start is a national program that promotes school readiness by enhancing children's social and cognitive development through educational, health, nutritional, social and other services.

Between July 2001 and January 2002, researchers enrolled 302 new mothers in the postpartum unit at the Hospital of the University of Pennsylvania in the MOM Program. All of the mothers were low-income and had given birth to healthy infants. Researchers tested their cognitive ability, defining lower cognitive ability as an IQ of less than 80.

Researchers randomized 152 women to the intervention group and 150 women to the control group. The mean IQ was 84, with no significant difference in IQ between the intervention group and the control group.

Mothers in the control group received a packet of information about child development and local programs for women and children. Mothers in the intervention group received the same information as well as regular home visits and reminder phone calls focused on preparing for upcoming pediatric care visits, understanding their child's development and supporting participation in early intervention services and Head Start.

Researchers trained lay people and nurse practitioners as home visitors to conduct the home visits and prepared easy-to-understand educational materials on child development for these visits. The home visitors made routine home visits at two weeks, six weeks, four months, six months, nine months, 12 months and 30 months, then every six months thereafter. They gave mothers a personal organizer and other materials to track their children's development, and to organize key documents.

The home visitors discussed each child's development and behavior during specified home visits, and conducted screenings of each child's development at 18 months. They followed children who showed developmental delays, and encouraged their mothers to seek early intervention services. They also notified the children's pediatricians about developmental delays.

The William Penn Foundation supported the MOM study and provided partial support for the evaluation.

Evaluating the MOM Study

In 2004, researchers began to assess cognitive outcomes for children from birth to 33 months of age in the intervention and control groups. They:

  • Called mothers every four months to collect data about programs and services received.
  • Conducted personal assessments of the children.

Researchers who conducted the evaluation were not involved with the intervention.

Preliminary results indicated that children in the intervention group were more likely to participate in early intervention services and Head Start than those in the control group-especially children of mothers with lower cognitive ability. Researchers planned to conduct the final evaluation of the effect of the MOM Program as the children were about to enter kindergarten (at age 5).

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RWJF STRATEGY

RWJF has supported a number of major efforts to improve child development.

The main one has been its long-term support of the Nurse-Family Partnership program (1979 to 2011). See an article in a 2004 issue of Pediatrics, the Grant Results on the program and a special report on David Olds, who created and has nurtured this program.

RWJF has also supported Healthy Steps, which was started with funding from the Commonwealth Fund. See Grant Results on RWJF's early support of Healthy Steps. Also see Grant Results on RWJF's support to help Healthy Steps find a permanent home (ID# 053792).

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THE PROJECT

Researchers at Children's Hospital conducted the final evaluation of the MOM Program, which consisted of:

  • Collection of five-year-data and analysis of data collected throughout the project on:
    • Children's use of primary care services and any hospitalizations
    • Referral to and receipt of early intervention services
    • Enrollment into special education services and Head Start.
  • An individual assessment of the children at the age of five, which consisted of cognitive and behavioral tests to assess:
    • IQ
    • Phonological processing (the ability to identify sounds that make words and to associate these sounds with written words; this is an early predictor of literacy)
    • Child behavior.

    Researchers who conducted the evaluation were not involved with the intervention.

Of the 302 mothers enrolled in the MOM study when their children were born, 254 — or 83.7 percent — participated in the final evaluation (128 in the intervention group and 126 in the control group).

Other Funding

The William Penn Foundation provided $1,245,121 to support the MOM study and evaluation. The Claneil Foundation ($40,000) and a private donor ($25,000) also supported the evaluation.

Communications

The project director presented the project's findings to several local agencies to which staff referred project participants, including the Philadelphia School District and the Department of Health and Human Services Region III Head Start.

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FINDINGS

Researchers reported the following findings in a report to RWJF.

  • Children in the intervention group were less physically aggressive than those in the control group. The intervention group had significantly lower ratings on aggressive behavior and fewer cases of abnormal aggressive behavior than the control group. The intervention group also had fewer children with reported attention-deficit hyperactivity disorder and fewer cases of abnormal attention-deficit hyperactivity disorder than the control group.
  • Twice as many children in the intervention group as in the control group enrolled in Head Start. By age five, 59 (46.1 percent) of the 128 children in the intervention group and 29 (23 percent) of the 126 children in the control group were enrolled in Head Start. There was no significant difference in Head Start participation between children whose mothers had lower or higher cognitive ability.
  • More 0- to 3-year-olds in the intervention group received referrals to, and participated in, early intervention services than those in the control group. At 33 months of age, health care providers had referred 24 (18.8 percent) of the 128 children in the intervention group for early intervention services. In the control group, only eight (6.3 percent) of the 126 children had been referred for services. Of these, 19 children (14.8 percent) in the intervention group and seven children (5.6 percent) in the control group actually received early intervention services.
  • There was no difference between the intervention and control groups in participation in early intervention services for 3- to 5-year olds. Researchers attributed this finding to barriers within the system and barriers families seeking services face. For example, within the system, the provider of early intervention services for the 0- to 3-year-olds accepted the MOM Program's screening results, shortening the time between referral and service initiation. The provider for 3- to 5-year-olds would not permit a similar collaboration.

    To receive early intervention services for 3- to 5-year old children, families faced barriers such as having to go to two separate appointments during the workday for screening and evaluation. Some families did not have access to a working telephone and/or an answering system to receive information about appointments.
  • There was no difference between the intervention and control groups in the number of primary care visits. Children in both groups had the same opportunity to receive developmental screening and referrals to early intervention services from their primary care physicians.
  • There were no significant differences between the intervention and control groups in cognitive ability at age five. Researchers attributed this finding to the fact that significant differences in Head Start enrollment between the intervention and control groups only occurred in the last six months of the study.
  • The intervention had no impact on behaviors that are directed inwards — anxiety/depression, withdrawal/depression and complaints about bodily aches and pains (somatic complaints) — at age five.
  • The child's cognitive ability was strongly related to the mother's cognitive ability. However, the mother's cognitive ability was not related to phonological processing or behavior issues. Differences in children's cognitive ability between the intervention and control groups were not related to their mothers' cognitive ability.

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AFTER THE GRANT

As of February 2008, researchers continued to analyze the data and were writing articles about the evaluation findings. The William Penn Foundation funded the data analysis.

As a result of the MOM Program and its evaluation, the Children's Hospital of Philadelphia has revised its developmental screening practices. Practices first developed in the MOM Program, such as using the developmental screening measure used within the city of Philadelphia for screening children's development, is now done throughout pediatric practices to routinely screen children at 18 and 36 months of age for developmental delays.

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GRANT DETAILS & CONTACT INFORMATION

Project

Assessment of a Program Aimed at Maximizing the Cognitive Potential of Children From Low-Resource Families

Grantee

The Children's Hospital of Philadelphia (Philadelphia,  PA)

  • Amount: $ 134,400
    Dates: October 2006 to May 2007
    ID#:  058418

Contact

Jerilynn Radcliffe, Ph.D.
(215) 590-7446
Radcliffe@email.chop.edu

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Report prepared by: Paul Jablow
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Jeane Ann Grisso

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