The Evaluation of the Preparing for Life Early Childhood Intervention Programme
Last registered on January 23, 2019

Pre-Trial

Trial Information
General Information
Title
The Evaluation of the Preparing for Life Early Childhood Intervention Programme
RCT ID
AEARCTR-0000066
Initial registration date
September 02, 2013
Last updated
January 23, 2019 5:21 AM EST
Location(s)
Region
Primary Investigator
Affiliation
University College Dublin
Other Primary Investigator(s)
Additional Trial Information
Status
On going
Start date
2008-05-31
End date
2019-10-01
Secondary IDs
Abstract
Background and study aims

This study is a randomised control trial (RCT) evaluation of a preventative programme which aims to improve school readiness and life outcomes of socioeconomically disadvantaged children. The programme is operating in several disadvantaged communities in Dublin with above national average rates of unemployment, early school leavers, lone parent households and social housing. The Preparing for Life (PFL) programme, which began in 2008, works with families from pregnancy until school entry in order to promote positive child development through improved parental behaviour and social support.

The programme is being evaluated using a mixed methods approach, incorporating a longitudinal experimental design and implementation analysis. The experimental component involves the random allocation of participants from the PFL communities to either the low or high treatment group for the duration of the programme.

Who can participate?
All pregnant women from the target communities in Dublin were eligible to participate. 233 pregnant were recruited into the PFL Programme between 2008 and 2010. Randomisation resulted in 115 participants assigned to the high treatment group and 118 participants assigned to the low treatment group. In addition, 99 pregnant women were recruited into a comparison group from comparable community. The population based recruitment rate was 52%.

What does the study involve?
Preparing for Life provides a range of supports to participating families from pregnancy until school entry. The programme targets a range of child outcomes which are related to school readiness, including cognitive development, physical health and motor skills, socio-emotional development, behavioural skills, language development and emergent literacy.

On recruitment during pregnancy, participants are randomly assigned to either a low treatment group or a high treatment group. Both the high and low treatment groups receive €100 worth of developmental toys annually and facilitated access to one year of high quality preschool. In addition, the high treatment group receive two additional supports that are not available to the low treatment group. First, participants in the high treatment group receive a home-visiting mentoring support service. The aim of the home visits is to support and help the parents with key parenting issues. Secondly, participants in the high treatment group also participate in group parent training using the Triple P Positive Parenting Programme which aims to improve positive parenting in a group-based setting for eight consecutive weeks.

The evaluation collects data from all three groups (high treatment, low treatment, comparison group) at baseline during pregnancy (t0), and when the child is six months (t1), 12 months (t2), 18 months (t3), 24 months (t4), three years (t5), and four years old (t6). A comprehensive set of data are collected at each point. At each time point, we compare the outcomes of the high treatment group, low treatment and comparison groups.

To determine if the effects of the programme are sustained later in childhood, data collected from high and low treatment groups at 7-11 years (age 9 on average are collected and compared as part of a follow-up study

What are the possible benefits and risks of participating?
If the programme is effective, families in the high treatment group may benefit from the programme by gaining greater parenting knowledge and skills; and their children will be better prepared for school.

Risks of participation are few. The main risk is that some study questions are of a personal nature and may cause participant discomfort or stress. Potential participants are informed as part of the consent process that participation is voluntary and that they can withdraw from the study or decline to answer any question at any time without penalty.

Where is the study run from?
The Evaluation of PFL is housed at the Geary Institute at University College Dublin in Dublin Ireland.

When is study starting and how long is it expected to run for?
Recruitment took place from 2008 to 2010. The evaluation continues until all children are 4 years of age, in March 2015.

A follow-up study from January 2019 to September 2019 examines the impact of receiving the PFL programme between the ages of 0 and 5 on children's outcomes later in childhood (approximately age 9).

Who is funding the study?
The evaluation of the Preparing for Life programme is funded by the Northside Partnership through the Department of Children and Youth Affairs and The Atlantic Philanthropies.

The follow-up study at ~age 9 is funded by the Northside Partnership

Who is the main contact?
Dr. Orla Doyle, [email protected]
External Link(s)
Registration Citation
Citation
Doyle, Orla. 2019. "The Evaluation of the Preparing for Life Early Childhood Intervention Programme." AEA RCT Registry. January 23. https://doi.org/10.1257/rct.66-2.0.
Former Citation
Doyle, Orla. 2019. "The Evaluation of the Preparing for Life Early Childhood Intervention Programme." AEA RCT Registry. January 23. http://www.socialscienceregistry.org/trials/66/history/40510.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The Preparing for Life (PFL) programme works with families from pregnancy until school entry in order to promote positive child development through improved parental behaviour and social support. Preparing for Life provides a range of supports to participating families from pregnancy until school entry. The programme targets a range of child outcomes which are related to school readiness, including cognitive development, physical health and motor skills, socio-emotional development, behavioural skills, language development and emergent literacy.

On recruitment during pregnancy, participants are randomly assigned to either a low treatment group or a high treatment group. Both the high and low treatment groups receive €100 worth of developmental toys annually and facilitated access to one year of high quality preschool. In addition, the high treatment group receive two additional supports that are not available to the low treatment group. First, participants in the high treatment group receive a home-visiting mentoring support service. The aim of the home visits is to support and help the parents with key parenting issues. Secondly, participants in the high treatment group also participate in group parent training using the Triple P Positive Parenting Programme which aims to improve positive parenting in a group-based setting for eight consecutive weeks.
Intervention Start Date
2008-05-31
Intervention End Date
2015-03-31
Primary Outcomes
Primary Outcomes (end points)
School Readiness Skills (cognitive development, physical health and motor skills, socio-emotional development, behavioural skills, language development and emergent literacy)

Age 9 follow-up study, child health and development outcomes (~age9): cognitive development, physical health and motor skills, socioemotional development, school attendance and performance, differential susceptibility.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
On recruitment during pregnancy, participants are randomly assigned to either a low treatment group or a high treatment group. Both the high and low treatment groups receive €100 worth of developmental toys annually and facilitated access to one year of high quality preschool. In addition, the high treatment group receive two additional supports that are not available to the low treatment group. First, participants in the high treatment group receive a home-visiting mentoring support service. The aim of the home visits is to support and help the parents with key parenting issues. Secondly, participants in the high treatment group also participate in group parent training using the Triple P Positive Parenting Programme which aims to improve positive parenting in a group-based setting for eight consecutive weeks.
Experimental Design Details
Randomization Method
PFL participants were randomised after informed consent was obtained. To ensure randomisation was not compromised an unconditional probability computerised randomisation procedure was used whereby the participant pressed a key on a computer which randomly allocated her treatment group assignment. Once assignment was completed, an automatic email was generated which included the participant’s unique ID number and assignment condition. This email was automatically sent to the PFL programme manager and the evaluation manager. This method was used to ensure that the recruiter had no influence on the treatment assignment. Thus if any attempts to reassign participants from one group to another group, by either directly changing the database or repeating the randomisation procedure, a second email would be generated to automatically highlight this intentional subversion.
Randomization Unit
Individual level
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
1
Sample size: planned number of observations
233
Sample size (or number of clusters) by treatment arms
115 treatment participants and 118 control participants
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

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IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
University College Dublin Human Research Ethics Committee
IRB Approval Date
2018-12-11
IRB Approval Number
HS-18-90-Doyle
IRB Name
University College Dublin Human Research Ethics Committee
IRB Approval Date
2008-05-08
IRB Approval Number
HS-07-26-Harmon-Doyle
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
March 31, 2015, 12:00 AM +00:00
Is data collection complete?
Data Publication
Data Publication
Is public data available?
Yes
Program Files
Program Files
Reports and Papers
Preliminary Reports
Abstract
Overall, PFL achieved its aim of improving children's school readiness. The programme had a positive and significant impact on each of the five domains school readiness domains: cognitive development, language development, approaches to learning, social & emotional development, and physical wellbeing & motor development.

Report series documents intervention outcomes at 6 months, 12 months, 18 months, 24 months, 36 months, 48 months, and school entry.
Completion Date
March 31, 2016 12:00 AM +00:00
Url
https://geary.ucd.ie/preparingforlife/?page_id=146
Relevant Papers
Abstract
OBJECTIVES: To investigate the developmental impact of a prenatal–to–age-5 multicomponent early intervention program targeting families living in low socioeconomic conditions.

METHODS: Pregnant women from a disadvantaged Irish community were randomly assigned into a treatment group (home visits, baby massage, and parenting program; n = 115) or control group (n = 118). Children’s behavioral problems (externalizing, internalizing), cognitive skills (general, vocabulary), and health service use (number of health clinic visits), were regularly assessed (6 months to 4 years of age). Children’s developmental trajectories were modeled by using latent class growth analyses to test whether certain subgroups benefited more than others.

RESULTS: High and low developmental trajectories were identified for each outcome. Treated children were more likely to follow the high-level trajectory for cognition (odds ratio = 2.89; 95% confidence interval = 1.55–5.50) and vocabulary skills (odds ratio = 2.02; 95% confidence interval = 1.08–3.82). There were no differences by treatment condition in the risk of belonging to a high externalizing or high health clinic visit trajectory. However, within the high externalizing trajectory, treated children had lower scores than controls (Hedges’ g range (2–4 years) = 0.45–0.58; P < .05) and, within the high health clinic visit trajectory, only children in the control group experienced an increasing number of visits.

CONCLUSIONS: This program revealed moderate positive impacts on trajectories of cognitive development and number of health clinic visits for all children, whereas positive impacts on externalizing behavior problems were restricted to children with the most severe problems.
Citation
Cote, S. M., et al. A Multicomponent Early Intervention Program and Trajectories of Behavior, Cognition, and Health. Pediatrics, 2018, 141.5, pii: e20173174. doi: 10.1542/peds.2017-3174.
Abstract
This study uses data from an evaluation of an early intervention programme, Preparing for Life, to estimate the impact of book gifting on shared reading during infancy and the association between reading and later development. Participants were randomised during pregnancy to a high intensity intervention group, receiving mentoring and book packs (n = 78), and a low intensity intervention group, receiving book packs only (n = 80). A no-intervention comparison group were allocated using non-random assignment (n = 78). At 6 and 12 months both the high and low intensity groups were more likely to read to their infant a few times per week or daily than the comparison group. The intervention groups did not differ statistically on reading frequency. Daily reading at 6 months predicted higher vocabulary comprehension and production, cognition, and socioemotional competence at 12 months. Book gifting may offer an efficient means of reading promotion in disadvantaged communities.
Citation
O’Farrelly, C. et al. Shared book reading during infancy and later development: Evidence from an early intervention, Journal of Applied Developmental Psychology, 2018, 54, 69-83. doi: 10.1016/j.appdev.2017.12.001.
Abstract
Using a randomized experiment, this study investigates the impact of sustained investment in parenting, from pregnancy until age five, in the context of extensive welfare provision. Providing the Preparing for Life program, incorporating home visiting, group parenting, and baby massage, to disadvantaged Irish families raises children’s cognitive and socio-emotional/behavioral scores by two-thirds and one-quarter of a standard deviation respectively by school entry. There are few differential effects by gender and stronger gains for firstborns. The results also suggest that socioeconomic gaps in children’s skills are narrowed. Analyses account for small sample size, differential attrition, multiple testing, contamination, and performance bias.
Citation
Doyle, O. The first 2,000 days and child skills: Evidence from a randomized experiment of home visiting. University College Dublin. School of Economics, 2017.
Abstract
Preparing for Life (PFL) is a prevention and early intervention programme which aims to improve the life outcomes of disadvantaged children in Dublin, Ireland. PFL was designed and implemented by the Northside Partnership and was subject to an extensive evaluation conducted by the UCD Geary Institute for Public Policy between 2008 and 2015 using a randomised control trial design. The evaluation found that the PFL programme had a significant impact on children’s skills by raising cognitive ability, reducing behavioural problems, and improving health. Please see Doyle (2017) and Doyle and PFL Evaluation Team (2016) for a description of the final results. The programme was one of 52 programmes funded by The Atlantic Philanthropies and the Department of Children and Youth Affairs as part of the Prevention and Early Intervention Initiative. In mid-2017 almost all the quantitative data collected as part of the PFL evaluation were placed in the Irish Social Science Data Archive (ISSDA). The decision to archive the data was made prospectively during the design of the study. The aim of this article is to describe the motivation for archiving the PFL data and the processes involved in prospectively designing, collecting, and storing data which was destined for a national archive.
Citation
Doyle, O. Archiving the Preparing for Life Data – Motivation and historical context, Children’s Research Digest, 2017, 4.3, 13-17.
Abstract
Objective
This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children’s school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems.

Methods
Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing.

Results
The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday.

Conclusion
The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments.
Citation
Doyle, O. et al. Can early intervention policies improve well-being? Evidence from a randomized controlled trial, PLoS ONE, 2017, 12.1, e0169829. doi: 10.1371/journal.pone.0169829.
Abstract
Studies support cognitive and social domains of development as entwined in childhood, however, there is a paucity of investigation into the nature of the mother–child relationship within an interdependence framework. Furthermore, the focus on these processes within families from impoverished communities using frequent assessments in early childhood has been limited. Our objectives were to identify (1) the directional associations between toddler’s communication ability and social competence, (2) to establish whether the association between toddler’s communication ability and social competence is mediated by maternal warmth, and (3) to establish support for transactional models between toddlers’ outcomes and maternal warmth in disadvantaged communities in Ireland. Participants included 173 toddlers and their families enrolled in a prenatally commencing prevention programme. Toddler’s communication and social competence were assessed at 12, 18, 24 and 36 months and maternal warmth at 6 and 24 months. Cross-lagged models were estimated examining multiple paths of associations simultaneously. Direct and indirect paths of maternal warmth were also examined. Bi-directional associations were found between communication ability and social competence from 12 to 24 months but not thereafter. Maternal warmth did not significantly mediate these associations, however, support of a transactional model was found with social competence. The results support early positive associations between better communication ability and social competence in the first 2 years, however, they suggest that these associations are no longer present by the third year. The role of maternal warmth in fostering social competencies is important for toddlers and equally important is toddler’s level of social competence in eliciting increased maternal warmth.
Citation
Girard, L., Doyle, O., and Tremblay, R. Maternal warmth and toddler development: support for transactional models in disadvantaged families, European Child and Adolescent Psychiatry, 2017, 26.4, 497-507. doi: 10.1007/s00787-016-0913-7
Abstract
Research shows that children facing socioeconomic risk often have poorer skills at school entry, greater difficulty adjusting to school, more negative school experiences, and lower scholastic achievement, relative to their peers. However, the promotion of positive early school experiences is constrained by a lack of insight into disadvantaged children’s own perspectives. To address this gap, this study interviewed 26 children living in a disadvantaged community in Ireland who had recently commenced formal schooling. Interviews included semi-structured questions and a draw-and-talk activity. Interview questions and drawings were analysed using the principles of thematic analysis and content analysis respectively, and the findings were integrated to identify four overarching themes. These included children’s sense of self in school, what happens in school, the importance of peer relationships, and children’s lives around school. The results provide reflection points for research and practice, such as the promotion of positive peer experiences and strong family–school connections.
Citation
O'Rourke, Claire, et al. "‘Little Bit Afraid ‘Til I Found How It Was’: Children’s Subjective Early School Experiences in a Disadvantaged Community in Ireland." European Early Childhood Education Research Journal 25.2 (2017): 206-23. doi: 10.1080/1350293X.2017.1288386.
Abstract
This paper presents evidence on early skill formation and parental investment using an experimentally designed, home visiting program targeting disadvantaged Irish families. Program effects from pregnancy to 18 months are estimated using measures of parenting and child cognitive, noncognitive and physical development. Permutation testing, a stepdown procedure, and inverse probability weighting are applied to account for small sample size, multiple hypothesis testing, and attrition. The program's impact is concentrated on parental behaviors and the home environment with small to moderate effect sizes found. Deficits in parenting skills can be offset within a relatively short timeframe, yet continued investment may be required to observe child effects.
Citation
Doyle, O. et al. Early skill formation and the efficiency of parental investment: A randomized controlled trial of home visiting, Labour Economics, 2017, 45, 40-58. doi: 10.1016/j.labeco.2016.11.002.
Abstract
Objective
To investigate the impact of an early intervention programme, Preparing for Life, on dietary intake between 12 and 36 months of age, and the mediating role played by diet on cognitive functioning.

Design
A randomised controlled trial evaluation of a community-based home visiting programme. The intervention involved biweekly visits from mentors from pregnancy until age 5 years and parent training at age 2 years. Dietary intake was assessed at 12, 18, 24 and 36 months using an FFQ to calculate the proportion meeting dietary recommendations. Cognitive functioning was measured at 24 and 36 months. Treatment effects were estimated using conventional χ 2 tests, permutation testing, inverse probability weighting and the stepdown procedure. Mediation analysis examined the indirect effect of the intervention on cognitive functioning via its effect on dietary intake.

Setting
Socio-economically disadvantaged communities in Dublin, Republic of Ireland.

Subjects
Pregnant women (n 233) were assigned to the intervention (n 115) or control (n 118) group using an unconditional probability randomisation strategy.

Results
Positive treatment effects were observed for meeting dietary recommendations for protein foods at 24 (OR=2·52) and 36 (OR=2·42) months, and all food groups at 24 (OR=3·92) months. There were no effects on grain, dairy, fruit and vegetable, or fatty/sugary food recommendations in most models. The conventional and more novel methods yielded similar results. Mediation analysis indicated that 13 % of the intervention’s effect on cognitive functioning was mediated by 36-month protein food consumption.

Conclusions
The study demonstrates some potential to alter early childhood dietary patterns through community-based intervention programmes.
Citation
O’Sullivan, A., Fitzpatrick, N., & Doyle, O. Effects of early intervention on dietary intake and its mediating role on cognitive functioning: a randomised controlled trial, Public Health Nutrition, 2017, 20.1, 154-164. doi: 10.1017/S1368980016001877.
Abstract
Children’s use of the toilet at school, although rarely explored, is an important facet of school experience with consequences for physical and psychological health. A mixed methods study investigated views of 25 children (4–5 years) regarding potential stressors in the first school year, including views of toileting, in Dublin, Ireland. Despite very positive responses to school, most responses to toileting (15 of 25) were mixed or negative. Although some liked to go, or noted the toilets were clean, most indicated delayed toilet use (“bursting” to go) and ambivalent or negative experiences such as fear of not identifying the right toilet, fear of being alone, lack of privacy, and potential bullying. Many children did not expect to receive help from the teacher. As delaying toilet use can have lasting health consequences, teacher–nurse collaboration could be used to develop whole-school policies to support children’s early adjustment in this sensitive area of functioning.
Citation
Tatlow-Golden, M., et al. “Bursting” to Go and Other Experiences:Children’s Views on Using the Toilet in the First School Year. The Journal of School Nursing, 2017, 33.3, 214-22. doi: 10.1177/1059840516646422.
Abstract
Early home visiting intervention programmes have been associated with greater familial well-being, yet their success depends on attaining engagement from the outset. Implementation practices, central to positive programme outcomes, rely on a strong relationship between programme providers and families. The present study explored the role of this relationship in the implementation of an Irish early childhood intervention. A randomised controlled trial of the Preparing for Life (PFL) programme was conducted in disadvantaged Dublin communities involving 233 participants recruited during pregnancy and assigned to a high or low intervention group. High intervention involved regular home visits from a trained home visitor providing parenting support and information. This study presents qualitative findings from focus groups with high intervention parents (n=11) and interviews with home visitors (n=5) conducted when participating children were on average 5 months old. Though early engagement challenges were identified, in time parents noted the strengthening parent-home visitor relationship. Findings highlight the importance of programme flexibility and parent-home visitor rapport to programme engagement. Wellbeing did not arise as a salient theme, though it may emerge as a longer-term programme outcome. These findings reveal key aspects of early implementation which may contribute to the ultimate success of the programme.
Citation
Doyle, O. et al. Friend, foe or facilitator? The role of the parent-service provider relationship in the early implementation of a family-based community intervention, Community Psychology in Global Perspective, 2016, 2.1, 52-72. doi: 10.1285/i24212113v2i1p52
Abstract
Children from economically disadvantaged communities frequently lack the socio-emotional, cognitive and behavioural skills needed for successful early school adjustment. Assessments of early school experience often rely on parent and teacher perspectives, yet children’s views are essential to design effective, resilience-promoting school ecologies. This mixed methods study explored children’s appraisals of potential stressors in the first school year with 25 children from a disadvantaged suburban community in Ireland. School scenarios were presented pictorially (Pictorial Measure of School Stress and Wellbeing, or PMSSW), to elicit children’s perspectives on social ecological factors that enable or constrain resilience. Salient positive factors included resource provision, such as food, toys and books; school activities and routines, including play; and relationships with teachers. Negative factors included bullying; difficulties engaging with peers; and using the toilet. Drawing on these factors, we indicate how school psychologists can develop resilience-fostering educational environments for children in vulnerable communities.
Citation
Tatlow-Golden, Mimi, et al. ‘Look, I Have My Ears Open’: Resilience and Early School Experiences among Children in an Economically Deprived Suburban Area in Ireland. School Psychology International, 2016, 37.2, 104-20. doi: 10.1177/0143034315613777
Abstract
This study examined the impact of a targeted Irish early intervention program on children’s emotional and behavioral development using multiple methods to test the robustness of the results. Data on 164 Preparing for Life participants who were randomly assigned into an intervention group, involving home visits from pregnancy onwards, or a control group, was used to test the impact of the intervention on Child Behavior Checklist scores at 24-months. Using inverse probability weighting to account for differential attrition, permutation testing to address small sample size, and quantile regression to characterize the distributional impact of the intervention, we found that the few treatment effects were largely concentrated among boys most at risk of developing emotional and behavioral problems. The average treatment effect identified a 13% reduction in the likelihood of falling into the borderline clinical threshold for Total Problems. The interaction and subgroup analysis found that this main effect was driven by boys. The distributional analysis identified a 10-point reduction in the Externalizing Problems score for boys at the 90th percentile. No effects were observed for girls or for the continuous measures of Total, Internalizing, and Externalizing problems. These findings suggest that the impact of this prenatally commencing home visiting program may be limited to boys experiencing the most difficulties. Further adoption of the statistical methods applied here may help to improve the internal validity of randomized controlled trials and contribute to the field of evaluation science more generally.
Citation
Doyle, O., et al. Can Targeted Intervention Mitigate Early Emotional and Behavioral Problems?: Generating Robust Evidence within Randomized Controlled Trials. PLoS One, 2016, 11.6, e0156397. doi: 10.1371/journal.pone.0156397
Abstract
This article investigates the impact of an early intervention program, which experimentally modifies the parenting and home environment of disadvantaged families, on child physical health in the first 3 years of life. We recruited and randomized 233 (115 intervention, 118 control) pregnant women from a socioeconomically disadvantaged community in Dublin, Ireland into an intervention or control group. The treatment includes regular home visits commencing antenatally and an additional parenting course commencing at 2 years. Maternal reports of child health are assessed at 6, 12, 18, 24, and 36 months. Treatment effects are estimated using permutation testing to account for small sample size, inverse probability weighting to account for differential attrition, and both the stepdown procedure and an indices approach to account for multiple hypothesis testing. Following adjustment for multiple testing and attrition, we observe a positive and statistically significant main treatment effect for wheezing/asthma. The intervention group are 15.5 percentage points (pp) less likely to require medical attention for wheezing/asthma compared to the control group. Subgroup analysis reveals more statistically significant adjusted treatment effects for boys than girls regarding fewer health problems (d = 0.63), accidents (23.9 pp), and chest infections (22.8–37.9 pp). Our results suggest that a community-based home visiting program may have favorable impacts on early health conditions.
Citation
Doyle, O., et al. Early Intervention and Child Physical Health: Evidence from a Dublin-Based Randomized Controlled Trial. Economics & Human Biology, 2015, 19, 224-45. doi: 10.1016/j.ehb.2015.09.004
Abstract
This study examined the factors influencing participant engagement in a home visiting program. Specifically, it explored the relationship between dosage and the constituent components of psychological resources: mental health, mastery, and cognitive resources. Multiple linear regression analyses were conducted utilising implementation data from a sample (n = 95) of participants in an Irish home visiting program. Psychological resources significantly predicted dosage, yet an investigation of each component found that only cognitive resources remained significant. Furthermore, when considering types of cognitive resources, verbal ability was found to significantly predict the number of home visits but not the average duration of visits. Conversely, perceptual reasoning was found to predict the average duration of home visits but not the number of home visits. These results suggest that cognitive resources may be the driving component behind previous findings that link psychological resources and level of dosage in home visiting programs. Practice and policy implications are explored.
Citation
Booth, A., Palamaro Munsell, E, and Doyle, O. Maternal Engagement in a Home Visiting Intervention: What Lies beneath Psychological Resources. Journal of Community Psychology, 2014, 42.1, 29-46. doi: 10.1002/jcop.21592
Abstract
Objectives
Pregnancy, labour, and delivery involve risk for mothers and infants. This study tested the effectiveness of a home-based programme to improve perinatal outcomes among socially disadvantaged women. The hypothesis was that the intervention group who received education and support during pregnancy would have better perinatal outcomes than the control group.

Study design
This is a randomised controlled trial. Pregnant women from a disadvantaged community in Dublin, Ireland were eligible for participation in Preparing for Life, a home visiting early intervention programme. 233 participants were recruited and assigned to an intervention (n = 115) and control (n = 118) group using an unconditional probability randomisation strategy. Maternity hospital records were available for 206 participants (nintervention = 106; ncontrol = 100). Consent to access records was not provided by 9 participants, records were missing for 17 participants and 1 record was excluded due to miscarriage. The intervention group were prescribed an average of ten prenatal home visits from a trained mentor. Mentors provided information on healthy prenatal behaviours and the birthing experience using tip sheets and social support. The control group received care as usual including the opportunity to attend standard antenatal classes. The outcomes included neonatal (Apgar scores, birth weight, gestational age and prematurity) and maternal (labour onset method and delivery method) outcomes. Statistical analyses were conducted using t -tests, tests of proportions, regression, logistic regression and permutation testing.

Results
There were no differences on any of the neonatal outcomes or the majority of the maternal outcomes. Two secondary results were found such that there was an increase in the rate of spontaneous onset of labour in the intervention group compared to the control group (69.8% v 58.0%; OR 1.67, 95% CI = 0.94, 2.97; p < 0.05) and there was a reduction in caesarean section rates in the intervention group compared to the control group (15.1% v 25.0%; OR 0.53, 95% CI = 0.27, 1.07; p < 0.05).

Conclusions
This prenatal home visiting programme had no impact on neonatal outcomes, yet there was suggestive evidence that it prepared women for birth, and potentially led to increased spontaneous onset of labour and reduced caesarean section. Further studies are required to test these observation generating hypotheses.
Citation
Doyle, O., et al. Home Based Educational Intervention to Improve Perinatal Outcomes for a Disadvantaged Community: A Randomised Control Trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014, 180, 162-7. doi: 10.1016/j.ejogrb.2014.06.006