An Examination of Home Visiting As an Injury Prevention Program for Children with Special Healthcare Needs

Introduction: Unintentional and intentional injuries are leading causes of morbidity and mortality for infants and toddlers. In addition, there is a strong and well-established association between children with diagnosed special healthcare needs (SHCN) and increased risk of injury. The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was established in 2013 to assist low-income families raise healthy children, particularly in the areas of early childhood injury prevention and child development. Despite serving as the predominant injury prevention program in the public health infrastructure, it is unknown what proportion of children with SHCN are enrolled in home visiting and how effective the programs are at preventing injury for this population.

Methods: Entropy-balanced retrospective cohort analysis comparing children of Pennsylvania Nurse-Family Partnership (NFP) and children of Pennsylvania Medicaid eligible women from 2008-2014. Special healthcare needs (SHCN) diagnoses through age four and injury episodes were identified in medical assistance claims with ICD-9 codes. The most common SHCN for infants and toddlers were categorized as behavioral (ADHD, autism, conduct disorder) or delay (developmental, intellectual, growth, sensory, mobility). Weighted proportions and logistic regression odds of injury within 24 months are presented.

Results: Overall, 8,736 NFP clients with Medicaid-eligible children from 2008-2014 were weighted to 165,033 comparison women. Prevalence of a SHCN diagnosis was significantly higher (p<0.001) in clients (33.8%) than comparison children (22.5%). The weighted proportion of clients with behavioral (4.9% vs. 3.7%) and delay (32.4% vs. 21.0%) diagnoses was significantly greater (p<0.001) than comparisons. Client children with SHCN were significantly more likely to experience an injury episode than client children without SHCN: OR: 1.76, 95% CI: [1.58, 1.95]; translating to marginal effects of 29.4% of client children with SHCN and 19.2% of client children without SHCN sustaining an injury within 24 months of life. No program effect was seen for clients with SHCN relative to community comparisons. The most prevalent injury for both clients and non-clients with SHCN was superficial injury (11.5% and 6.5%, respectively).

Conclusions: Home visiting clients with SHCN are disproportionately burdened by early childhood injuries with limited program effectiveness in injury prevention. Given that a sizable portion of home visiting clients are diagnosed with SHCN and these children are at heightened risk for injury, injury prevention curricula for this population may require an alternative approach.