Replicating Evidence-Based Practices With Flexibility for Perinatal Home Visiting by Paraprofessionals




Erin J. Rotheram-Fuller, Dallas Swendeman, Kimberly D. Becker, Eric Daleiden, Bruce Chorpita, Danielle M. Harris, Neil T. Mercer, and Mary Jane Rotheram-Borus

Brief Type

Journal publication



Introduction: Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods: Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). Results: Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants’ growth (weight/height Z score) tended to be significantly better compared to the control condition. Discussion: There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean–American mothers in Los Angeles, CA. (author abstract)

Data Collection Methods

  • Program administrative record reviews
  • Standardized assessment tools



For More Information

Rotheram-Fuller, E. J., Swendeman, D., Becker, K. D., Daleiden, E., Chorpita, B., Harris, D. M., . . . Rotheram-Borus, M. J. (2017). Replicating evidence-based practices with flexibility for perinatal home visiting by paraprofessionals. Maternal and Child Health Journal, 21(12), 2209–2218. http://doi.org/10.1007/s10995-017-2342-8
Author Contact Information:
Erin J. Rotheram-Fuller


  • Home Visiting Workforce Characteristics and Workforce Development
  • Participant Characteristics
  • Participant, Family, and Program Outcomes