CClinicalTrials.gg
Active, not recruitingNCT04438031Updated Aug 21, 2026

Navigation Study: Durham

An interventional study of Navigation Intervention Version 1.0 (discontinued, modified to Version 2.0. Data will not be used) and Control Intervention in Prenatal; Postnatal, sponsored by Duke University. Active, not recruiting at 1 site in United States. Open to participants aged 0 Years and older. Per ClinicalTrials.gov, last updated 2026-08-21.

Sponsored by Duke University · Not applicable, Interventional, and Health services research

Phase
Not applicable
Study type
Interventional
Enrollment
815
Allocation
Randomized
Ages
0 Years and older
Sex
All
01

Study summary

The purpose of this RCT is to evaluate the implementation and impact of a new, community-wide prevention program, "Community Navigation", on maternal and child health and well-being. This program recruits mothers at the OB/GYN or pediatrician's office prenatally and provides up to six Navigation visits (prenatally, and at child ages 12, 24, 36, 48, and 60 months) to assess family strengths and needs, establish connections between the family and primary health care or other community providers based on identified needs and family preference, and then follows up one month later to confirm these referrals.

Read the detailed description

Note: 400 families were enrolled in this RCT under Navigation 1.0. However, their data will not be included in any analysis due to changes to the Navigation intervention design resulting in Navigation 2.0. The final RCT sample includes of 815 participants enrolled during the implementation of Navigation 2.0.

02

Conditions studied

  • Prenatal; Postnatal
03

In context

Lead sponsor

Duke University is the lead sponsor of 2,025 studies on the registry; 275 are open to participants now.

Of its 194 completed or terminated interventional studies of FDA-regulated products, 159 (82%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
0 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Pregnant individuals residing in Durham County, NC who are receiving prenatal care from a Duke University OB/GYN clinic, the Durham County Health Department, or the local Fetal Diagnostic Center.
  2. Primary language is English or Spanish
  3. Recruited into the study at or before 28 weeks gestation.

Exclusion criteria

Exclusion Criteria:

  • Families residing outside of Durham County
  • Families that are planning to move out of either county within the next 2 months at the time of recruitment
  • Families will also be ineligible if the parent has a cognitive impairment that impairs their ability to consent/participate.
05

Study design

Phase
Not applicable
Primary purpose
Health services research
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
815 participants (actual)

Study arms

  • Experimental
    Navigation Version 1.0 (discontinued, modified to Version 2.0. Data will not be used)

    Navigation 1.0 recruits mothers in OB/GYN (prenatal) offices, provides up to three Navigation visits, establishes connections between the family and primary health care or other community providers, and then follows up one month later to confirm these referrals. Navigators will assess and support family needs across multiple developmentally-appropriate domains at each age. Prenatally, the domains include support for (1) health and access to healthcare, (2) adjustments to pregnancy, (3) household and material needs, and (4) family safety. At 12, 24, and 36 months, the domains include support for (1) child basic needs, (2) parenting and child behavior, (3) child health and development, and (4) parent health and well-being.

    Behavioral: Navigation Intervention Version 1.0 (discontinued, modified to Version 2.0. Data will not be used)

  • Other
    Control Intervention

    Brief educational information will be provided about pregnancy (provided prenatally) and child development when the child is approximately 12, 24, 36, 48, and 60 months old.

    Behavioral: Control Intervention

  • Experimental
    Navigation Intervention Version 2.0

    Navigation 2.0 recruits mothers in OB/GYN offices. Mothers are offered visits from a Navigator prenatally and postnatally (at child ages 12, 24, 36, 48, and 60 months). During visits, the Navigator works with the mother/caregiver to identify family needs, establishes connections between the family and community providers, and follows up one month later to confirm these referrals. At all touch points, Navigators assess and support family needs in four domains. For the prenatal, 12, and 24 month Navigation visits, the domains include (1) Health Care; (2) Caring for the Infant; (3) A Safe Home; and (4) Parent Well-Being. At the 36, 48, and 60 month Navigation visits, the domains include: (1) Health Care; (2) Caring for the Child; (3) Child Development; and (4) Family Interactions. Families are also invited at all visits to nominate other needs not related to these four domains.

    Behavioral: Navigation Intervention Version 2.0

Interventions

  • BehavioralNavigation Intervention Version 1.0 (discontinued, modified to Version 2.0. Data will not be used)

    Navigation 1.0 recruits mothers in OB/GYN (prenatal) offices, provides up to three Navigation visits, establishes connections between the family and primary health care or other community providers, and then follows up one month later to confirm these referrals. Navigators will assess and support family needs across multiple developmentally-appropriate domains at each age. Prenatally, the domains include support for (1) health and access to healthcare, (2) adjustments to pregnancy, (3) household and material needs, and (4) family safety. At 12, 24, and 36 months, the domains include support for (1) child basic needs, (2) parenting and child behavior, (3) child health and development, and (4) parent health and well-being.

  • BehavioralControl Intervention

    Brief educational information will be provided about pregnancy (provided prenatally) and child development when the child is approximately 12, 24, 36, 48, and 60 months old.

  • BehavioralNavigation Intervention Version 2.0

    Navigation 2.0 recruits mothers in OB/GYN offices. Mothers are offered visits from a Navigator prenatally and postnatally (at child ages 12, 24, 36, 48, and 60 months). During visits, the Navigator works with the mother/caregiver to identify family needs, establishes connections between the family and community providers, and follows up one month later to confirm these referrals. At all touch points, Navigators assess and support family needs in four domains. For the prenatal, 12, and 24 month Navigation visits, the domains include (1) Health Care; (2) Caring for the Infant; (3) A Safe Home; and (4) Parent Well-Being. At the 36, 48, and 60 month Navigation visits, the domains include: (1) Health Care; (2) Caring for the Child; (3) Child Development; and (4) Family Interactions. Families are also invited at all visits to nominate other needs not related to these four domains.

06

What researchers measure

Primary outcomes

  1. Evaluate the implementation by the rate of enrollment in the Navigation program.

    Proportion of participants in the Navigation group who agree to schedule a prenatal Navigation visit, which will be collected from enrollment logs.

    Time frame: Prenatally (up until delivery of target child)

  2. Evaluate the implementation by the rate of retention in the Navigation program.

    This will be collected from participant tracking logs completed by the navigators (i.e., whether they completed the 12-month Navigation visit with the participant).

    Time frame: 12 months

  3. Evaluate the implementation by the rate of retention in the Navigation program.

    This will be collected from participant tracking logs completed by the navigators (i.e., whether they completed the 24-month Navigation visit with the participant).

    Time frame: 24 months

  4. Evaluate the implementation by the rate of retention in the Navigation program.

    This will be collected from participant tracking logs completed by the navigators (i.e., whether they completed the 36-month Navigation visit with the participant).

    Time frame: 36 months

  5. Evaluate the implementation by the fidelity of implementation of the Navigation manual by Navigators.

    For 10% of the Navigation visits, a second Navigator will observe the primary Navigator. The second Navigator will check using a list of program elements from the program manual to assess whether the primary Navigator adheres to each program element. In addition, the second Navigator will score the family on each of the Navigation domains. Fidelity of implementation will be measure by the percent adherence to the program manual and the inter-rater reliability on the domain scores using Cohen's kappa statistic.

    Time frame: 12 months

  6. Evaluate the implementation by the fidelity of implementation of the Navigation manual by Navigators.

    For 10% of the Navigation visits, a second Navigator will observe the primary Navigator. The second Navigator will check using a list of program elements from the program manual to assess whether the primary Navigator adheres to each program element. In addition, the second Navigator will score the family on each of the Navigation domains. Fidelity of implementation will be measure by the percent adherence to the program manual and the inter-rater reliability on the domain scores using Cohen's kappa statistic.

    Time frame: 24 months

  7. Evaluate the implementation by the fidelity of implementation of the Navigation manual by Navigators.

    For 10% of the Navigation visits, a second Navigator will observe the primary Navigator. The second Navigator will check using a list of program elements from the program manual to assess whether the primary Navigator adheres to each program element. In addition, the second Navigator will score the family on each of the Navigation domains. Fidelity of implementation will be measure by the percent adherence to the program manual and the inter-rater reliability on the domain scores using Cohen's kappa statistic.

    Time frame: 36 months

  8. Evaluate the implementation by the proportion of families receiving screening scores that indicate risk for negative child and/or family outcomes.

    This will be collected from case report forms completed by the Navigators. For each intervention domain of interest, Navigators will rate family needs on a 1-4 scale with scores of 3 and 4 indicating a need for referral to community resources. This outcome will be measured as the proportion of families receiving at least one score of 3 or 4.

    Time frame: Prenatal (before delivery of target child)

  9. Evaluate the implementation by the proportion of families receiving screening scores that indicate risk for negative child and/or family outcomes.

    This will be collected from case report forms completed by the Navigators. For each intervention domain of interest, Navigators will rate family needs on a 1-4 scale with scores of 3 and 4 indicating a need for referral to community resources. This outcome will be measured as the proportion of families receiving at least one score of 3 or 4.

    Time frame: 12 months

  10. Evaluate the implementation by the proportion of families receiving screening scores that indicate risk for negative child and/or family outcomes.

    This will be collected from case report forms completed by the Navigators. For each intervention domain of interest, Navigators will rate family needs on a 1-4 scale with scores of 3 and 4 indicating a need for referral to community resources. This outcome will be measured as the proportion of families receiving at least one score of 3 or 4.

    Time frame: 24 months

  11. Evaluate the implementation by the proportion of families receiving screening scores that indicate risk for negative child and/or family outcomes.

    This will be collected from case report forms completed by the Navigators. For each intervention domain of interest, Navigators will rate family needs on a 1-4 scale with scores of 3 and 4 indicating a need for referral to community resources. This outcome will be measured as the proportion of families receiving at least one score of 3 or 4.

    Time frame: 36 months

  12. Evaluate the implementation by the proportion of families referred to community resources.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate any community resources to which they refer families. This outcome will be measured as the proportion of families that are referred to one or more community resources by the Navigator.

    Time frame: Prenatally (before delivery of target child)

  13. Evaluate the implementation by the proportion of families referred to community resources.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate any community resources to which they refer families. This outcome will be measured as the proportion of families that are referred to one or more community resources by the Navigator.

    Time frame: 12 months

  14. Evaluate the implementation by the proportion of families referred to community resources.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate any community resources to which they refer families. This outcome will be measured as the proportion of families that are referred to one or more community resources by the Navigator.

    Time frame: 24 months

  15. Evaluate the implementation by the proportion of families referred to community resources.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate any community resources to which they refer families. This outcome will be measured as the proportion of families that are referred to one or more community resources by the Navigator.

    Time frame: 36 months

  16. Evaluate the implementation by the proportion of families that initiate community services.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate whether families initiated participation in the community services to which they were referred, if any. This outcome will be measured as the proportion of families referred to community services that initiate participation in at lease one community service.

    Time frame: Prenatally (before delivery of target child)

  17. Evaluate the implementation by the proportion of families that initiate community services.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate whether families initiated participation in the community services to which they were referred, if any. This outcome will be measured as the proportion of families referred to community services that initiate participation in at lease one community service.

    Time frame: 12 months

  18. Evaluate the implementation by the proportion of families that initiate community services.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate whether families initiated participation in the community services to which they were referred, if any. This outcome will be measured as the proportion of families referred to community services that initiate participation in at lease one community service.

    Time frame: 24 months

  19. Evaluate the implementation by the proportion of families that initiate community services.

    This will be collected from case report forms completed by the Navigators. On the CRFs, Navigators will indicate whether families initiated participation in the community services to which they were referred, if any. This outcome will be measured as the proportion of families referred to community services that initiate participation in at lease one community service.

    Time frame: 36 months

  20. Evaluate the implementation by the families' satisfaction with the Navigation program.

    This will be measured via participant self-reports as the percentage of families that rate themselves as satisfied or very satisfied with their Navigation experience and the percentage of families that would recommend the program to other families.

    Time frame: 3 months

  21. Evaluate the implementation by the families' satisfaction with the Navigation program.

    This will be measured via participant self-reports as the percentage of families that rate themselves as satisfied or very satisfied with their Navigation experience and the percentage of families that would recommend the program to other families.

    Time frame: 15 months

  22. Evaluate the implementation by the families' satisfaction with the Navigation program.

    This will be measured via participant self-reports as the percentage of families that rate themselves as satisfied or very satisfied with their Navigation experience and the percentage of families that would recommend the program to other families.

    Time frame: 27 months

  23. Evaluate the implementation by the families' satisfaction with the Navigation program.

    This will be measured via participant self-reports as the percentage of families that rate themselves as satisfied or very satisfied with their Navigation experience and the percentage of families that would recommend the program to other families.

    Time frame: 39 months

  24. Evaluate the impact of the Navigation program by reviewing child maltreatment.

    This will be measured through Child Protective Services records via a comparison of the Navigation group and control group in their likelihood of having a substantiated or "services needed" case of maltreatment.

    Time frame: 12 months

  25. Evaluate the impact of the Navigation program by reviewing child maltreatment.

    This will be measured through Child Protective Services records via a comparison of the Navigation group and control group in their likelihood of having a substantiated or "services needed" case of maltreatment.

    Time frame: 24 months

  26. Evaluate the impact of the Navigation program by reviewing child maltreatment.

    This will be measured through Child Protective Services records via a comparison of the Navigation group and control group in their likelihood of having a substantiated or "services needed" case of maltreatment.

    Time frame: 36 months

  27. Evaluate the impact of the Navigation program by reviewing child maltreatment.

    This will be measured through Child Protective Services records via a comparison of the Navigation group and control group in their likelihood of having a substantiated or "services needed" case of maltreatment.

    Time frame: 48 months

  28. Evaluate the impact of the Navigation program by reviewing child maltreatment.

    This will be measured through Child Protective Services records via a comparison of the Navigation group and control group in their likelihood of having a substantiated or "services needed" case of maltreatment.

    Time frame: 60 months

  29. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 3 months

  30. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 15 months

  31. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 27 months

  32. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 39 months

  33. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 51 months

  34. Evaluate the impact of the Navigation program by reviewing maternal health.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores of their ratings of their overall health, depression symptoms, anxiety symptoms, and substance abuse symptoms.

    Time frame: 63 months

  35. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 3 months

  36. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 15 months

  37. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 27 months

  38. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 39 months

  39. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 51 months

  40. Evaluate the impact of the Navigation program by reviewing child health and development.

    This will be measured from parent reports via a comparison of the Navigation and control groups' mean scores on ratings of their overall health, social-emotional development, and cognitive development.

    Time frame: 63 months

  41. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 3 months

  42. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 15 months

  43. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 27 months

  44. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 39 months

  45. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 51 months

  46. Evaluate the impact of the Navigation program by reviewing parent and parent-child relationships.

    This will be measured from participant self-reports via a comparison of Navigation and control groups' mean scores on ratings of their knowledge of child development, parenting self-efficacy, parenting stress, parent discipline behavior, and parent attributions of child behavior.

    Time frame: 63 months

  47. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 3 months

  48. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 15 months

  49. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 27 months

  50. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 39 months

  51. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 51 months

  52. Evaluate the impact of the Navigation program by reviewing family service receipt and children's connection to medical home.

    Family services receipt will be measured from parent reports via a comparison of the Navigation and control groups' mean number of community services they have accessed since receiving Navigation/the control intervention. Connection to a medical home will be measured from parent report via a comparison of the Navigation and control groups' likelihood of having a primary care physician for their child.

    Time frame: 63 months

  53. Evaluate the impact of the Navigation program by assessing child kindergarten readiness

    This will be measured from North Carolina Department of Public Instruction administrative records via a comparison of Navigation and control groups' mean child achievement scores child reading and math, as well as behavior and discipline records.

    Time frame: 66 months

07

Study locations

1 site
  • Duke University
    Durham, North Carolina 27708, United States
08

References and documents

Publications

  • Milojevich HM, Best DL, Goodman WB, Rehder PD, Dodge KA. Community Navigation: Iterative Development and Implementation of a Prenatal Psychosocial System of Care. Prev Sci. 2026 Aug;27(6):971-982. doi: 10.1007/s11121-026-01939-7. Epub 2026 Jun 25. PubMed 42350752 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 21, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04438031
Lead sponsor
Duke University
Responsible party
Sponsor
First posted
Jun 18, 2020
Start date
Nov 20, 2020
Primary completion
Jun 30, 2030 (estimated)
Completion
Jun 30, 2030 (estimated)
Last update
Aug 21, 2026

Study contacts

Kenneth Dodge, PhD
principal investigator · Duke University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion