Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment

Lugg-Widger, Fiona; Robling, Michael; Lau, Mark A.; Paranjothy, Shantini; Pell, Jill P.; Sanders, Julia; White, James; Cannings‐John, Rebecca

doi:10.23889/ijpds.v5i1.1154

Cited by 5 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 Another UK-based evaluation of the FNP in Scotland using routinely collected data will assess maltreatment and is due to report in 2021. 30 Appendix 1, Table 25, summarises the outcomes relevant to BB:2-6 that the NFP [9][10][11] and VoorZorg [25][26][27] trials evaluated.…”

Section: Other Evaluations Of the Nurse-family Partnershipmentioning

confidence: 99%

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The short-term effectiveness (to 24 months post partum) of a preventative home-visiting intervention, the Family Nurse Partnership, was previously assessed in the Building Blocks trial (BB:0–2). Objectives The objectives were to establish the medium-term effectiveness of the Family Nurse Partnership in reducing maltreatment and improving maternal health (second pregnancies) and child health, developmental and educational outcomes (e.g. early educational attendance, school readiness); to explore effect moderators and mediators; and to describe the costs of enhancing usually provided health and social care with the Family Nurse Partnership. Design Children and their mothers from an existing trial cohort were followed up using routine data until the child was 7 years of age. Setting This study was set in 18 partnerships between local authorities and health-care organisations in England. Participants The participants were mothers [and their firstborn child(ren)] recruited as pregnant women aged ≤ 19 years, in local authority Family Nurse Partnership catchment areas, at < 25 weeks’ gestation, able to provide consent and able to converse in English. Participants mandatorily withdrawn (e.g. owing to miscarriage) from the BB:0–2 trial were excluded. Interventions The intervention comprised up to a maximum of 64 home visits by specially trained family nurses from early pregnancy until the firstborn child was 2 years of age, plus usually provided health and social care support. The comparator was usual care alone. Main outcome measures The primary outcome measure was child-in-need status recorded at any time during follow-up. The secondary outcomes were as follows: (1) referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions at any time during follow-up; (2) early child care and educational attendance, school readiness (Early Years Foundation Stage Profile score) and attainment at Key Stage 1; and (3) health-care costs. Data sources The following data sources were used: maternally reported baseline and follow-up data (BB:0–2), Hospital Episode Statistics data (NHS Digital), social care and educational data (National Pupil Database) and abortions data (Department of Health and Social Care). Results There were no differences between study arms in the rates of referral to social services, being registered as a child in need, receiving child protection plans, entering care or timing of first referral for children subsequently assessed as in need. There were no differences between study arms in rates of hospital emergency attendance, admission for injuries or ingestions, or in duration of stay for admitted children. Children in the Family Nurse Partnership arm were more likely to achieve a good level of development at reception age (school readiness), an effect strengthened when adjusting for birth month. Differences at Key Stage 1 were not statistically different, but, after adjusting for birth month, children in the Family Nurse Partnership arm were more likely to reach the expected standard in reading. Programme effects were greater for boys (Key Stage 1: writing); children of younger mothers (Key Stage 1: writing, Key Stage 1: mathematics); and children of mothers not in employment, education or training at study baseline (Key Stage 1: writing). There were no differences between families who were part of the Family Nurse Partnership and those who were not for any other outcome. The differences between study arms in resource use and costs were negligible. Limitations The outcomes are constrained to those available from routine sources. Conclusions There is no observable benefit of the programme for maltreatment or maternal outcomes, but it does generate advantages in school readiness and attainment at Key Stage 1. Future work The trajectory of longer-term programme benefits should be mapped using routine and participant-reported measures. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.

show abstract

Section: Other Evaluations Of the Nurse-family Partnershipmentioning

confidence: 99%

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…We selected outcomes for the FNP evaluation based on the FNP logic model (table 1). 37 Derivation of these outcomes is described in detail in online supplemental tables 1-3.…”

Section: Discussionmentioning

confidence: 99%

Intensive home visiting for adolescent mothers in the Family Nurse Partnership in England 2010–2019: a population-based data linkage cohort study using propensity score matching

Cavallaro,

Gilbert,

Van der Meulen

et al. 2024

bmjph

View full text Add to dashboard Cite

BackgroundWe evaluated the effectiveness of the Family Nurse Partnership (FNP), an intensive home visiting programme aiming to improve birth outcomes, child health and development, and to promote economic self-sufficiency among teenage mothers.MethodsWe created a linked cohort of >130 000 mothers aged 13–19 years with live births between April 2010 and March 2019, using administrative data from health (Hospital Episode Statistics), education and children’s social care (National Pupil Database). Using propensity score matching, we compared indicators of child maltreatment, health and development outcomes, and maternal hospital utilisation and educational outcomes up to 7 years following birth for mothers who did or did not enrol in FNP.ResultsWe found no evidence of an association between FNP and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 years for children born to FNP mothers (6.6% vs 5.7%, relative risk (RR) 1.15; 95% CI 1.07, 1.24). There was weak evidence that children born to FNP mothers were more likely to achieve a good level of development at age 5 years (57.5% vs 55.4%, RR 1.05; 95% CI 1.00, 1.09). FNP mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs 9.3%, RR 0.92; 95% CI 0.88, 0.97).ConclusionOur study supports findings from previous evaluations of FNP showing no evidence of benefit for child maltreatment or health outcomes measured in administrative data. Bias by indication, and variation in the intervention and usual care, may have limited our ability to detect effects. Future evaluations should capture more information on maternal risk factors and additional outcomes relating to maternal/child well-being.

show abstract

“…In Scotland, all mothers and children were additionally linked to General/Acute Inpatient and Day Case (SMR01), Child Health Systems Programme Pre-School and School. Mothers and their children were linked to education and children’s social care information (National Pupil Database in England, and Education Analytical Services in Scotland), including Children in Need and Children Looked After returns [ 5 , 6 ]. Mothers and children enrolled in FNP were identified through linkage of hospital data to the FNP (Scottish) Information System.…”

Section: Methodsmentioning

confidence: 99%

Lessons learned from using linked administrative data to evaluate the Family Nurse Partnership in England and Scotland

Cavallaro

Cannings‐John

Lugg-Widger

et al. 2023

IJPDS

Self Cite

View full text Add to dashboard Cite

Introduction“Big data” – including linked administrative data – can be exploited to evaluate interventions for maternal and child health, providing time- and cost-effective alternatives to randomised controlled trials. However, using these data to evaluate population-level interventions can be challenging. ObjectivesWe aimed to inform future evaluations of complex interventions by describing sources of bias, lessons learned, and suggestions for improvements, based on two observational studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP) in England and Scotland. MethodsWe first considered how different sources of potential bias within the administrative data could affect results of the evaluations. We explored how each study design addressed these sources of bias using maternal confounders captured in the data. We then determined what additional information could be captured at each step of the complex intervention to enable analysts to minimise bias and maximise comparability between intervention and usual care groups, so that any observed differences can be attributed to the intervention. ResultsLessons learned include the need for i) detailed data on intervention activity (dates/geography) and usual care; ii) improved information on data linkage quality to accurately characterise control groups; iii) more efficient provision of linked data to ensure timeliness of results; iv) better measurement of confounding characteristics affecting who is eligible, approached and enrolled. ConclusionsLinked administrative data are a valuable resource for evaluations of the FNP national programme and other complex population-level interventions. However, information on local programme delivery and usual care are required to account for biases that characterise those who receive the intervention, and to inform understanding of mechanisms of effect. National, ongoing, robust evaluations of complex public health evaluations would be more achievable if programme implementation was integrated with improved national and local data collection, and robust quasi-experimental designs.

show abstract

Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment

Cited by 5 publications

References 27 publications

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

Intensive home visiting for adolescent mothers in the Family Nurse Partnership in England 2010–2019: a population-based data linkage cohort study using propensity score matching

Lessons learned from using linked administrative data to evaluate the Family Nurse Partnership in England and Scotland

Contact Info

Product

Resources

About