Nurse-led home-visitation programme for first-time mothers in reducing maltreatment and improving child health and development (BB:2-6): longer-term outcomes from a randomised cohort using data linkage

Robling, Michael; Lugg-Widger, Fiona; Cannings‐John, Rebecca; Angel, Lianna; Channon, Sue; Fitzsimmons, Deborah; Hood, Kerenza; Kenkre, Joyce; Moody, Gwenllian; Owen-Jones, Eleri; Pockett, Rhys; Sanders, Julia; Segrott, Jeremy; Slater, Tom

doi:10.1136/bmjopen-2021-049960

Cited by 9 publications

(22 citation statements)

References 35 publications

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“…Thirteen RCTs reported on hospitalization outcomes (eTables 24-27 in the Supplement). Outcomes varied in their degree of specificity to child abuse and neglect. For example, highly specific measures included the number of children with hospital admission as a result of an injury that were referred for independent investigation by the Family and Children’s Services staff and whose injuries were concluded to be nonaccidental; nonspecific measures included proportions with and mean number of all-cause hospitalization .…”

Section: Resultsmentioning

confidence: 95%

“…Twenty-five studies described in 43 publications were eligible (Figure 2). A list of full-text articles that were screened but excluded is provided in the List of Excluded Studies section in the Supplement. Table 1 summarizes study characteristics, and eTables 6-10 in the Supplement provide details.…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen RCTs reported in 27 publications analyzed the association between child maltreatment interventions and likelihood of reports to CPS (eTables 11-14 in the Supplement). All except 1 trial reported initial results during the intervention (1 year from baseline), at the end of the intervention, or within a year of completing the intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen RCTs reported on emergency department visits (eTables 20-23 in the Supplement). Lower emergency department visit rates in the intervention group were interpreted as beneficial. The results were generally inconsistent in direction of effect.…”

Section: Resultsmentioning

confidence: 99%

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Primary Care Interventions to Prevent Child Maltreatment

Viswanathan,

Rains,

Hart

et al. 2024

JAMA

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ImportanceChild maltreatment is associated with serious negative physical, psychological, and behavioral consequences.ObjectiveTo review the evidence on primary care–feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023.Study SelectionEnglish-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment.Data Extraction and SynthesisTwo reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and MeasuresDirectly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms.ResultsTwenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (&lt;2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health.Conclusion and RelevanceThe evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Primary Care Interventions to Prevent Child Maltreatment

Viswanathan,

Rains,

Hart

et al. 2024

JAMA

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“…Only the longer-term follow-up of the BABBLE sample will determine whether the impact of FNP on mother’s language interactions observed in the current study leads to improved offspring outcomes. Recent evidence from a data linkage study indicates small but positive effects of FNP on development (school readiness) and educational outcomes when children were approximately 7-years-old [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of a specialist home-visiting intervention on the language outcomes of young mothers and their children: a pragmatic randomised controlled trial

et al. 2022

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Background Young mothers are more likely to provide a suboptimal early language environment for their children who in turn show impairments in their language development, yet few studies have used observational methods to assess the effectiveness of home-visiting programmes in improving the language outcomes of young mothers and their children. The Family Nurse Partnership (FNP) is a licensed home-visiting intervention developed in the USA and introduced into practice in England. The intervention involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained Family Nurses. We assessed the effectiveness of FNP in improving the language outcomes of first-time teenage mothers and their infants. Method We conducted a pragmatic, non-blinded, randomised controlled trial to test whether the FNP programme improved mothers’ and children’s language production at 24 months postpartum. Eligible participants were nulliparous, aged 19 years or younger, and were recruited at less than 25 weeks’ gestation from community midwifery settings (Country). Pregnant young mothers were randomly assigned to FNP plus usual care (n = 243) or usual care alone (n = 233). At 24 months postpartum, mother–child dyads were observed during a standardised free-play task with their first-born child and features of their language production was coded. Data was analysed using multi-level modelling; linear or poisson/negative binomial regression models were used as appropriate. Results A small effect of FNP on mothers’ productive language was detected, where mothers in the FNP group demonstrated higher mean length of utterances than mothers who received usual care alone, mean difference (adjusted by minimisation variables and by site, linear regression) = 0.10, p < .05, 95% CI (0.004–0.20), d = .18. No differences were detected between groups regarding other characteristics of maternal language or children’s language outcomes. Conclusion This observational study conducted within the context of a randomised-controlled trial suggests that the FNP home-visiting programme may have a small, but potentially important impact on young mothers’ speech to their toddlers. Exploratory analyses identified family environment, maternal, and child related predictors of the language outcomes of young mothers and their offspring. Trial registration This trial is registered with ISRCTN, number ISRCTN23019866, 20/04/2009.

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