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

Abstract

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 Participants mandatorily withdrawn (e.g. owing to miscarriage) from the BB:0–2 trial were excluded.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.

Primary Care Interventions to Prevent Child Maltreatment

“…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.…”

“…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.…”

Data Resource: Children Receiving Care and Support and Children in Need, administrative records in Wales.

“…Knowledge about predictors and outcomes of social care services is especially lacking for Wales, as the relatively few social care studies that have used linked administrative data sets have looked only at England, e.g. [ 34 , 35 ]. Examples include a focus on health and education outcomes, including the comparison of children in different service categories (child protection, looked after, others); comparisons of outcomes for the different duration and intensity of social care involvement (e.g., using placement data from the looked after children return); and the possible impact of policy changes (e.g., further exploring the interesting finding in this paper about GP contact).…”

Characteristics of enrolment in an intensive home-visiting programme among eligible first-time adolescent mothers in England: a linked administrative data cohort study

“…The FNP aims to improve birth outcomes, child health and development 6. Although a randomised trial in England found no evidence of benefit on outcomes including birth weight and hospital admissions before age 2 years, improved development and educational outcomes were reported, and there remains strong support for the programme locally 5 7–9…”