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

Abstract

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.

Effectiveness of nurse‐home visiting in improving child and maternal outcomes prenatally to age two years: a randomised controlled trial (British Columbia Healthy Connections Project)

“…We previously published findings showing reduced prenatal cannabis use and modest reduction in number of cigarettes smoked among smokers, although no reduction in rates of prenatal cigarette and alcohol use (Catherine, Lever, et al., 2020). After we launched our trial, findings from NFP trials conducted in Netherlands, England and United States (South Carolina) were published showing mixed results by age two years (McConnell et al., 2022; Mejdoubi et al., 2013, 2015; Robling et al., 2016; Waters et al., 2022). Our trial adds to this body of research.…”

“…However, despite a moderate positive correlation between maternal report and observed assessments of child language, we did not see NFP benefits in a sub‐sample using direct child observation, which is a more rigorous measure. Whereas results from exploratory analyses within a sub‐sample of the English NFP trial detected improved maternal language (mean length of utterances) by 24 months postpartum, assessed via direct observation, but no improvements in child language (Waters et al., 2022). By child age seven years, benefits were found for child reading achievement assessed via administrative records (Robling et al., 2022).…”