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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

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

Public Health Research, Volume: 9, Issue: 2, Pages: 1 - 160

Swansea University Authors: Deborah Fitzsimmons Orcid Logo, Rhys Pockett Orcid Logo

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DOI (Published version): 10.3310/phr09020

Abstract

BackgroundThe 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).ObjectivesThe objectives were to establish the medium-term effectiveness of the Family Nurse Par...

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Published in: Public Health Research
ISSN: 2050-4381 2050-439X
Published: National Institute for Health Research 2021
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Participants mandatorily withdrawn (e.g. owing to miscarriage) from the BB:0&#x2013;2 trial were excluded.InterventionsThe intervention comprised up to a maximum of 64 home visits by specially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 measuresThe 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 sourcesThe following data sources were used: maternally reported baseline and follow-up data (BB:0&#x2013;2), Hospital Episode Statistics data (NHS Digital), social care and educational data (National Pupil Database) and abortions data (Department of Health and Social Care).ResultsThere 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.LimitationsThe outcomes are constrained to those available from routine sources.ConclusionsThere 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.</abstract><type>Journal Article</type><journal>Public Health Research</journal><volume>9</volume><journalNumber>2</journalNumber><paginationStart>1</paginationStart><paginationEnd>160</paginationEnd><publisher>National Institute for Health Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2050-4381</issnPrint><issnElectronic>2050-439X</issnElectronic><keywords/><publishedDay>10</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-02-10</publishedDate><doi>10.3310/phr09020</doi><url/><notes/><college>COLLEGE NANME</college><department>Public Health</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PHAC</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>NIHR</funders><lastEdited>2021-11-19T03:41:24.0656505</lastEdited><Created>2021-02-10T11:07:35.9457806</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care</level></path><authors><author><firstname>Michael</firstname><surname>Robling</surname><order>1</order></author><author><firstname>Fiona</firstname><surname>Lugg-Widger</surname><order>2</order></author><author><firstname>Rebecca</firstname><surname>Cannings-John</surname><order>3</order></author><author><firstname>Julia</firstname><surname>Sanders</surname><order>4</order></author><author><firstname>Lianna</firstname><surname>Angel</surname><order>5</order></author><author><firstname>Sue</firstname><surname>Channon</surname><order>6</order></author><author><firstname>Deborah</firstname><surname>Fitzsimmons</surname><orcid>0000-0002-7286-8410</orcid><order>7</order></author><author><firstname>Kerenza</firstname><surname>Hood</surname><order>8</order></author><author><firstname>Joyce</firstname><surname>Kenkre</surname><order>9</order></author><author><firstname>Gwenllian</firstname><surname>Moody</surname><order>10</order></author><author><firstname>Eleri</firstname><surname>Owen-Jones</surname><order>11</order></author><author><firstname>Rhys</firstname><surname>Pockett</surname><orcid>0000-0003-4135-7383</orcid><order>12</order></author><author><firstname>Jeremy</firstname><surname>Segrott</surname><order>13</order></author><author><firstname>Thomas</firstname><surname>Slater</surname><order>14</order></author></authors><documents><document><filename>56228__19260__2ba796035a2443f5919faf2e49f57bcc.pdf</filename><originalFilename>3035852.pdf</originalFilename><uploaded>2021-02-10T11:16:34.5924033</uploaded><type>Output</type><contentLength>6559933</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Released under the terms of a UK government&#x2019;s non-commercial license for public sector information</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm</licence></document></documents><OutputDurs/></rfc1807>
spelling 2021-11-19T03:41:24.0656505 v2 56228 2021-02-10 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 e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 8a3882ebcc6a8fb3b2c13fc2ff716bf2 0000-0003-4135-7383 Rhys Pockett Rhys Pockett true false 2021-02-10 PHAC BackgroundThe 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).ObjectivesThe 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.DesignChildren and their mothers from an existing trial cohort were followed up using routine data until the child was 7 years of age.SettingThis study was set in 18 partnerships between local authorities and health-care organisations in England.ParticipantsThe 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.InterventionsThe 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 measuresThe 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 sourcesThe 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).ResultsThere 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.LimitationsThe outcomes are constrained to those available from routine sources.ConclusionsThere 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. Journal Article Public Health Research 9 2 1 160 National Institute for Health Research 2050-4381 2050-439X 10 2 2021 2021-02-10 10.3310/phr09020 COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University NIHR 2021-11-19T03:41:24.0656505 2021-02-10T11:07:35.9457806 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Michael Robling 1 Fiona Lugg-Widger 2 Rebecca Cannings-John 3 Julia Sanders 4 Lianna Angel 5 Sue Channon 6 Deborah Fitzsimmons 0000-0002-7286-8410 7 Kerenza Hood 8 Joyce Kenkre 9 Gwenllian Moody 10 Eleri Owen-Jones 11 Rhys Pockett 0000-0003-4135-7383 12 Jeremy Segrott 13 Thomas Slater 14 56228__19260__2ba796035a2443f5919faf2e49f57bcc.pdf 3035852.pdf 2021-02-10T11:16:34.5924033 Output 6559933 application/pdf Version of Record true Released under the terms of a UK government’s non-commercial license for public sector information true eng http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm
title 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
spellingShingle 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
Deborah Fitzsimmons
Rhys Pockett
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv e900d99a0977beccf607233b10c66b43
8a3882ebcc6a8fb3b2c13fc2ff716bf2
author_id_fullname_str_mv e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
8a3882ebcc6a8fb3b2c13fc2ff716bf2_***_Rhys Pockett
author Deborah Fitzsimmons
Rhys Pockett
author2 Michael Robling
Fiona Lugg-Widger
Rebecca Cannings-John
Julia Sanders
Lianna Angel
Sue Channon
Deborah Fitzsimmons
Kerenza Hood
Joyce Kenkre
Gwenllian Moody
Eleri Owen-Jones
Rhys Pockett
Jeremy Segrott
Thomas Slater
format Journal article
container_title Public Health Research
container_volume 9
container_issue 2
container_start_page 1
publishDate 2021
institution Swansea University
issn 2050-4381
2050-439X
doi_str_mv 10.3310/phr09020
publisher National Institute for Health Research
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
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description BackgroundThe 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).ObjectivesThe 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.DesignChildren and their mothers from an existing trial cohort were followed up using routine data until the child was 7 years of age.SettingThis study was set in 18 partnerships between local authorities and health-care organisations in England.ParticipantsThe 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.InterventionsThe 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 measuresThe 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 sourcesThe 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).ResultsThere 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.LimitationsThe outcomes are constrained to those available from routine sources.ConclusionsThere 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.
published_date 2021-02-10T04:03:43Z
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