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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

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

BMJ Open, Volume: 12, Issue: 2, Start page: e049960

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

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DOI (Published version): 10.1136/bmjopen-2021-049960

Abstract

Objectives: Measure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs.Design: Follow-up of BB:0-2 trial cohort (...

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ISSN: 2044-6055 2044-6055
Published: BMJ 2022
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Intervention families were offered up to a maximum of 64 home visits by specially trained nurses from pregnancy until firstborn child was 2 years old, plus usually provided health and social care support. Comparator was usual care alone.Outcome measures: Primary outcome: state-verified child-in-need status recorded at any time during follow-up.Secondary outcomes: referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions any time during follow-up, early childcare and educational attendance, school readiness and attainment at key stage 1 (KS1), healthcare costs.Results: Match rates for 1547 eligible children (1517 singletons, 15 sets of twins) were 98.3% (NHS Digital) and 97.4% (National Pupil Database). There was no difference between study arms in the proportion of children being registered as in need (adjusted OR 0.98, 95% CI 0.74 to 1.31), or for any other measure of maltreatment. Children in the FNP arm were more likely to achieve a good level of development at reception age (school readiness) (adjusted OR 1.24, 95% CI 1.01 to 1.52). After adjusting for birth month, children in FNP arm were more likely to reach the expected standard in reading at KS1 (adjusted OR 1.26, 95% CI 1.02 to 1.57). We found no trial arm differences for resource use and costs.Conclusions: FNP did not improve maltreatment or maternal outcomes. 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spelling 2022-12-09T11:50:59.0956436 v2 59380 2022-02-11 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 e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 8a3882ebcc6a8fb3b2c13fc2ff716bf2 0000-0003-4135-7383 Rhys Pockett Rhys Pockett true false 2022-02-11 PHAC Objectives: Measure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs.Design: Follow-up of BB:0-2 trial cohort (ISRCTN:23019866) up to age 7 years in England using record linkage.Participants: 1618 mothers aged 19 years or younger and their firstborn child(ren) recruited to BB:0-2 trial at less than 25 weeks gestation and not mandatorily withdrawn from trial or opted out. Intervention families were offered up to a maximum of 64 home visits by specially trained nurses from pregnancy until firstborn child was 2 years old, plus usually provided health and social care support. Comparator was usual care alone.Outcome measures: Primary outcome: state-verified child-in-need status recorded at any time during follow-up.Secondary outcomes: referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions any time during follow-up, early childcare and educational attendance, school readiness and attainment at key stage 1 (KS1), healthcare costs.Results: Match rates for 1547 eligible children (1517 singletons, 15 sets of twins) were 98.3% (NHS Digital) and 97.4% (National Pupil Database). There was no difference between study arms in the proportion of children being registered as in need (adjusted OR 0.98, 95% CI 0.74 to 1.31), or for any other measure of maltreatment. Children in the FNP arm were more likely to achieve a good level of development at reception age (school readiness) (adjusted OR 1.24, 95% CI 1.01 to 1.52). After adjusting for birth month, children in FNP arm were more likely to reach the expected standard in reading at KS1 (adjusted OR 1.26, 95% CI 1.02 to 1.57). We found no trial arm differences for resource use and costs.Conclusions: FNP did not improve maltreatment or maternal outcomes. There was evidence of small advantages in school readiness and attainment at KS1. Journal Article BMJ Open 12 2 e049960 BMJ 2044-6055 2044-6055 10 2 2022 2022-02-10 10.1136/bmjopen-2021-049960 COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University Another institution paid the OA fee This project was funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (reference:11/3002/11) 2022-12-09T11:50:59.0956436 2022-02-11T12:44:52.6264599 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Michael Robling 0000-0002-1004-036x 1 Fiona V Lugg-Widger 0000-0003-0029-9703 2 Rebecca Cannings-John 3 Lianna Angel 4 Sue Channon 5 Deborah Fitzsimmons 0000-0002-7286-8410 6 Kerenza Hood 7 Joyce Kenkre 8 Gwenllian Moody 9 Eleri Owen-Jones 0000-0003-0850-4724 10 Rhys Pockett 0000-0003-4135-7383 11 Julia Sanders 12 Jeremy Segrott 0000-0001-6215-0870 13 Thomas Slater 0000-0003-3840-2454 14 59380__22358__4ae2f2fa55e84b3e9e54fe12dc99c31d.pdf e049960.full.pdf 2022-02-11T12:49:14.5677502 Output 1407730 application/pdf Version of Record true © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY true eng https://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Deborah Fitzsimmons
Rhys Pockett
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
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 V Lugg-Widger
Rebecca Cannings-John
Lianna Angel
Sue Channon
Deborah Fitzsimmons
Kerenza Hood
Joyce Kenkre
Gwenllian Moody
Eleri Owen-Jones
Rhys Pockett
Julia Sanders
Jeremy Segrott
Thomas Slater
format Journal article
container_title BMJ Open
container_volume 12
container_issue 2
container_start_page e049960
publishDate 2022
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2021-049960
publisher BMJ
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
document_store_str 1
active_str 0
description Objectives: Measure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs.Design: Follow-up of BB:0-2 trial cohort (ISRCTN:23019866) up to age 7 years in England using record linkage.Participants: 1618 mothers aged 19 years or younger and their firstborn child(ren) recruited to BB:0-2 trial at less than 25 weeks gestation and not mandatorily withdrawn from trial or opted out. Intervention families were offered up to a maximum of 64 home visits by specially trained nurses from pregnancy until firstborn child was 2 years old, plus usually provided health and social care support. Comparator was usual care alone.Outcome measures: Primary outcome: state-verified child-in-need status recorded at any time during follow-up.Secondary outcomes: referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions any time during follow-up, early childcare and educational attendance, school readiness and attainment at key stage 1 (KS1), healthcare costs.Results: Match rates for 1547 eligible children (1517 singletons, 15 sets of twins) were 98.3% (NHS Digital) and 97.4% (National Pupil Database). There was no difference between study arms in the proportion of children being registered as in need (adjusted OR 0.98, 95% CI 0.74 to 1.31), or for any other measure of maltreatment. Children in the FNP arm were more likely to achieve a good level of development at reception age (school readiness) (adjusted OR 1.24, 95% CI 1.01 to 1.52). After adjusting for birth month, children in FNP arm were more likely to reach the expected standard in reading at KS1 (adjusted OR 1.26, 95% CI 1.02 to 1.57). We found no trial arm differences for resource use and costs.Conclusions: FNP did not improve maltreatment or maternal outcomes. There was evidence of small advantages in school readiness and attainment at KS1.
published_date 2022-02-10T04:16:38Z
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