How effective is Family Nurse Partnership Programme in England?

Written by Alison Kemp

The results of the Building Blocks randomised controlled trial evaluating the Family Nurse Partnership (FNP) programme in England were published in the Lancet in October. The Nurse Family Partnership has been shown to be effective in several US states and was adapted and introduced widely in England.

The study was set in eighteen FNP sites in England. First time teenage mothers aged 19 years or younger with a confirmed pregnancy were recruited to the study prior to 24 weeks gestation. 823 participants were randomized to receive FNP in conjunction with usual care and 822 received usual care alone. The two approaches were compared and outcome measures related to pregnancy (self reported smoking validated by urinary cotinine) and birth (birth weight), child health (emergency admissions and hospital attendances) and development, parental life-course and self-sufficiency were evaluated.

Results suggested no difference in birth weight (mean birth weight 3.2kg), smoking in late pregnancy (56% of both groups smoked), second pregnancy within two years (rate of second pregnancy 66%). Marginally more children (81%) in the FNP group attended emergency department or were admitted to hospital than in controls (77%) and there were suggestions of improvement in the intervention group on secondary measures : intention-to-breastfeed, maternally reported child cognitive development (at 24 months only), language development, levels of social support, partner-relationship quality, and general self-efficacy. Rates of child safeguarding concerns documented in primary care records were higher for FNP clients. Many more secondary outcome measures were evaluated and showed no differences.

The study concluded that the addition of FNP to usual care gave no added short term benefit. On the basis of short term evaluation, the continuation of the programme could not be justified.

These findings were very different to the intervention in United States which showed many benefits. However young mothers in the U.S do not have access to the wide array of support systems available as part of usual care in the UK. This may explain why differences between intervention and non intervention arms in the UK were minimal.

Full details of the Trial are available

Alison Kemp

Professor of Child Health and Honorary Consultant Community Paediatrician, Cardiff University School of Medicine and Cardiff and Vale UHB

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