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Scheme to boost teen mums’ parenting skills not worth the money

It’s no better than usual care, and isn’t justified, finds DH-funded study

Caroline White

Wednesday, 14 October 2015

A Department of Health scheme that aims to help first time teen mums with their parenting skills and give vulnerable kids a better start in life is not worth the money and can’t be justified, concludes a government funded study*, published today in the The Lancet.

The Family Nurse Partnership (FNP) programme, which was set up in 2007, is no better than usual care and is a waste of money, say the researchers.

“On the basis of the limited benefit to families seen in the trial, continued provision of the Family Nurse Partnership programme cannot currently be justified in the UK,” says Dr Michael Robling, chief investigator for the Building Blocks trial and Director of the South East Wales Trials Unit at the Centre for Trials Research, Cardiff University.

The FNP programme offers intensive home visiting from a specialist nurse for teenagers expecting their first baby. Its main goals are to improve pregnancy outcomes, boost children’s health and development, and help parents to be financially self-sufficient.

The FNP programme was developed in the USA more than 35 years ago and adapted for use in England on the basis that the evidence suggested that mums in the programme enjoyed better prenatal health, had fewer and less closely-spaced subsequent pregnancies, and were more likely to be in work.

Their kids also seemed to do better at school, were less likely to be involved in youth crime, and had fewer unintentional injuries and mental health issues.

The Building Blocks trial monitored women aged 19 or younger who were expecting their first child at 18 sites across England from 2009 onwards.

Women were either randomly assigned (823) to either the FNP programme, which involved up to 64 structured home visits during pregnancy until the child’s second birthday plus usual care from health and social services, or to usual care alone (822).

The outcomes measured included whether the mums to be were smoking throughout  pregnancy; the child’s birthweight; the numbers and spacing of subsequent pregnancies; A&E attendance and admissions up to the child’s second birthday.

The results showed that adding the FNP programme to existing health care services offered no additional short-term benefits to the main outcomes measured.

The proportion of women who smoked throughout their pregnancy did not differ between the groups (56% in both); average birthweight was similar (3217g in the FNP group vs 3197g in the usual care group); the proportions of children attending hospital in an emergency were similar (81% vs 77%); and neither FNP nor usual care prevented a subsequent pregnancy, with two-thirds of women in both groups becoming pregnant within 2 years of the birth of their first child.

“The results have shown no additional benefit to the mothers who received FNP and, there is a substantial additional cost of the Family Nurse Partnership programme at approximately £1993 per mother,” write the researchers.

“Continued evaluation of families enrolled in the trial will be required to determine whether the programme improves outcomes for mothers and children in the longer term,” they say.

In a linked comment, David Olds of the Department of Pediatrics at the University of Colorado, Denver, writes: “The results of Robling and colleagues’ trial underscore why we cannot simply disseminate programmes without assessing them, and why, to accelerate construction of a solid early-intervention evidence base, we need to ensure that results and insights from previous studies are integrated thoroughly into the designs of new ones.”

*Robling, M et al. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks); a pragmatic randomised controlled trial. The Lancet. Doi:10.1016/S0140-6736(15)00392-X.

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