The feasibility of delivering Group Family Nurse Partnership

PURPOSE: To evaluate the feasibility of delivering the Group Family Nurse Partnership (gFNP) programme, combining elements of the Family Nurse Partnership programme and Centering Pregnancy and offered from early pregnancy to 12 months postpartum to mothers under 25. DESIGN/METHODOLOGY: A mixed method descriptive feasibility study. Quantitative data from anonymised forms completed by nurses from November 2009 to May 2011 (pilot 1) and January 2012 to August 2013 (pilot 2) reporting referrals, attendance and client characteristics. Qualitative data collected between March 2010 and April 2011 (pilot 1) and November 2012 and November 2013 (pilot 2) from semi-structured interviews or focus groups with clients and practitioners. FINDINGS: There were challenges to reaching eligible clients. Uptake of gFNP was 57% to 74%, attendance ranged from 39% to 55% of sessions and attrition ranged from 30% to 50%. Clients never employed attended fewest sessions overall compared to those working full time. The group format and the programme’s content were positively received by clients but many struggled to attend regularly. FNP practitioners were positive overall but involving community practitioners (pilot 2) placed more stress on them. RESEARCH IMPLICATIONS: Further feasibility and then cost and effectiveness research is necessary to determine the optimal staffing model. PRACTICAL IMPLICATIONS: The content and style of support of the home-based FNP programme, available only to first time mothers under 20, could be offered to women over 20 and to those who already have a child. Social implications A range of interventions is needed to support potentially vulnerable families. ORIGINALITY/VALUE: This new complex intervention lacks evidence. This paper documents feasibility, the first step in a thorough evaluation process. Keywords: Group support, pregnancy, early infancy, nurses, parent-child relationship

Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study.

INTRODUCTION: Almost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation. METHODS AND ANALYSIS: We will construct a retrospective cohort of all women aged 13-24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education). ETHICS AND DISSEMINATION: The Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers

Using linked administrative data for monitoring and evaluating the Family Nurse Partnership in England: A scoping report

This report, commissioned by the FNP National Unit and undertaken by researchers at UCL and the London School of Hygiene and Tropical Medicine, presents a scoping review of how population-based linkage between data from the Family Nurse Partnership (FNP) in England and administrative datasets from other services could be used to generate evidence for commissioning, service evaluation and research. It addresses the methodological considerations, permission pathways and technical challenges of using data from the FNP linked with routinely collected, administrative data from other public services for population-based analyses, at a national and local authority level. Our ambition, when commissioning this work, was to explore whether linking data from FNP with administrative datasets might help provide a richer view about how the FNP intervention is affecting different cohorts of clients and their child after they have graduated. The report suggests that the potential for data linkage to support ongoing evaluation of a wide range of interventions including FNP at a national level is promising and an important area to explore. It makes a significant contribution to understanding the possibilities and constraints for doing this, which include barriers to data linkage at a local level (which we know is crucial for local commissioners) and the significant investment required to realise the potential of this project. We believe this report offers valuable insights other organisations interested in the delivery of evidence based policy may want to pursue

Issues emerging from the first 10 pilot sites implementing the Nurse-Family Partnership home-visiting programme in England

"Issues emerging from the first 10 pilot sites implementing the FNP home-visiting programme in England" builds on those previously published, and identifies national and local system contributions to effective delivery of FNP, the emerging expertise of FNP practitioners and the influence of FNP practice on universal service provision

Characteristics of enrolment in an intensive home-visiting programme among eligible first-time adolescent mothers in England: a linked administrative data cohort study

Background: Intensive home visiting for adolescent mothers may help reduce health disparities. Given limited resources, such interventions need to be effectively targeted. We evaluated which mothers were enrolled in the Family Nurse Partnership (FNP), an intensive home-visiting service for first-time young mothers commissioned in >130 local authorities in England since 2007. Methods: We created a population-based cohort of first-time mothers aged 13–19 years giving birth in English National Health Service hospitals between 1 April 2010 and 31 March 2017, using administrative hospital data linked with FNP programme, educational and social care data. Mothers living in a local authority with an active FNP site were eligible. We described variation in enrolment rates across sites, and identified maternal and FNP site characteristics associated with enrolment. Results: Of 110 520 eligible mothers, 25 680 (23.2% (95% CI: 23.0% to 23.5%)) were enrolled. Enrolment rates varied substantially across 122 sites (range: 11%–68%), and areas with greater numbers of first-time adolescent mothers achieved lower enrolment rates. Mothers aged 13–15 years were most likely to be enrolled (52%). However, only 26% of adolescent mothers with markers of vulnerability (including living in the most deprived areas and ever having been looked after as a child) were enrolled. Conclusion: A substantial proportion of first-time adolescent mothers with vulnerability markers were not enrolled in FNP. Variation in enrolment across sites indicates insufficient commissioning of places that is not proportional to level of need, with mothers in areas with large numbers of other adolescent mothers least likely to receive support