Family Nurse Partnership called into question

The Department of Health’s Family Nurse Partnership (FNP), which helps first-time teenage mothers in England, shows little benefit over usual care and is not cost-effective, according to new Cardiff University research published in The Lancet.

Healthcare's Dr Julia Sanders, Reader in Midwifery and Professor Lesley Lowes are members of the Building Blocks Study team who evaluated the effectiveness and cost effectiveness of the Family Nurse Partnership programme.

“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,”  according to Dr Michael Robling, School of Medicine, who led the research.

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

The FNP programme was developed in the USA over 35 years ago and was adapted for use in England on the basis that there was evidence to suggest that mothers who received the programme had better prenatal health, fewer and less closely-spaced subsequent pregnancies, and increased employment.

Longer term benefits were also seen: their children appeared to do better at school, were less likely to be involved in youth crime, and had fewer accidents and mental health problems.

Beginning in 2009, the Building Blocks trial enrolled women aged 19 or younger and expecting their first baby from 18 sites across England. Women were randomly assigned to FNP consisting of up to 64 structured home visits during pregnancy until the child’s second birthday, plus usual care from health and social services (823 women) or usual care alone (822).

To measure the success of the programme, Dr Robling and colleagues looked at smoking by mothers at the end of pregnancy, birthweight, subsequent pregnancies, emergency hospital attendances and admissions up to the child’s second birthday and other markers of child wellbeing and maternal life course.

The researchers found that adding the FNP programme to existing health care services offered no additional short-term benefits to the main measured outcomes: the proportion of women who smoked at the end of pregnancy did not differ between the groups (56% in both groups); average birthweight was similar (3,217g in the FNP group vs 3,197g in the usual care group); the proportion of children attending or being admitted to hospital in an emergency were similar (81% in FNP vs 77% in usual care); and neither FNP or usual care were effective in preventing a subsequent pregnancy, with two-thirds of women in both groups having another pregnancy within two years of their first child.

Dr Robling said: “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 £1,993 per mother.

“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.”

The full trial report and Lancet publication can be found online.