Specialist home visiting improves school readiness and learning but does not reduce abuse and neglect by Key Stage 1 new research by Cardiff reveals

A new report led by Cardiff researchers released today by NIHR provides new insight into how specialist home visiting can support families. The Family Nurse Partnership provides intensive support to teenage mothers expecting their first child with a programme of home visits that may extend up to the child’s second birthday.

The new report funded and published by NIHR Public Health Research programme shows how children of families with specialist nurse support perform better on national tests of school readiness at aged four years (Early Years Foundation Stage Profile) and also score higher on reading at Key Stage 1 when children are aged 6 to 7 years old.

However, for other key measures the programme made no difference by aged 7 years, in particular rates at which children were referred to social services or assessed as in need of additional support.

Chief investigator, Professor Mike Robling, the Director of Population Health at Cardiff University’s Centre for Trial Research said ‘the study significantly extends our understanding about how the FNP programme supports families in the UK. Before, we knew what the likely short-term benefits were but we know have a clearer understanding of the longer-term impact of the programme for some of the most vulnerable families in our community’.

‘Children from families visited by Family Nurses exhibited a better all-round level of school readiness in their reception year. By the time the same children had reached key stage 1, they were still doing better of teacher-assessed measures of reading. There is clearly an enduring impact of the early support they received. This raises the hope of an even longer-term beneficial impact for these children’s life chances.’

‘Nevertheless, there was no evidence of programme impact upon outcomes indicative of abuse or neglect, a key programme goal. The results therefore present a mixed picture and policy makers will want to take in account their own priorities in deciding how this evidence informs future developments in supporting families.’

The key findings are:

When comparing families in receipt of specialist home visiting and those who did not:

• There were no differences in rates of children referred to social services, being registered as in need of additional support, receiving a child protection plan or entering care.
• There were no differences in rates of children attending or being admitted to hospital for injuries or having swallowed something, nor in how long they stayed in hospital if admitted.
• Children from families visited by a Family Nurse were more likely to achieve a good level of development at reception age. This effect was strengthened when we accounted for child’s month of birth.
• There were no statistically significant differences on educational measures at Key Stage 1. However, when we adjusted for a child’s month of birth, families visited by a Family Nurse were more likely to reach the expected standard in reading.

The report recommends:

• Where FNP remains locally commissioned, these new study results may inform client prioritisation
• Why the programme appears to address some but not all of its intended outcomes needs to be further explored. This should take into account how its implementation in a UK setting has differed from its US origin and also recent adaptations introduced in England
• Whether the benefits observed for children in their school life extend to their later school years should be assessed and the existing cohort of families remains well placed to achieve this

Further information

Background: The Cardiff team led by Professor Mike Robling conducted the original Building Blocks trial of the Family Nurse Partnership which followed over 1600 families in England until children were aged 2 years old. The study was funded by NIHR Policy Research Programme and reported its main results in 2016. This showed few benefits for the programme upon maternal and child outcomes but with some indicative benefits for maternally-reported cognitive and language outcomes.

The newly reported study has involved following the same families until children were age 6 to 7 years old (ie to Key Stage 1 assessments). This has been achieved using a novel model of linking together the original trial records with health, education and social care data and using a trusted third-party data safe haven. This has meant that a very high proportion of families have been successfully followed up reducing bias in the current analysis.

This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. www.nihr.ac.uk/patientdata