Evaluation of the Family Nurse Partnership Scotland: A Natural Experiment Approach

A new report on the Family Nurse Partnership (FNP), which aims to help first-time young mothers and their children in Scotland, shows positive results for mothers and babies in areas such as breastfeeding rates, child exposure to second-hand smoking, developmental concerns and child dental registrations, according to a new study by Cardiff University.

Dr Rebecca Cannings-John and Professor Mike Robling, Centre for Trials Research, co-led the evaluation of the FNP programme in Scotland. The study, funded by the Scottish Government, compared outcomes in women enrolled into FNP (Clients) with mothers eligible for FNP but with an antenatal booking date outside of FNP recruitment periods (Controls). It used routine administrative data sets across health, education and social work and examined a wide range of outcomes across the maternal life course and health and wellbeing of the child up to the age of 5 years.

The FNP programme offers intensive home visiting from a specialist nurse for women aged 19 and under (and eligible 20-25 year olds) expecting their first child, from early pregnancy until their child’s second birthday. The programme’s main goals are to improve pregnancy outcomes, children’s health and development, and parents’ economic stability. The Nurse Family Partnership (NFP) programme was developed in the USA and is available across more than 40 states and provides a service to over 60,000 families annually. The programme was formally adapted for use under license in the UK using the term FNP.

The researchers found that the FNP programme offered no short- and mid-term benefits to the majority of measured outcomes. However, women in the FNP group, were statistically more likely to be breastfeeding at 10-14 days and 6-8 weeks post-partum compared to Controls. Children born to women in the FNP group were more likely to be registered with a dentist by 24-months old, and less likely to be recorded with a new child development concern by 27-30 months compared to Controls. The trend in rates of children exposed to second-hand smoke in FNP Clients was significantly different to that observed in Controls, with a greater reduction in exposure to second-hand smoke seen earlier in FNP (between 10-14 days and 6-8 weeks) compared to Controls (between 6-8 weeks and 27-30 months).

Commenting on the results, Dr Cannings-John said: “While we found statistically significant differences between FNP Clients and Controls for five outcomes, there was no statistically significant differences for 34 other outcomes assessed. Accessing routine data was a real strength of the study, enabling us to evaluate programme impact on a large number of families. We recognise though that other outcomes of relevance to FNP could not be assessed but remain of importance.”

Professor Robling added: “The commissioning of the study by the Scottish Government shows the value being placed on evaluating policy innovation to improve life chances for children. These new results provide insights to inform any further policy development in Scotland and add to a broader understanding of how such specialist support may work in the United Kingdom.”

Public Health Minister Jenni Minto said: “The Scottish Government appreciates that the youngest parents and their children are more likely to face adversity and inequality. That is why, the Family Nurse Partnership supports young, first-time mothers to prepare for parenthood and throughout the first two years of their child’s life. The programme is tailored to meet the specific needs of young parents.”

"We welcome the Cardiff University ‘s report into Family Nurse Partnership Programme in Scotland that shows positive results for the supported mothers and babies in areas such as breastfeeding rates and reducing passive smoking, uptake in dental registrations and earlier identification of developmental concerns. This is testament to the hard work of the family nurses, and clearly shows the benefits of supporting families from pre-birth to early childhood, focussed on earlier intervention.

“Recognising that these families are more likely to experience child poverty, we have recently increased the reach of this programme to older first-time mothers up to 25, including those who are Care Experienced.”

This work builds on previous evaluations carried out by the same research team. The Building Blocks trial followed over 1600 families in England up until the child’s second birthday. Half the families received additional support from a specially trained family nurse whereas the other half received usually provided health and social care alone. The trial showed that FNP offered little benefit over usual care and was not cost-effective when outcomes to age 2 were assessed. The evaluation continued with BB:2-6; using the existing trial cohort linked to routine data to determine whether the programme improved outcomes for mothers and children up to around the child’s 6^th birthday. FNP had a clear impact upon some important outcomes but not on others. Children in receipt of FNP did better in their reception year and were also more likely to reach the expected level of development for reading at Key Stage 1. Other studies of early years programmes including FNP have shown longer term benefits through to adolescence (e.g., Sure Start), however the majority of children in receipt of FNP in the UK have not yet reached that life stage.

The full study report can be found here.