The Family Nurse Partnership (FNP) programme in has been developed from over 35 years of extensive US research, including three large-scale randomised control trials (RCTs), the most rigorous way of determining whether a cause-effect relationship exists.

These trials have tested the US programme, the Nurse-Family Partnership (NFP) with diverse populations in different contexts in Elmira, New York (1977), Memphis, Tennessee (1988) and Denver, Colorado (1994). All three studies tracked families from pregnancy through to adulthood, and in the case of Elmira, observed how children benefitted up to the age of 28. This research has shown consistent improvements to the lives of children and mothers. It has:

  • Improved pregnancy health and behaviours
  • Reduced child abuse and neglect
  • Improved school readiness
  • Increased maternal employment and economic self sufficiency
  • Reduced closely spaced subsequent pregnancies.

US research has also shown significant returns on investment to Government and to wider society.

Better outcomes for mothers

FNP aims to improve pregnancy outcomes by supporting mothers-to-be to make informed choices about healthy pregnancy behaviours, as well as improving the future life course of young mothers, by supporting them to make changes to their lives and providing them and their babies with a better future.

Better pregnancy outcomes

Improved outcomes during pregnancy observed in the US trials include:

  • Decreases in cigarette smoking during pregnancy [1, 2]
  • Fewer hypertensive disorders of pregnancy and fewer pregnancy related infections [1]
  • Improvements in prenatal diets. [3]

Improved life course

Specific benefits to mother’s life course observed in the US trials include:

  • Fewer subsequent pregnancies and births and greater intervals between first and second babies [2,3,4]
  • Greater maternal employment [5]
  • Reductions in use of welfare and other government assistance [4, 6, 7]
  • 61% fewer arrests and 72% fewer convictions of mothers by the time their child is aged 15 [4]
  • More stable relationships with partners and with their child’s father. [7]

Reduced domestic abuse

Evidence the US and the Netherlands suggests FNP is effective in helping prevent and reduce domestic abuse, both for the mother as a victim and perpetrator. [8] This includes psychological, physical assault and sexual abuse during pregnancy, and physical assault by the time the child is two years old. [9]

 

Better outcomes for children

Reduced child neglect and abuse

Reduced child abuse, neglect, and resultant child injuries are the most consistent benefits of the NFP programme. The programme is frequently cited as one of the most effective programmes for preventing child abuse and neglect [16] as evidenced by reductions in both verified child abuse and neglect and in health care encounters for child injuries. More specifically, the US RCTs of NFP found:

  • 48% reduction in verified cases of child abuse and neglect by the time the children were aged 15 [4]
  • 56% reduction in A&E attendances for injuries and ingestions during child’s second year of life [10]
  • 28% relative reduction in all types of health care encounters during child’s first two years of life [3]
  • 79% relative reduction in the number of days that children were hospitalised with injuries or ingestions in child’s first two years of life. [3]

Improved school readiness

The US research trials show that the NFP improves children’s readiness for school, notably those from at risk backgrounds. Children of families who benefitted from NFP had better early language and cognitive development, and scored higher on school achievement tests than similar children who do not receive the programme. These important early outcomes are associated with improved school performance and increased earnings in adulthood.

Specifically, NFP children had:

  • 50% reduction in language delay at 21 months [2]
  • Better academic achievement in the first six years of elementary school (low resource mothers) [11]
  • Better language and emotional development at age 4 (low resource mothers) [12].

Improved emotional and behavioural development

Research from the US shows that NFP children had better emotional and behavioural development, including less early risk taking behaviours (such as substance abuse), than their control group counterparts. More specifically, NFP children had:

  • 67% reduction in behaviour and emotional problems at age six [1]
  • 28% reduction in 12 year olds mental health (anxiety and depression) problems [2]
  • 67% reduction in 12 year olds use of cigarettes, alcohol and marijuana [3]
  • 59% reduction in child arrests at age 15.
Significant returns on investment

Independent studies from the US show that delivering the FNP programme results in significant financial benefits to participants, the public purse and wider society. Economic benefits increase over time as the children get older, but there are indications that the cost of the programme is recovered by the time the children are aged four for the highest risk families and certainly by age 12. [7, 13, 14, 15]

In the US, financial return estimates vary between $3 - $5 for every $1 invested by the time the children reach adulthood, depending on the target group and the scope of the benefits taken into account. [7, 13, 14] A 2012 study by Washington State Institute for Public Policy estimated long-term benefits of almost $23,000 per participant. [13]

Findings from the Memphis trial showed that NFP saved the government substantial amounts in welfare payments alone with $12,300 saved per family between the child being born and reaching 12 years old. [7]

The Dartington Social Research Unit have translated the Washington State methodology and US evidence into an English context to estimate the potential savings from FNP in England.

Internationally recognised evidence base

FNP has an internationally-recognised evidence base, and is accredited by research organisations such as the Coalition for Evidence-Based Policy, Blueprints for Healthy Young Development and the National Academy of Parenting Research.

The FNP programme has also been rated as having the highest level of effectiveness by the National Academy of Parenting Research at King’s College in their Parenting Programmes Commissioning ToolKit.

The Coalition for Evidence-Based Policy rates FNP as the only early childhood programme as having ‘top tier’ evidence – 'interventions shown in well-designed and implemented RCTs, preferably conducted in typical community settings, to produce sizeable, sustained benefits to participants and/or society.'

FNP has also been:

  • Identified as the most effective home visiting programme in an independent review for the US Government’s Department of Health and Human Services, highlighting it had 64 positive effects across seven different domains, many of which were long lasting.
  • Approved as a proven programme by Blueprints for Healthy Youth Development, one of the leading ‘what works’ databases of programmes that work in improving children and young people’s outcomes.
  • Identified by MacMillian and colleagues as the strongest of one of only two programmes proven to prevent child abuse and neglect. [16]
References

[1] Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16.

[2] Olds DL, Robinson J, O'Brien R, Luckey DW, Pettitt LM, Henderson CR Jr., Ng RK, Sheff KL, Korfmacher J, Hiatt S, Talmi A. (2002) Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics 2002: 110(3):486-496.

[3] Kitzman H, Olds DL, Henderson CR Jr, Hanks C, Cole R, Tatelbaum R, McConnochie KMSidora K, Luckey DW, Shaver D, et al. (1997) Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. Journal of the American Medical Association Aug 27;278(8):644-52.

[4] Reanalysis of Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA: The Journal of the AmericanMedical Association, 278(8), 637–643.

[5] Olds, D. L., Henderson, Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the lifecourse development of socially disadvantaged parents: A randomized trial of nurse home visitation. American Journal of Public Health, 78, 1436–1445.

[6] Kitzman, H., Olds, D. L., Sidora, K., Henderson, C. R., Hanks, C., Cole, R., et al. (2000). Enduring effects of nurse home visitation on maternal life course: A 3-year follow-up of a randomized trial. JAMA: The Journal of the American Medical Association, 283(15), 1983–1989.

[7] Olds, D. L. Kitzman, H. J., , Cole, R.E. et al (2010) Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Maternal Life Course and Government Spending – Follow up of a Randomized Trial Among Children at Age 12. Arch Pediatr Adolesc Med. 2010;164 (5):419-424.

[8] Eckenrode J, Ganzel B, Henderson, Jr CR & et al. Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. JAMA 284, 1385–1391 (2000).

[9] Mejdoubi, J. et al. Effect of Nurse Home Visits vs. Usual Care on Reducing Intimate Partner Violence in Young High-Risk Pregnant Women: A Randomized Controlled Trial. PLoS ONE 8, e78185 (2013).

[10] Olds, D. L., Henderson Jr., C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65–78.

[11] Kitzman, H. J., Olds, D.L., Cole, R.E. et al (2010) Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Children – Follow up of a Randomized Trial Among Children at Age 12. Arch Pediatr Adolesc Med. 2010;164 (5):412-418.

[12] Olds DL, Robinson J,; Luckey DW, Pettitt LM; Holmberg J; Ng RK; Isacks K; Sheff KL; Henderson CR Jr. (2004) Effects of Home Visits by Paraprofessionals and by Nurses: AgeFour Follow-up Results of a Randomized Trial Pediatrics; 114(6):1560-8.

[13] Lee, S., Aos, S., Drake, E. Pennucci, A., Miller, M., & Anderson, L. (2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-02-1201). Olympia: Washington State Institute for Public Policy.

[14] Karoly, Lynn A., Peter W. Greenwood, Susan S. Everingham and others. 1998. Investing in Our Children. Santa Monica, Calif.: RAND Corporation.

[15] Olds, D.L., Henderson, C.R. Jr, Phelps, C., Kitzman, H., & Hanks, C. (1993). Effect of prenatal and infancy nurse home visitation on government spending. Medical Care, 31(2), 155-74.

[16] MacMillan, H.L., Wathen, C.N., Barlow, J., Fergusson, D., Leventhal, J.M. and Taussig, N. (2009) Interventions to prevent child maltreatment and associated impairment. Lancet 373:250-266.