Children of vulnerable teenage mums see early developmental benefits from family nurse intervention

A study conducted by Cardiff University and published in The Lancet today is providing important new evidence on the effectiveness of the Family Nurse Partnership (FNP) in England, an NHS service working to support vulnerable teenage mothers-to-be, pregnant with their first child.

The Building Blocks randomised control trial began six years ago and followed over 1,600 young mothers-to-be until their baby reached two years old. It provides an independent assessment of the effectiveness of FNP between early pregnancy and the child’s second birthday, focusing on four primary outcomes and a range of secondary outcomes.

The trial showed that there were some positive effects on early child development and that FNP may prevent children slipping through the net by identifying safeguarding risks early. It also found that young mothers engaged well with FNP and especially valued the close and trusting relationship that they had with their family nurses. However, its effect on the main short term outcome measures was disappointing.  Notably FNP did not help mothers to stop smoking in pregnancy, nor did the service lower the rates of subsequent pregnancy within two years.

We fully take on board the need to review the effectiveness of FNP in the early stages of the programme, particularly in these areas. However as the study itself concludes, both ‘changes to the intervention’ and ‘positive benefits observed through longer term follow up of the trial cohort’ could ‘shift the evidentiary balance’ in favour of FNP. This warrants adaptation and continued evaluation of this much needed service which is so valued by the population it supports.

Ailsa Swarbrick, Director of the FNP National Unit said: This research has given us valuable new insight into the lives of vulnerable families and into FNP.  We must use this information well.  We are committed to improving outcomes for young families and will act quickly to apply this learning by adapting the way FNP works in this country.  In particular we will work with local authorities, nurses, young parents and other experts to build on the clear strengths of FNP at the same time as ensuring a sharp focus on what works to reduce smoking in pregnancy and to improve pregnancy planning.

“The impact of FNP on early child development is positive and we know the real benefits in this area may only fully emerge as their children get older. The financial return from early intervention comes later in life, often linked to better child development and other longer term measures. This trial helpfully assessed short term cost effectiveness based on maternal health outcomes but a much fuller and longer term view is needed to understand the overall value for money of FNP.”

The FNP National Unit is committed to finding a way to ensure that we can help young families to make changes in their lives, while maintaining the close and trusting relationships family nurses forge with their clients. Smoking during pregnancy is a significant risk to a baby’s health and development, and stopping smoking is a huge challenge for first time teen mothers-to-be.

The trial findings have shone a light on the very high level of vulnerability amongst first time young mothers, whether they were receiving FNP or not, and which we know are associated with increased risk for their child’s life time development:

  • 48% were Not in Education, Employment or Training (NEET)
  • 35% had previously been arrested
  • 46% had been suspended, expelled or excluded from school
  • 56% were smoking in late pregnancy
  • 40% of the young women in the study had experienced domestic violence in the two years after the birth of their child.

These young parents face serious challenges in their lives and this means there are greater risks of poor outcomes for their children who are more likely to fall behind their peers, academically, emotionally and socially. It is imperative to break this cycle and give them the life chances they need and deserve. We know from other countries that the long term impact of this intervention is significant.

 

Notes to editors

  1. For more information or to arrange an interview, please contact Georgie Day, Communications Manager at gday@fnp.nhs.uk or on 07718 575552.

  2. The open access report was published in The Lancet. An executive summary has been published on the Cardiff University website.

  3. The Family Nurse Partnership is an intensive, structured home visiting programme and has been running in England since 2007. A voluntary programme, for first time young mums, aged 19 years or under, a specially trained family nurse visits the young mum regularly from the early stages of pregnancy until their child is two.

  4. The RCT is an independent trial commissioned by Department of Health.  It was led by Cardiff University.

  5. The national delivery of FNP is led by the FNP National Unit which also supports local organisations with implementation. The Unit is led by a consortium of the Tavistock and Portman NHS Foundation Trust, the Social Research Unit at Dartington and Impetus - Private Equity Foundation

  6. For more information visit www.fnp.nhs.uk.