An evaluation of the First Parent Health Visitor Scheme

Abstract

Aims: To assess outcomes in families who received the First Parent Health Visitor Scheme (FPHVS), in comparison with families who received conventional ("generic") health visiting. Methods: Retrospective data on 2113 families were collected during 1986-92 as part of National Health Service (NHS) service provision. Prospective data were collected during 1993-98 on 459 mothers and their children, with outcomes assessed at one year (93% follow up) and two years (80% follow up). Results: There were no differences between the groups of mothers in self esteem, locus of control, or depression rates. The women who received the FPHVS were more likely to have changed partners, but they also had a wider support network than comparison women, and consulted their general practitioner (GP) less often. Breast feeding rates were higher in the FPHVS mothers, who also gave their infants more fruit juice drinks than the comparison group. No differences were apparent in developmental outcome using the Bayley Scales at 1 and 2 years of age. Both height and weight Z scores at 2 years of age were lower in the FPHVS children than the comparison children. Receipt of the FPHVS was associated with increased use of electric socket covers and lower accident rates in the second year of life. No differences were seen in immunisation rates, uptake of child health surveillance, or use of hospital services. A higher proportion of families who received the FPHVS were registered on the local child protection register compared with comparison families. Conclusion: Clustering effects dominated the analysis, but overall this evaluation could not show a clear advantage for the FPHVS over conventional health visiting.T he Child Development Programme (CDP) 1 aims to improve the health and development of young children from deprived backgrounds by offering a programme of parental support, based on the principles of empowerment. The CDP was initiated in 1979 by Dr Walter Barker at the School of Applied Social Studies, University of Bristol, and by the time this evaluation commenced in 1993 the programme had been adopted by 18 NHS (National Health Service) provider units across the UK. One of the most important interventions in the CDP is the First Parent Health Visitor Scheme (FPHVS), in which first time parents from deprived areas are offered a programme of regular home visits by a specially trained health visitor who aims to help, support, and advise the mother during the first phase of parenting. The FPHVS contrasts with the usual pattern of health visiting in targeting first time mothers, emphasising empowerment, and using appropriate written materials, including cartoons.The FPHVS was implemented in three areas of socioeconomic deprivation (two inner city areas and one suburban estate) in the city of Bristol in February 1989. Families receiving the FPHVS in Bristol are visited at home antenatally (in the third trimester), at the statutory primary birth visit, at three weeks postnatally, and then every five weeks until the infant is 8 months old. For ...

Health visitors’ assessments of parent–child relationships: A focus group study

“…The peer group is nevertheless clearly a crucial resource in helping many HVs formulate their difficult cases. Internationally, there have been many initiatives designed to help HVs provide support to families with difficulties in parent-child relationships (for example Barlow et al 2007;Collins & Reinke 1997;Emond et al 2002;Hewitt & Crawford 1988;McIntosh & Shute 2007;Olds 2002;Sanders et al 2003). There are however far fewer reports of how best to target the delivery of these interventions effectively towards those families who could gain most from them, and most of these have been based on simple demographics -for example Olds' seminal work on intensive home visitation was aimed at a target group of mothers who were in their teens, unmarried or living in deprived areas (Olds et al 1998b).…”

The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial

“…Four studies 73,75,81,88 used clustered allocation. Thirteen studies [72][73][74][78][79][80]82,84,85,[88][89][90] [70][71][72]74,75,[77][78][79]81,[83][84][85]90 recruited socioeconomically disadvantaged participants.…”

“…Some authors reported results from the same study at different follow-up time points in separate papers and several authors reported results from the same study in more than one paper. Sixteen [70][71][72]74,[76][77][78]80,[82][83][84][85]87,89,90 (73%) included studies were RCTs, two 73,81 (9%) were non-RCTs, one 86 (5%) was a partially randomised study with two randomised intervention arms and one non-randomised control arm, two 75,88 (9%) were CBA studies and one 79 (5%) was a quasi-RCT. Four studies 73,75,81,88 used clustered allocation.…”

“…Sixteen [70][71][72]74,[76][77][78]80,[82][83][84][85]87,89,90 (73%) included studies were RCTs, two 73,81 (9%) were non-RCTs, one 86 (5%) was a partially randomised study with two randomised intervention arms and one non-randomised control arm, two 75,88 (9%) were CBA studies and one 79 (5%) was a quasi-RCT. Four studies 73,75,81,88 used clustered allocation. Thirteen studies [72][73][74][78][79][80]82,84,85,[88][89][90] [70][71][72]74,75,[77][78][79]81,[83][84][85]…”

“…Seventeen studies [70][71][72][73][74][75][77][78][79][80][81][83][84][85][86]89,90 evaluated multifaceted home visiting programmes aimed at improving a range of child, and often maternal, health outcomes. Three 82,88 evaluated paediatric practice-based multifaceted interventions, aimed at improving a range of child health outcomes, all of which included some home visits.…”