Randomized controlled trial and economic evaluation of nurse-led group support for young mothers during pregnancy and the first year postpartum versus usual care

Barnes, Jacqueline; Stuart, Jane; Allen, Elizabeth; Petrou, Stavros; Sturgess, Joanna; Barlow, Jane; Macdonald, Geraldine; Spiby, Helen; Aistrop, Dipti; Melhuish, Edward; Kim, Sung Wook; Elbourne, Diana

doi:10.1186/s13063-017-2259-y

Cited by 21 publications

(40 citation statements)

References 28 publications

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“…The absence of evidence for the effectiveness of the current intervention program in high-risk adolescent mothers in Germany is also in line with recent RCTs (Barnes et al, 2017; Robling et al, 2016) in other countries. An intervention for adolescent mothers, which has previously shown to be effective in adolescent mothers in the United States to enhance parental care (Olds, Henderson, Chamberlin, & Tatelbaum, 1986), was not effective in the UK for reducing child maltreatment risk or enhancing parental caregiving behaviors in this high-risk group.…”

Section: Discussionsupporting

confidence: 63%

A mother–child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study)

et al. 2020

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Abstract Children of adolescent mothers are a high-risk group for negative child development. Previous findings suggest that early interventions may enhance child development by improving mother–child interaction. The purpose of the current study was to evaluate a mother–child intervention (STEEP-b) program in high-risk adolescent mother–infant dyads (N = 56) within a randomized controlled trial (RCT). Mother–child interaction was assessed at baseline (T1), postintervention (T2), and follow-up (T3). The primary outcome was the change in maternal sensitivity and child responsiveness from T1 to T2 that was measured by blinded ratings of videotaped mother–child-interaction with the Emotional Availability Scales. A modified intention-to-treat analysis was performed to examine the data. No intervention effect was found for maternal sensitivity, 95% CI [-0.59–0.60], p = .99, and child responsiveness, 95% CI [-0.51–0.62], p = .84. Maternal sensitivity and child responsiveness did not change over time in both groups (all ps > .05). A statistically nonsignificant, but potentially clinically meaningful difference emerged between rates of serious adverse events, SC: 4 (14.8%), STEEP-b: 1 (3.4%), possibly driven by different intensity of surveillance of dyads in the treatment groups. The current findings question the effectiveness of STEEP-b for high-risk adolescent mothers and do not justify the broad implementation of this approach.

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Section: Discussionsupporting

confidence: 63%

A mother–child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study)

et al. 2020

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“…18,19 An implementation evaluation reported progress in the delivery of the programme in 10 test sites. 20 The differing pattern of service provision and sociocultural context meant that the relative costs and benefits of the programme needed to be replicated in England before widespread implementation could be recommended. This was an explicit licensing requirement of the programme, and the stimulus for the BB:0-2 trial (ISRCTN23019866) of the FNP.…”

Section: Specialist Home Visiting: the Family Nurse Partnershipmentioning

confidence: 99%

“…25 A trial assessing the effectiveness and cost-effectiveness of group FNP in England to reduce risk factors for maltreatment found no differences for child abuse potential and parent-infant interaction at 12 months. 20 Pro Kind is a German adaptation of the NFP; it was trialled between 2006 and 2012 with 755 first-time mothers. 28 A current study to evaluate the medium-term impact of Pro Kind (to age 7 years) will assess maltreatment by parental self-report and also assess child development and school achievement.…”

Section: Other Evaluations Of the Nurse-family Partnershipmentioning

confidence: 99%

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

et al. 2021

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Background The short-term effectiveness (to 24 months post partum) of a preventative home-visiting intervention, the Family Nurse Partnership, was previously assessed in the Building Blocks trial (BB:0–2). Objectives The objectives were to establish the medium-term effectiveness of the Family Nurse Partnership in reducing maltreatment and improving maternal health (second pregnancies) and child health, developmental and educational outcomes (e.g. early educational attendance, school readiness); to explore effect moderators and mediators; and to describe the costs of enhancing usually provided health and social care with the Family Nurse Partnership. Design Children and their mothers from an existing trial cohort were followed up using routine data until the child was 7 years of age. Setting This study was set in 18 partnerships between local authorities and health-care organisations in England. Participants The participants were mothers [and their firstborn child(ren)] recruited as pregnant women aged ≤ 19 years, in local authority Family Nurse Partnership catchment areas, at < 25 weeks’ gestation, able to provide consent and able to converse in English. Participants mandatorily withdrawn (e.g. owing to miscarriage) from the BB:0–2 trial were excluded. Interventions The intervention comprised up to a maximum of 64 home visits by specially trained family nurses from early pregnancy until the firstborn child was 2 years of age, plus usually provided health and social care support. The comparator was usual care alone. Main outcome measures The primary outcome measure was child-in-need status recorded at any time during follow-up. The secondary outcomes were as follows: (1) referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions at any time during follow-up; (2) early child care and educational attendance, school readiness (Early Years Foundation Stage Profile score) and attainment at Key Stage 1; and (3) health-care costs. Data sources The following data sources were used: maternally reported baseline and follow-up data (BB:0–2), Hospital Episode Statistics data (NHS Digital), social care and educational data (National Pupil Database) and abortions data (Department of Health and Social Care). Results There were no differences between study arms in the rates of referral to social services, being registered as a child in need, receiving child protection plans, entering care or timing of first referral for children subsequently assessed as in need. There were no differences between study arms in rates of hospital emergency attendance, admission for injuries or ingestions, or in duration of stay for admitted children. Children in the Family Nurse Partnership arm were more likely to achieve a good level of development at reception age (school readiness), an effect strengthened when adjusting for birth month. Differences at Key Stage 1 were not statistically different, but, after adjusting for birth month, children in the Family Nurse Partnership arm were more likely to reach the expected standard in reading. Programme effects were greater for boys (Key Stage 1: writing); children of younger mothers (Key Stage 1: writing, Key Stage 1: mathematics); and children of mothers not in employment, education or training at study baseline (Key Stage 1: writing). There were no differences between families who were part of the Family Nurse Partnership and those who were not for any other outcome. The differences between study arms in resource use and costs were negligible. Limitations The outcomes are constrained to those available from routine sources. Conclusions There is no observable benefit of the programme for maltreatment or maternal outcomes, but it does generate advantages in school readiness and attainment at Key Stage 1. Future work The trajectory of longer-term programme benefits should be mapped using routine and participant-reported measures. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.

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“…The primary outcome effects of most studies were non‐significant, as were the effects on QALYs, with the exception of one trial on the effectiveness of cognitive therapy for PTSD (Shearer et al., 2018). In four trials, negative QALY effects were found (Anderson et al., 2014; Barnes et al., 2017; Goodyer et al., 2017; Sayal et al., 2016). It is difficult to see the relevance of a cost–utility analysis in the absence of a QALY gain of the intervention, except maybe when a small negative effect is outweighed by much lower expenses compared to care as usual.…”

Section: Child and Adolescent Mental Health Economics In Practicementioning

confidence: 99%

Problematic cost–utility analysis of interventions for behavior problems in children and adolescents

IJzendoorn

Bakermans‐Kranenburg

2020

New Directions for Child and Adolescent Development

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Cost-utility analyses are slowly becoming part of randomized control trials evaluating physical and mental health treatments and (preventive) interventions in child and adolescent development. The British National Institute of Health and Care Excellence, for example, insists on the use of gains in Quality Adjusted Life Years (QALYs) to compute the "value for money" of interventions. But what counts as a gain in quality of life? For one of the most widely used instruments, the EuroQol 5 Dimensions scale (EQ-5D), QALYs are estimated by healthy individuals who provide utility scores for specific health states, assuming that the best life is a life without self-experienced problems in five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The worst imaginable outcome is defined as "a lot of problems" in each of these five domains. The impact of the individual's problems on the social network is not weighted, and important social-developmental domains (externalizing problems, social competence) are missing. Current costutility computations based on EQ-5D favor physical health over mental health, and they rely on adult weights for child and adolescent quality of life. Thus, a level playing field is absent, and developmental expertise is sorely missing. K E Y W O R D S cost-utility analysis, interventions, children, mental health, Quality Adjusted Life-Years (QALY), EuroQol 5 Dimensions scale (EQ-5D), critical review This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Randomized controlled trial and economic evaluation of nurse-led group support for young mothers during pregnancy and the first year postpartum versus usual care

Cited by 21 publications

References 28 publications

A mother–child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study)

A mother–child intervention program for adolescent mothers: Results from a randomized controlled trial (the TeeMo study)

The Family Nurse Partnership to reduce maltreatment and improve child health and development in young children: the BB:2–6 routine data-linkage follow-up to earlier RCT

Problematic cost–utility analysis of interventions for behavior problems in children and adolescents

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