evaluating the family nurse partnership in england: a randomised controlled trial south east wales...
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Evaluating the Family Nurse Partnership in England: a randomised controlled trial
South East Wales Trials Unit, Cardiff University
Dr Julia SandersConsultant Midwife / Senior Project Manager
Family Nurse Partnership Programme
Who are Family Nurses?
• Registered Nurses or Midwives
• Health Visitors• School Nurses
• Additional training programme
• Central team at Department of Health
Family Nurse Partnership Programme
• A structured, intensive home visiting programme delivered by Family Nurses to pregnant teenagers
• Programme runs through pregnancy and until baby’s second birthday.
• Licensed programme developed and tested in the USA with fidelity measures to ensure replication of original research
Visiting Schedule
• 1/week first month
• Every other week during pregnancy
• 1/week first 6 weeks after delivery
• Every other week until 21 months
• Once a month until age 2
Content of visits 6 domains
• Personal health – women’s health practices and mental health
• Environmental health – adequacy of home and neighbourhood
• Life course development – women’s future goals• Maternal role – skills and knowledge to promote health
and development of their child• Family and friends – helping to deal with relationship
issues and enhance social support• Health and human services – linking to other services
7
FNP GOALS1. Improve pregnancy
outcomes
2. Improve child health and development and future school readiness and achievement
3. Improve parents’ economic self-sufficiency
8
FNP Structure1. Small teams of
Family Nurses (max 6)
2. A FNP supervisor to each team
3. Training and supervision provided directly by DoH
US trials of NFP
N = 400
Low-income whites
Semi-rural
N = 1,138
Low-income blacks
Urban
Elmira, NY
1977
Memphis, TN
1987
Denver, CO
1994
N = 735
Large portion of Hispanics
Nurse v para-professional
visitors
• Improvements in women’s antenatal health
• Reductions in children’s injuries
• Fewer subsequent pregnancies
• Greater intervals between births
• Increases in fathers’ involvement
• Increases in employment • Reductions in welfare and
food stamps• Improvements in school
readiness
Consistent positive effects across at least two trials
Sept 2006: Action Plan for Social Exclusion - proposal for 10 test sites of NFP
£30M support allocated (2008-9 to 2010-11)
Pilot running from March 2007 (10 sites): evaluation reported July 2008
US NFP adapted for English setting – Family Nurse Partnership
18 new sites invited to apply to be part of RCT – selected March 2008
Developing the Family Nurse Partnership In England
Family Nurse PartnershipAn introductory DVD
Overview of Trial Design
Overview of the Trial
Design: • Individually randomised controlled trial
Participants: • 2400 women aged 19 or under, recruited to RCT by
24 weeks and expecting first child
Randomisation: • Following baseline assessment by automated
telephone allocation • Stratification by site, gestation, smoking status and
language of data collection
Trial Sites• Barnsley• Cornwall • Coventry• Cumbria• Derby City• Berkshire East• Hull• Lambeth • Leeds• Liverpool• Manchester• Northamptonshire• South Birmingham• Southwark• Sunderland • South East Essex• Tower Hamlets • Walsall
Eligibility Criteria
Women will be included if they:
Are aged 19 or under Live within the catchment area covered by the local FNP team Are expecting their first child (women whose previous pregnancy ended in
miscarriage, stillbirth or termination are eligible for the trial) Can be recruited at no later than 24 weeks gestation Are Gillick competent to provide adequate informed consent to research
participation (including competence in English at conversational level or higher).
But excluded if they: Plan to have their child adopted Plan to leave the FNP area during the time of the trial either for 3+ months Women who would require an interpreter to receive the FNP programme
Outcome domain
•Changes in prenatal tobacco use (maternal measure)
•Birth weight (child measure)
Pregnancy & birth
Child health & development
Maternal life course and economic self-sufficiency
•Emergency attendances / admissions within two years of birth
•Proportion of women with a second pregnancy within two years of first birth
•Intention to breastfeed•Prenatal attachment
•Injuries & ingestions•Breast feeding (initiation & duration)
•Language development
•Education•Employment•Health status•Social supportPaternal involvement
Primary Secondary
Overview of the TrialStudy Outcomes
Executive Management Group
Lead applicant: Mike RoblingSnr Project Mgr: Julia SandersCo-applicants: Chris Butler
Alison KempJoyce KenkreAlan MontgomeryKate PickettDavid Torgerson
WP managers: Eleri Owen-JonesRia PooleEconomist (tbc)
Dir, SEWTU: Kerry Hood
Progress Update
Ethics
MREC Approval granted
Global Governance Checks completed
Contracts R & D
Required with 41 PCTs and NHS Trusts
Eight variations have been required to cover different models of working
Researchers
Being employed by CLRNs, Trusts, PCTs, Joint Trusts
Recruitment
500 + women recruited to date
Project Timetable
• Train local researchers (From May 2009)• Recruit / randomise participants (June 2009 – Feb 2010)• 34 -36 urine collection
• Consultation recordings (Jul 2009 – Jun 2012)• Initial Service Mapping Interviews (Oct 2008 – Jun 2009)• Focus groups (Feb 2010 – Aug 2010 / Dec 2011 – Jun 2012)• 2 year FUP interview (Aug 2011 – Jun 2012)
• Reporting Jan 2013
Katy Addison, Study Administrator 029 2068 7617 [email protected]
South East Wales Trials Unit, Cardiff University,7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS
Dr Eleri Owen-Jones, Trial Manager 029 2068 7601
Dr Julia Sanders, Midwife & Senior Project Manager 029 2068 7623
Dr Mike Robling, Chief Investigator 029 2068 7177
www.cf.ac.uk/medic/buildingblocks
Research team details