Effectiveness of Family Nurse Partnership: WAVE Trust comment on National Evaluation
WAVE Trust welcomes the indications of potential positive outcomes for child development in the recently published national evaluation of the Family Nurse Partnership programme. Better cognitive development, language development, relationship quality and fewer maternal depressive symptoms all show apparent impacts of the programme, and these are welcome and important. Further, although the commentary by the authors describes these impacts as ‘small’, a difference in concern about their child’s language development at 12 months of 11.0% in the FNP mothers compared with 19.9% (almost double) in the control group, and concern about cognitive development at 24 months of 8.1% in FNP mothers compared with 12.6% (i.e. more than half as large again) in the control group are not what we would call ‘small’ effects. The researchers emphasise the lack of impact on the four medically-oriented measures which were chosen as their ‘primary’ outcomes, and these are no doubt disappointing to the programme designers.
The focus in the National Health Service on medical and physical aspects of child wellbeing – and relative neglect by the NHS of child mental and emotional health – could explain why an American-designed programme does not out-perform UK ‘business as normal’ in the former – but does do so on some measures of the latter – and it is the latter category of improvement that has the strongest effect on social and economic outcomes for society.
We welcome the recommendation of continued evaluation of the cohort studied over a longer period as this is essential to confirm the potential benefits for child development. The positive effects are maternally reported and need to be validated by more independent measures. However we think the authors’ conclusion that the programme is not value for money needs to be revisited with a far wider and less narrow focus than on the purely medical.
One last important point: In a world where we know levels of serious abuse and neglect of children typically run at 15-20% or more of children (WHO and NSPCC data), that FNP families had 13.6% signalled as needing safeguarding procedures, while the control group found only 8.0% is probably a measure of success rather than failure.
It is also relevant to note that on a number of measures, such as maternal sensitivity, child affect and breastfeeding, the impact of the programme is indeed disappointing, and all these factors should be taken into account in a re-evaluation of its merit. We do not, however, share the very negative slant put on the results by the evaluation team, which is in our view overly influenced by their narrow choice of primary outcomes.
George would be happy to take part in any media discussion of the study.
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