1.1. The Family Nurse Partnership
Individual, social and economic circumstances faced by many young mothers present a challenge to a successful start in life for children and may interrupt the mother’s longer term economic stability (1). Children of young mothers are more likely to have lower birth weight, not be breastfed, be at greater risk of accidents and early death, do worse educationally, have more emotional and behavioural problems, and become young parents themselves (2–5).
Intervention early in the lives of families with young mothers might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) was developed in the USA as an intensive preventative home visiting intervention delivered by specially recruited and trained nurses (6), and was formally adapted for use under license in the UK. FNP traditionally offers home-visiting support to women aged 19 and under and expecting their first child, from early pregnancy until their child’s second birthday. Potential Clients are identified at booking via local maternity systems and contact information is passed on to FNP teams who make contact to offer participation in the programme and enrol the individual as a Client if appropriate.
Introduced into Scotland in 2010 for initial feasibility and acceptability testing in NHS Lothian, the service was extended to a further nine Health Boards (HBs). Scotland also opened eligibility to 20 to 24-year-old first time mothers and personalised the programme to the strengths and risks of each Client. Establishing the evidence base for what works, for whom and in what circumstances, is key to policy decision making. The clinical need and public borne intervention cost requires a robust evaluation of the programme‘s impact. An independent academic collaboration undertook an ‘Evaluability Assessment’ to consider options for evaluating impact of the programme in Scotland, the feasibility of these options and cost (7). It recommended data linkage as a preferred method for evaluating impact using a natural experiment approach, on the basis of being far less expensive than a randomised controlled trial (RCT), and allowing data on all participants from the initiation of FNP in Scotland to be used to the point at which complete coverage was achieved. The well-specified programme logic model (Appendix 1) and the availability of routine data mapping onto key outcomes complements this recommendation.
1.2. Research aim
The aim of this study is to examine the association between the provision of FNP when added to existing services and a range of outcomes covering maternal health, child health and development, and parental life course, compared to existing services alone for first time mothers.
The original objectives of the study were:
1. To obtain approval and link Client and Control identifiers to health, education, and social care data available in public sector records;
2. To identify families in receipt of FNP support at all relevant Scottish sites (FNP Clients) and a control sample of families who would meet criteria for FNP but did not receive support (Controls) from routine data;
3. To compare FNP Clients and Controls across a range of maternal and child outcomes within programme defined domains of pregnancy outcomes, child health and development and parental economic self-sufficiency;
4. To examine the association between provision of FNP on a range of pre-specified outcomes and for key sample sub-groups;
5. To explore variation in effectiveness by geographical area and over time;
6. To explore variation in effectiveness by level of exposure to the intervention (such as the number of FNP visits).
1.2.2. Scope of this methodological paper
This paper describes the methods to addresss all six study objectives. It also describes the narrative and descriptive results of the first two objectives.