scholarly journals Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1640 ◽  
Author(s):  
Kerry Bell ◽  
Belen Corbacho ◽  
Sarah Ronaldson ◽  
Gerry Richardson ◽  
Kerry Hood ◽  
...  
Keyword(s):  
Home Visiting ◽  
Controlled Trial ◽  
Full Range ◽  
Building Blocks ◽  
Public Health Services ◽  
Intervention Programme ◽  
The Family ◽  
Cost Consequence ◽  
Implementation Costs ◽  
Family Nurse Partnership

Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration: ISRCTN23019866 (20/04/2009)

scholarly journals Cost-effectiveness of the Family Nurse Partnership (FNP) programme in England: Evidence from the building blocks trial

2017 ◽  
Vol 23 (6) ◽  
pp. 1367-1374 ◽  
Author(s):  
Belen Corbacho ◽  
Kerry Bell ◽  
Eugena Stamuli ◽  
Gerry Richardson ◽  
Sarah Ronaldson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Building Blocks ◽  
The Family ◽  
Family Nurse Partnership

scholarly journals Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e038530
Author(s):  
Francesca L Cavallaro ◽  
Ruth Gilbert ◽  
Linda Wijlaars ◽  
Eilis Kennedy ◽  
Ailsa Swarbrick ◽  
...  
Keyword(s):  
Real World ◽  
Home Visiting ◽  
Data Linkage ◽  
Hospital Admissions ◽  
Maternal Characteristics ◽  
The Real ◽  
Wide Range ◽  
The Family ◽  
Children In Care ◽  
Family Nurse Partnership

IntroductionAlmost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation.Methods and analysisWe will construct a retrospective cohort of all women aged 13–24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education).Ethics and disseminationThe Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers.

Benefits of a support programme for family caregivers of patients at the end of life: A randomised controlled trial

2020 ◽  
pp. 135910532094499
Author(s):  
Ana Lucila Soto-Rubio ◽  
Selene Valero-Moreno ◽  
Marián Pérez-Marín
Keyword(s):  
End Of Life ◽  
Family Caregivers ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Intervention Programme ◽  
Care Recipients ◽  
Support Programme ◽  
The Family ◽  
Randomised Controlled ◽  
The Impact

This study aims to analyse the impact that a psychological intervention programme has on the emotional state of family caregivers of patients at the end of life. The study is longitudinal with two arms (control and experimental). Data was collected from 154 primary family caregivers of patients at the end of life as well as from their respective 154 care-recipients. The intervention programme has shown its effectiveness in reducing anxiety, emotional distress and burden in the family caregivers of end-of-life patients. A reduction of anxiety of patients whose family caregivers participated in the intervention was also observed.

scholarly journals Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Fiona V Lugg-Widger ◽  
Michael Robling ◽  
Mandy Lau ◽  
Shantini Paranjothy ◽  
Jill Pell ◽  
...  
Keyword(s):  
Home Visiting ◽  
Natural Experiment ◽  
Routine Data ◽  
Young Mothers ◽  
Data Systems ◽  
Multilevel Regression ◽  
Eligibility Criteria ◽  
Prenatal Health ◽  
The Family ◽  
Family Nurse Partnership

Introduction: Individual, social and economic circumstances faced by young mothers can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which aims to improve prenatal health behaviours, birth outcomes, child development and health outcomes, and maternal life course. Establishing evidence of effectiveness beyond the original US setting is important to understand where further adaptation is required within a country specific context. Objective: This study will form one strand of the Scottish Governments’ plan to evaluate the effectiveness of FNP as compared to usual care for mothers and their children in Scotland and will focus only on outcomes that can be identified using routine administrative data systems. Methods: This study is a natural experiment with a case-cohort design using linked anonymised routine health, educational and social care data. Cases will be women enrolled as FNP Clients in ten NHS Health Boards in Scotland and Controls will be women who met FNP eligibility criteria but were pregnant at a time when the programme was not recruiting. Outcomes are mapped to the Scottish FNP logic model. All comparative analyses will be pre-specified, conducted on an intention to treat basis and will use multilevel regression models to compare outcomes between groups. Discussion: The study protocol is based upon the specification of FNP commissioned by the Scottish Government. This study design is novel for the evaluation of the FNP/NFP programmes which are primarily evaluated with an RCT. Outcomes included within the study have been selected on the basis that they are outcomes FNP aims to influence and where there is routine data available to assess the outcome.

Case studies of interests at play

2017 ◽  
Author(s):  
Val Gillies ◽  
Rosalind Edwards ◽  
Nicola Horsley
Keyword(s):  
Early Intervention ◽  
Case Studies ◽  
Intervention Programme ◽  
High Profile ◽  
Network Position ◽  
First Case ◽  
The Family ◽  
The Uk ◽  
Family Nurse Partnership

This chapter builds on the review of the interests at play in the early intervention field and examines them through case studies of three high-profile initiatives. The first case study focuses on the Wave Trust, a campaigning and policy advocate organisation that has been highly influential politically in promoting brain-based early intervention in the UK. It claims a ‘business centred’ approach to breaking damaging intergenerational family cycles of abuse and violence. The second case study subjects the origins, delivery, and evidence claims of the Family Nurse Partnership (FNP) early intervention programme to scrutiny. The third case study explores the nodal network position of Parent Infant Partnership UK, which advocates for an emphasis on attachment between primary caregivers and babies.

scholarly journals Monitoring adverse social and medical events in public health trials: assessing predictors and interpretation against a proposed model of adverse event reporting

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Gwenllian Moody ◽  
Katy Addison ◽  
Rebecca Cannings-John ◽  
Julia Sanders ◽  
Carolyn Wallace ◽  
...  
Keyword(s):  
Adverse Event ◽  
Social Status ◽  
Home Visiting ◽  
Controlled Trial ◽  
Antisocial Behaviour ◽  
Well Being ◽  
Building Blocks ◽  
Good Clinical Practice ◽  
Adverse Event Reporting ◽  
Behaviour Score

Abstract Background Although adverse event (AE) monitoring in trials focusses on medical events, social outcomes may be important in public or social care trials. We describe our approach to reporting and categorising medical and other AE reports, using a case study trial. We explore predictors of medical and social AEs, and develop a model for conceptualising safety monitoring. Methods The Building Blocks randomised controlled trial of specialist home visiting recruited 1618 first-time mothers aged 19 years or under at 18 English sites. Event reports collected during follow-up were independently reviewed and categorised as either Medical (standard Good Clinical Practice definition), or Social (trial-specific definition). A retrospectively developed system was created to classify AEs. Univariate analyses explored the association between baseline participant and study characteristics and the subsequent reporting of events. Factors significantly associated at this stage were progressed to binary logistic regressions to assess independent predictors. Results A classification system was derived for reported AEs that distinguished between Medical or Social AEs. One thousand, three hundred and fifteen event reports were obtained for mothers or their babies (1033 Medical, 257 Social). Allocation to the trial intervention arm was associated with increased likelihood of Medical rather than Social AE reporting. Poorer baseline psycho-social status predicted both Medical and Social events, and poorer psycho-social status better predicted Social rather than Medical events. Baseline predictors of Social AEs included being younger at recruitment (OR = 0.78 (CI = 0.67 to 0.90), p = 0.001), receiving benefits (OR = 1.60 (CI = 1.09 to 2.35), p = 0.016), and having a higher antisocial behaviour score (OR = 1.22 (CI = 1.09 to 1.36), p < 0.001). Baseline predictors of Medical AEs included having a limiting long-term illness (OR = 1.37 (CI = 1.01 to 1.88), p = 0.046), poorer mental health (OR = 1.03 (CI = 1.01 to 1.05), p = 0.004), and being in the intervention arm of the trial (OR = 1.34 (CI = 1.07 to 1.70), p = 0.012). Conclusions Continuity between baseline and subsequent adverse experiences was expected despite potentially beneficial intervention impact. We hypothesise that excess events reported for intervention-arm participants is likely attributable to surveillance bias. We interpreted our findings against a new model that explicates processes that may drive event occurrence, presentation and reporting. Focussing only upon Medical events may miss the well-being and social circumstances that are important for interpreting intervention safety and participant management. Trial registration ISRCTN, ID: ISRCTN23019866. Registered on 20 April 2009.

Thienopyrrolocarbazoles: New Building Blocks for Functional Organic Materials

2019 ◽  
Author(s):  
Dorian Bader ◽  
Johannes Fröhlich ◽  
Paul Kautny
Keyword(s):  
Building Block ◽  
Organic Materials ◽  
Building Blocks ◽  
Molecular Properties ◽  
The Family ◽  
Facile Preparation

The facile preparation of three regioisomeric thienopyrrolocarbazoles applying a convenient C-H activation approach is presented. Derived from indolo[3,2,1-<i>jk</i>]carbazole, the incorporation of thiophene into the triarylamine framework significantly impacted the molecular properties of the parent scaffold. The developed thienopyrrolocarbazoles enrich the family of triarylamine donors and constitute a novel building block for functional organic materials.

Thienopyrrolocarbazoles: New Building Blocks for Functional Organic Materials

2019 ◽  
Author(s):  
Dorian Bader ◽  
Johannes Fröhlich ◽  
Paul Kautny
Keyword(s):  
Building Block ◽  
Organic Materials ◽  
Building Blocks ◽  
Molecular Properties ◽  
The Family ◽  
Facile Preparation

The facile preparation of three regioisomeric thienopyrrolocarbazoles applying a convenient C-H activation approach is presented. Derived from indolo[3,2,1-<i>jk</i>]carbazole, the incorporation of thiophene into the triarylamine framework significantly impacted the molecular properties of the parent scaffold. The developed thienopyrrolocarbazoles enrich the family of triarylamine donors and constitute a novel building block for functional organic materials.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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