JSNA topic report: children and young people
14. Summary of evidence of what works
Universal HCP services (Health Visitors and School Nursing)
There is a large body of evidence to suggest that public health interventions in early life (both before birth and during childhood) can improve health and wellbeing across the life course (source: What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years, Vaivada et al).
From its conception in 2009 the HCP has aimed to incorporate best evidence throughout the different elements of the programme.
Since this time there has also been a commitment for the programme to evolve, be informed by an increasing evidence base around interventions, and in response to the changing needs of the population (such as challenges brought about by the COVID-19 pandemic).
The commitment to adapt services in line with changing knowledge is demonstrated through the commissioning of an evidence review by the government in 2015 in which the knowledge for actions around topics contributing to the HCP was reviewed.
Guidance to local authorities around how to commission the HCP was also updated in 2021.
The Family Nurse Partnership (FNP)
Evidence that the FNP provides benefits to young mothers offered the intervention, as well as societal economic gains, are derived from several sources.
In randomised controlled trials conducted in the USA and the Netherlands*, the implementation of FNP compared to standard care was associated with:
- improved short-term outcomes including reductions in maternal smoking
- increased breastfeeding rates
- reduced hospital admissions and requirement for social support
- improved long-term cognitive and employment outcomes
- economic benefits
* The randomised controlled trials can be viewed at:
- Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation,
- Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial
- The effect of VoorZorg, the Dutch nurse-family partnership, on child maltreatment and development: a randomized controlled trial
In a large RCT conducted within the UK, the FNP was also associated with:
- improvements in cognitive outcomes at 24 months (reported development delay in 8.1% of the FNP group vs 12.6% of controls)
- language development at 12 months (delay in 11.0 vs 19.9%)
- language development at 18 months (17.1 vs 24.2%)
- school readiness at reception age (55.5% vs 50.1%)
- reading ability at key stage 1 age (with 65.3 vs 60.5% reaching at least the expected standard of reading)
Reductions in child-in need status and accident and emergency attendances were not observed in this UK trial. Other evidence of FNP efficacy includes increased reported in breastfeeding rates following regional implementation of FNP and reports of positive parenting behaviours in recipients.
FNP also adds significant value within the wider Buckinghamshire Healthy Child Programme, due to the training and expertise provided to health visitors and school nurses by its experienced staff.
There is anecdotal evidence that FNP may also improve staff retention in other parts of the HCP workforce since roles within the team may be considered aspirational for early career nurses and health visitors who do not wish to go into management.
Comparison of the Public Health Nursing Contract in Buckinghamshire with national policies
Comparison of the 2017-2022 0 to 19 years Public Health Nursing Contract (also known as the Healthy Child Programme contract) in Buckinghamshire with national policies and guidelines revealed a small number of possible gaps and potential suggestions for change as follows (although some may already be in place):
Start for Life offer
The suggestions were to:
- work with local partners to pull together a coherent and joined up Start for Life offer (0 to 2 years) which includes drop-in family hubs consisting of both physical and virtual places where services to support families come together, including birth registration, Midwifery, Health Visiting, mental health support, parenting courses and infant feeding advice- the offer should explain clearly to parents and carers what services they are entitled to, how they can access them and families with higher needs should be encouraged and supported to take up the offer
- set up Parent and Carer Panels to assist in co-designing services and provide regular feedback on their effectiveness and quality- the Panels need to represent parents and carers from every community including dads and partners, LGBT parents, adoptive parents, kinship carers and parents from a range of ethnic backgrounds
Health Visiting and School Nursing Services
The suggestions were:
- to conduct a needs assessment in partnership with parents and CYP to determine targeted interventions which can be met within the services or more specialist interventions that require referral or clear signposting
- to utilise an asset-based approach to deliver public health interventions
- to consider also including 3-month and 6-month health and wellbeing reviews and 7 to 8 year old, 12 to 13 year old, school leavers post-16, transition to adult services, and 18 to 24 year old health needs reviews
- that services should include championing and advocating culturally sensitive and non- discriminatory services that promote social inclusion, dignity and respect
- that commissioners and providers may wish to consider development of a COVID-19 recovery plan in partnership with other agencies to support multi-agency support, monitoring and evaluation- recovery planning should consider vulnerability in prioritisation, including children and young people who may be at high risk for clinical reasons, those with formal or legal support in place, and those at higher risk due to wider determinants of health and other factors that can lead to poor outcomes
Family Nurse Partnership (FNP) programme
It was suggested that:
- they aim the programme at first time mothers aged 19 to 24 with additional risk factors, as well as first time mothers aged 19 and under
- if an FNP client has a subsequent child while enrolled on the FNP programme, the family nurse should also deliver the HCP in relation to that subsequent child
- young mothers enrolling on the programme should be visited, as far as possible, by the same family nurse until the completion of the programme
- clinical and performance activity is to be supported by a real-time information system funded by the FNP National Unit called Turas FNP England, which collects data on delivery, client characteristics and programme outcomes
- an FNP Annual Review is to be held which provides an opportunity for commissioners, the local FNP Advisory Board and the National Unit to review the service and its outcomes in depth, strengthen stakeholder relationships and develop an improvement plan for the following year