• By Dartington SRU
  • Posted on Tuesday 27th April, 2010

Will a David Olds baby be first to make the big leap

Much as prevention scientists, service commissioners, economists and – lately – politicians may harp on about their value, no evidence-based program in the US or the UK has yet become part of standard practice.There have been trials and more trials, and sizable local investment in the most promising few, but none can yet claim to have successfully "gone to scale".Among the closest to qualifying is Nurse Family Partnership, which is already supporting young first-time mothers in 28 US states, and stands on the verge of general application since help for vulnerable young parents was written into federal policy.NFP is an intensive, preventive home visiting program that starts in early pregnancy and continues into the child's third year. Nurses are drawn from health visiting, midwifery and other branches of the profession and are trained to follow a carefully designed routine under strong clinical supervision. Long-term experimental evaluation has shown that its value to parents and children alike is lasting. Particularly important for policy makers is evidence that, despite being costly to deliver, the benefits to society far outweigh the investment.This pedigree has made it an equally attractive proposition in England, where, despite universal health visiting and integrated services for children and families, little has been on on offer for vulnerable first time mothers.It made the crossing in 2006 under the watchful eye of its developer David Olds, who managed to secure from the lead piloting agency, the Department of Health, guarantees of high quality delivery (aka “fidelity”) and rigorous evaluation.Four years later, the UK version, known as Family Nurse Partnership, has touched the lives of 4,000 families and 650 child "graduates". In the UK, the program has had central government backing from the outset. A small central team was established to provide training, site support, research and development, and sites were invited to nominate themselves to join one of a number of waves of roll-out.Those selected received grants to help fund the first year as well as access to training, materials and support from the central team. Fifty out of a possible 150 sites across England and Wales are now hosting implementation.Research in the early days concentrated on feasibility: whether the materials worked, whether normally hard-to-reach families (including fathers) engaged, and nurses were enthusiastic for the program. Those tests passed, more research was commissioned to establish the how far parents and children benefited. The answer will not be known until 2013, by which time the necessary 1,500 families should have been recruited and their progress tracked.In the meantime, the central team are busy with implementation-related projects. For example, they want to find out how to identify the practitioners who are most likely to make for really good family nurses; to be qualified as a health visitor or a midwife is not sufficient recommendation. They are also exploring different models for delivery. For example, in the Midlands city of Derby, they are planning to deliver FNP via social enterprise. As in the US, so in England – the program is close to becoming one of the first evidence-based programs to go to scale.Three obstacles remain. The political landscape is changing: no-one knows how a new parliament will view prevention science. The financial landscape has been turned into a minefield: public budgets are being slashed and the high unit cost of FNP makes it an easy target. Until the evaluation is complete, the program will be asking for investment in the absence of any robust evidence that it works in the UK, or whether, here too, the benefits it delivers outweigh the costs.

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