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Mixed success for early intervention schemes, finds major review

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Early intervention programmes involving nurses and health visitors working closely with vulnerable families have had mixed success with some showing “no effect”, according to a major review.

The review of 75 schemes by the Early Intervention Foundation charity focused on those aiming to boost early bonding and interaction between parents and children up to the age of five, and involved a detailed look at the evidence to show whether they work or not.

The government-backed Family Nurse Partnership scheme, which deploys specially trained nurses to work with first-time teenage mothers, was one of two to achieve the top rating for evidence.

It is among 17 programmes the EIF concluded was “likely to be effective” if commissioned carefully.

This was despite a previous evaluation, commissioned by the Department of Health, claiming the FNP scheme was “not beneficial” and could not currently be justified in the UK.

However, the EIF’s review did find the scheme, which involves long-term one-to-one work, was also one of the two most expensive programmes included in the study.

In its assessment of other initiatives it found the Parents as First Teachers scheme - designed to boost children’s early learning - which is widely available in the UK, was among 18 programmes that had promising early findings. The most recent evaluation in Switzerland found it was most effective when delivered by highly-trained and well-supervised health visitors.

Five of the schemes were rated by the review as having had “no effect” because rigorous evaluation had failed to confirm any positive benefits for parents or children.

They include the Social Baby programme developed at the University of Reading for mothers at risk of postnatal depression, which involves antenatal and postnatal visits by health visitors.

A recent UK trial found the scheme was unlikely to make a difference to mothers’ depression or help avoid disruption to the mother and baby bond.

“Local commissioners need to use this evidence alongside their knowledge of the local context to make carefully judged spending decisions”

Carey Oppenheim

The Maternal Early Childhood Sustained Home-visiting scheme delivered by child and family nurses or health visitors was another judged to have “no effect”. The approach was developed in Australia but had been tested in the UK.

However, the EIF stressed a rating of “no effect” does not necessarily mean a programme will never work as “some may adapt and be found to be effective in the future”.

Meanwhile the fact a programme has been shown to work in previous studies is no guarantee it will always work, it said.

EIF chief executive Carey Oppenheim said reduced local authority funding and cuts to other services meant it was vital to use “the best evidence available to inform commissioning”.

“This doesn’t mean commissioners should drop programmes which don’t yet have strong evidence,” she said.

“Local commissioners need to use this evidence and the ratings alongside their knowledge of the local context to make carefully judged spending decisions.”

One key finding from the review was a lack of robust evaluation of early intervention programmes in the UK with a tendency to rely on evidence from other countries like the US and Australia.

As well as examining new approaches, services should also seek to evaluate “business as usual” such as the day-to-day work of health visitors.

“Existing practices need better evaluation, learning from the best programmes and testing what works in the practices of health visitors for example,” said the report, called Foundations for Life: What Works to Support Parent Child Interaction in the Early Years.

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Readers' comments (1)

  • Important to note that this review focused only on attachment and emotion-focused outcomes. It is factually inaccurate to have described the maternal and early childhood sustained home visiting (MECSH) programme as 'attachment-based,' which it is not. Accordingly, it has not measured attachment-linked outcomes - but it shows significant benefits in terms of maternal responsiveness, breastfeeding, home environment and other maternal outcomes.
    Sarah Cowley

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