Abstract

Objectives: To evaluate the effectiveness and cost-effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families.

Design:Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n=67) or standard services (n=64). Incremental cost analysis.

Setting: 40 GP practices across two counties in the UK

Participants: 131 vulnerable pregnant women.

Intervention: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6-months antenatally to 12 months postnatally.

Main outcome measures: Mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse.

Results: At 12-months differences favouring the home visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. There was a non- significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group. The mean incremental cost per infant of the home visiting intervention was £3,246 (bootstrapped 95% confidence interval for the difference: £1,645 - £4,803).

Conclusion: The results show limited evidence of effectiveness at 12 months. The intervention may, however, have the potential to improve the identification of infants in need of child protection, but this needs further investigation, alongside the extent to which the observed outcomes are worth the incremental costs. Long-term follow-up is needed to assess possible sleeper effects.