Barlow, Jane, Davis, Hilton, McIntosh, Emma, Kirkpatrick, Sue, Peters, Rebecca, Jarrett, Patricia and Stewart-Brown, Sarah L. (2008) The Oxfordshire home visiting study : 3 year follow-up. Oxford: University of Oxford. Dept. of Public Health. Health Economics Research Centre. (Home Visiting Trial and Follow-up).

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Abstract

Background
The Oxfordshire Home Visiting Study is one of the few UK-based randomised controlled trials to evaluate the effectiveness of a professionally delivered, intensive home visiting programme beginning during the antenatal period, in improving parenting and child outcomes including the prevention of abuse and neglect.
Method
One hundred and thirty-one high-risk women registered with 40 GP practices across two counties were randomly allocated to receive intensive home visiting (n=68) or standard services (n=63). Women in the home visiting arm received weekly visits by specially trained health visitors beginning during the second trimester of pregnancy and continuing for a period of 18 months. All mothers and babies were followed up at 2-months, 6-months, and 12-months, and these results have been published elsewhere (McIntosh et al 2009; Barlow et al 2007; Kirkpatrick et al 2007; McIntosh and Barlow 2006; Barlow et al 2005; Brocklehurst et al 2004).
This report summarises the results of the 3-year follow-up of 131 women – Intervention group (n=51) and control group (n=46).
Results
Primary and secondary outcomes
The significant improvement in maternal sensitivity and infant co-operativeness that was identified at 12-month follow-up was not maintained at 3-years. The few significant differences between the intervention and control group for the remaining outcomes favoured the control group, although many non-significant findings favoured the intervention group.
Child abuse data
Non-significant trends were identified suggesting that children in the intervention group who suffered maltreatment were more likely to be identified, and more likely to suffer maltreatment for shorter periods of time. These differences may be clinically important, and may have reached statistical significance in a larger trial.
Economic Evaluation
The results suggest that intensive home visiting improved maternal sensitivity at 12-months and better enabled health visitors to identify infants in need of further protection at an incremental cost of £3,985 (95% bootstrapped CI for the cost difference: £192 - £5,297) per woman at 36 months. Looking at the ‘health service only’ costs, at 36-months the incremental cost was £4,232 (95% bootstrapped CI for the cost difference: £1,949 - £5,709). The extent to which these potential benefits are worth the costs, however, is a matter of judgment.
User perspectives
The majority of participants who were interviewed continued to view the home visiting service, in positive terms. Most were highly appreciative of the help and support they had received at the time, and reported significant ways in which they perceived the service to have been of help to them. Longer-term benefits included the close bond that they felt they had established with the study child, the introduction of parenting practices that helped them to address difficult behaviour, and a better ability to utilize other health services. However, only half of the women invited to take part in a 3-year follow-up interview accepted, and the views expressed in these interviews may not therefore be representative of the wider group of women who received the home visiting service.
Conclusion
This study did not identify any quantitative benefits from an eighteen-month intensive home visiting programme, and given the success of some other programmes of this nature, it seems likely that this may have been due to the
duration of the programme (many of the most effective programmes continue until the infant is 2-years of age), and the content of the visits (the lack of focus on specific child developmental outcomes), in conjunction with the fact that this study recruited a very high-risk group of women; just under a half of the sample were known to Child and Family Services by the time the child was three years of age.
However, data from in-depth interviews that were conducted with a range of stakeholders at both 12- and 36-months suggests that the partnership model of working that was provided to health visitors was effective in enabling the home visitors to gain the trust of a group of very vulnerable women, many of whom viewed all professionals very negatively, and that many of the participating women also felt that the service had had an ongoing impact in terms of their ability to parent, and their relationship with the study child.
Effective interventions for this very high-risk group of mothers and infants have yet to be identified, and will most probably involve the use of more intensive therapeutic interventions such as parent-infant psychotherapy (ref) or mentalisation-based parenting programmes (ref) or a multimodal approach that combines a number of these strategies. In the absence of effective interventions, early identification of infants in need of removal from the home remains the optimal strategy, and the data from this study suggest that home visited children were much more likely to be identified as abused, and more likely to suffer maltreatment for shorter periods of time. These findings may be particularly significant given what we now know about the impact of abuse during the first few years of life. While the findings of the economic analysis suggest that the costs of an intensive intervention of this nature are always likely to be significantly more, society must ultimately decide whether such additional costs are worthwhile.

Item Type:	Report
Subjects:	R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Home-based family services -- England -- Oxford, Maternal health services -- England -- Oxford, Visiting nurses -- England -- Oxford
Series Name:	Home Visiting Trial and Follow-up
Publisher:	University of Oxford. Dept. of Public Health. Health Economics Research Centre
Place of Publication:	Oxford
Official Date:	November 2008
Dates:	Date Event November 2008 Published
Number of Pages:	84
Status:	Not Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	1 August 2016
Date of first compliant Open Access:	1 August 2016
Funder:	Nuffield Foundation (NF), Great Britain. Dept. of Health (DoH)

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