A new, preliminary report from a trial of the Nurse Family Partnership (NFP) program in the United States provides valuable information about the long-term results and their impact on financial benefits. This is shown particularly in one of the most dramatic improvements - a reduction in mothers smoking.

David Olds and colleagues, the authors, provide an update on their research into the effectiveness and cost-benefit of NFP. The study followed mothers from pregnancy until their children were nine years of age.

The particular value of the report is that in many cost-benefit analyses, the long-term benefits are estimates based on knowledge about the likely outcomes for participants given their short-term results, rather than actual long-term data. This is because most trials of interventions are not able to follow people over long periods of time and do not often directly collect information about financial benefits.

The report shows that 18.7 per cent of expectant mothers smoked at least five cigarettes a day at the beginning of the study, but that nurse visiting was able to reduce smoking rates by 31.3 per cent.

The authors then estimated the impact of this reduction on outcomes such as reduced pregnancy complications and miscarriages, based on previous research. These impacts then had a bearing on the eventual medical costs to the family, private insurance, or government medical insurance. As no improvement in infant birth weight was found in this study, this was not included as a benefit of smoking reduction.

The researchers found that the cost-benefits from the program were derived from a wide range of outcomes such as reduced pregnancy complications, increased earnings, reduced domestic violence, improved maternal and child mental health, and improvements in children’s education.

The actual cost of the partnership in Denver were recorded and tracked over the course of the study, including costs for training, salaries, materials and travel. Additional costs due to research were removed from the program costs estimates. The average costs for each mother in the program were $10,503 if visited by a nurse, and $7,087 if visited by a para-professional.

Information about the actual earnings of mothers in the study was collected from official records. This showed that mothers had a 21.6 per cent increase in earnings if they received the program, compared to those who did not. The total difference in earnings over eight years was a $14,635 gain for mothers who were visited by nurses in the program, and a gain of $8,199 for mothers who were visited by para-professionals.

In addition, the researchers asked mothers to report any domestic violence from when their children were age four and until they were nine. According to these reports, the program was able to reduce the incidence of domestic violence by 37.1 per cent for nurse-visited mothers, as compared to mothers who did not receive the program. This saved approximately $214 for each family in medical costs and an estimated $4,701 a family for improved quality of life.

Mothers who were visited by nurses were also much less likely to have symptoms of depression, which also reduced medical costs and improved quality of life, as well as reducing the likelihood of being frequently absent from work.

As far as children were concerned, the study has found some indication of a reduction in incidence of attention deficit/hyperactivity disorder with the program, although these results were less conclusive. However, it was clear that these children made less use of medical and other treatment services by the time that they were six, saving approximately $133 a child.

However, in one key outcome, the families receiving NFP did not fare so well. By the age of nine, more children of nurse-visited mothers had repeated a year in school than children who had not been in the program. This was estimated to increase costs by $258 for each family.

Overall, this report indicates that nurse visitation costs $10,503 a family, but yields $31,944 in benefits, a cost-benefit ratio of $3.05 for every $1 spent. For families visited by para-professionals rather than nurses, the cost was estimated to be $7,087 a family, with $16,514 in benefits, a cost-benefit ratio of $2.33 for every $1.

These ratios show that this intervention seems to be a good investment and is likely to results in net benefits. However, these benefits are shared by a number of parties. The authors note that 92 per cent of the benefits go to the participating families, with the remaining benefits being shared by the government, health services, insurance providers, schools, and other services. Additional benefits may result from the program’s impacts in terms of reducing child poverty and improving health.

More work of this type is needed to improve estimates of the benefits of investment in programmes that impact on early childhood and improve lifelong outcomes. In particular, research into programs and policies would be improved if costs and financial benefits are directly measured and reported.

The impacts of this program are wide-ranging, as are the financial benefits. Work such as this is a primary focus of researchers such as those at the Washington State Institute for Public Policy, and it is very timely in this period of limited resources.

Reference:
David Olds, Ted R. Miller, Michael Knudtson, Dennis Luckey, Jessica Bondy, Amanda Stevenson, John Holmberg, Carole Hanks, Harriet Kitzman, Elizabeth Anson, Kimberly Arcoleo. Impact of the Nurse-Family Partnership on Neighborhood Context, Government Expenditures, and Children’s School Functioning. Rockville, MD: National Criminal Justice Reference Service, 2011.