Primary and secondary outcomes: CSCS outcomes, healthcare encounters for injuries/ingestions and out-patient non-attendance
| Outcome | FNP | Usual care (UC) | Adjusted* parameter estimate (95% CI) | P value | Absolute risk difference (FNP-UC) (95% CI) |
| Child protection outcomes | N=760 | N=746 | |||
| Child in need (CIN) status at any time during the follow−up period | |||||
| No | 599 (78.8%) | 584 (78.3%) | Reference | ||
| Yes | 161 (21.2%) | 162 (21.7%) | 0.98† (0.74 to 1.31) | 0.902 | −0.5% (−0.5 to 0.4%) |
| Age at first CIN referral (days) | |||||
| Median (25–75th centile) | 1602.5 (1153.0 to 1978.75) | 1649.5 (1130.75 to 1980.25) | 0.98‡ (0.79 to 1.23) | 0.875 | |
| Missing | 1 | 0 | |||
| Unique no of CIN referrals per child§ | 1 (1 to 2) | 1 (1 to 2) | 0.99¶¶ (0.82 to 1.19) | 0.890 | |
| CIN duration (days) | 210 (70.5 to 571.25) | 216 (72.75 to 503.25) | 1.20‡ (0.90 to 1.59) | 0.216 | |
| CIN categorisation (primary need) of first case | N=161 | N=162 | |||
| Abuse or neglect | 92 (57.1%) | 102 (63.0%) | Reference | ||
| Family dysfunction | 29 (18.0%) | 34 (21.0%) | 0.95¶ (0.54 to 1.69) | 0.868 | |
| Family in acute stress | 13 (8.1%) | 10 (6.2%) | 1.47¶ (0.61 to 3.54) | 0.389 | |
| Low income, absent parenting, socially unacceptable behaviour, not stated | 13 (8.1%) | 6 (3.7%) | 2.38§ (0.86 to 6.57) | 0.093 | |
| Child/parent disability | 7 (4.3%) | 5 (3.1%) | 1.47¶ (0.45 to 4.84) | 0.525 | |
| Cases other than CIN | 7 (4.3%) | 5 (3.1%) | 1.64¶ (0.50 to 5.37) | 0.417 | |
| Referred to children’s social care services (CSCS) | |||||
| No | 554 (72.9%) | 538 (72.1%) | Reference | ||
| Yes | 206 (27.1%) | 208 (27.9%) | 0.97† (0.74 to 1.28) | 0.829 | −0.8% (−5.3 to 3.7%) |
| Age at first referral (days) Median (25–75th centiles) | 1541.5 (1272.75 to 1975.75) | 1631.0 (1190.5 to 1984.75) | 0.96‡ (0.79 to 1.17) | 0.694 | |
| Child protection plan | |||||
| No | 708 (93.2%) | 697 (93.4%) | Reference | ||
| Yes | 52 (6.8%) | 49 (6.6%) | 1.04† (0.69 to 1.57) | 0.846 | 0.2% (−0.2 to 0.3%) |
| Category of child protection plan | n=52 | n=49 | |||
| Neglect | 17 (32.7%) | 22 (44.9%) | Reference | ||
| Emotional | 22 (42.3%) | 12 (24.5%) | 2.77¶¶ (1.02 to 7.56) | 0.046 | |
| Physical | 6 (11.5%) | 6 (12.2%) | 1.25¶¶ (0.32 to 4.88) | 0.743 | |
| Sexual and multiple** | 7 (13.5%) | 9 (18.4%) | 1.13¶¶ (0.33 to 3.86) | 0.848 | |
| Looked after status†† | |||||
| No | 735 (96.7%) | 719 (96.4%) | Reference | ||
| Yes | 25 (3.3%) | 27 (3.6%) | 0.90† (0.52 to 1.57) | 0.712 | −0.3% (−0.2 to 0.2%) |
| Child looked after period of care (months) | 10.0 (4.5 to 37.5) | 12.0 (6.0 to 33.0) | 0.75§ (0.65 to 0.86) | <0.001 | |
| Injuries and ingestions | N=760 | N=759 | |||
| Emergency attendance§§ | |||||
| None | 317 (41.7%) | 344 (45.3%) | Reference | ||
| At least one | 443 (58.3%) | 415 (54.7%) | 1.17† (0.95 to 1.45) | 0.149 | 3.6% (−1.4 to 8.6%) |
| No of attendances per child | 2 (1 to 2) | 2 (1 to 3) | 1.09¶¶ (0.93 to 1.28) | 0.281 | |
| Admission to hospital | |||||
| None | 671 (88.3%) | 660 (87.0%) | Reference | ||
| At least one | 89 (11.7%) | 99 (13.0%) | 0.87† (0.63 to 1.20) | 0.407 | −1.3% (−4.7 to 2.0%) |
| Unique admissions | 109 | 119 | |||
| Ratio of admissions to children | 1.22 | 1.20 | |||
| No of admissions per child, median (25–75th centile) | 1 (1 to 1) | 1 (1 to 1) | 0.93¶¶ (0.67 to 1.29) | 0.663 | |
| Length of stay (days)‡‡ | N=106 | N=119 | |||
| Median (25–75th centile) days | 0.5 (0.5 to 1.0) | 0.5 (0.5 to 1.0) | |||
| Hospital attendance and/or admission | |||||
| None | 306 (40.3%) | 324 (42.7%) | Reference | ||
| At least one | 454 (59.7%) | 435 (57.3%) | 1.11† (0.89 to 1.37) | 0.351 | 2.4% (−2.5 to 7.4%) |
| DNA outpatient appointment | N=580 | N=577 | |||
| Attended all appointments | 290 (50.0%) | 289 (50.1%) | Reference | ||
| DNA at least once | 290 (50.0%) | 288 (49.9%) | 1.00† (0.79 to 1.26) | 0.997 | 0.09% (−5.6 to 5.8%) |
Data are n (%), n/N (%) or median (25–75th centile) unless otherwise stated.
*FNP compared with usual care. Analysis adjusted for stratification (site), minimisation variables (gestational age, smoking status at recruitment, and first or preferred language).
†OR from logistic model.
‡HR from Cox model.
§A unique referral is counted as a distinct referral date per child.
¶Relative risk ratio from multinomial model.
**Multiple indicates when more than one category of abuse is relevant to the child’s current plan.
††We reflect here the terminology used at the time of the trial but note the more contemporary ‘care experienced’ as a more familiar and accepted term.
‡‡0.5 days indicates an admission and discharge on the same day (could be up to 1 day in hospital). Data available from NHS Digital which show an admission and discharge 1 day apart may not equate to one full day in hospital (ie, the child may have been in hospital for only a few hours if the admission spanned midnight). Source: National Pupil Database, The Department for Education.
§§Using diagnosis in any position.
¶¶Incidence rate ratio from Poisson model.
FNP, family nurse partnership; NHS, National Health Service.