First steps: study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse

Background: Evidence from the USA suggests that the home-based Family Nurse Partnership program (FNP), extending from early pregnancy until infants are 24 months, can reduce the risk of child abuse and neglect throughout childhood. FNP is now widely available in the UK. A new variant, Group Family Nurse Partnership (gFNP) offers similar content but in a group context and for a shorter time, until infants are 12 months old. Each group comprises 8 to 12 women with similar expected delivery dates and their partners. Its implementation has been established but there is no evidence of its effectiveness.

Methods/Design: The study comprises a multi-site randomized controlled trial designed to identify the benefits of gFNP compared to standard care. Participants (not eligible for FNP) must be either aged <20 years at their last menstrual period (LMP) with one or more previous live births, or aged 20 to 24 at LMP with low educational qualifications and no previous live births. 'Low educational qualifications' is defined as not having both Maths and English Language GCSE at grade C or higher or, if they have both, no more than four in total at grade C or higher. Exclusions are: under 20 years and previously received home-based FNP and, in either age group, severe psychotic mental illness or not able to communicate in English. Consenting women are randomly allocated (minimized by site and maternal age group) when between 10 and 16 weeks pregnant to either to the 44 session gFNP program or to standard care after the collection of baseline information. Researchers are blind to group assignment. The primary outcomes at 12 months are child abuse potential based on the revised Adult-Adolescent Parenting Inventory and parent/infant interaction coded using the CARE Index based on a video-taped interaction. Secondary outcomes are maternal depression, parenting stress, health related quality of life, social support, and use of services.

Discussion: This is the first study of the effectiveness of gFNP in the UK. Results should inform decision-making about its delivery alongside universal services, potentially enabling a wider range of families to benefit from the FNP curriculum and approach to supporting parenting.

Mother's Narratives of Trauma: An exploratory study of how mothers' narrate the impact of trauma on their families

This study explored the narratives of 10 mothers whose families had been impacted by potentially traumatising events. The study was set in the context of Post-Traumatic Stress Disorder (PTSD), a relatively narrow psychiatric construct, which currently dominates much professional discourse and practice in traumatology, but references literature that provides a theoretical rationale for a broader approach. Narrative Interviewing methodology was employed and mothers of families referred to a specialist clinical service were interviewed prior to professional therapeutic intervention. The 10 mothers' narratives were analysed thematically via a rigorous process involving two independent analysts and the data organised into an evolving theoretical framework of themes and supra-themes. As hypothesised, PTSD symptomatology constituted a small proportion of the mothers' narratives (6.2%). The major components of the narratives included family and relational distress (35.7%), non-pathological individual distress (24.4%), resilience (16.7%) and a prior history of adversity (16.6%). Although exploratory in nature, the results of this study are sufficiently strong to warrant further investigation and raise tentative questions regarding the appropriateness of many existing therapeutic services for people impacted by trauma.

Feasibility trial of a film-based educational intervention for increasing boy's and girl's intentions to avoid teenage pregnancy: study protocol

The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs. (C) 2014 The Authors. Published by Elsevier Ltd.

Design and Development of a Film-based Intervention about Teenage Men and Unintended Pregnancy: Applying the Medical Research Council Framework in Practice

Following the UK Medical Research Council’s (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys’ and girls’ intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: 1) know and engage the target population and engage gatekeepers in addressing contextual complexities; 2) know the targeted behaviours and model a process of change; and 3) look beyond development to evaluation and implementation.

How Mothers Talk About Placement of Their Child With Autism Outside the Home

In this article I use insights offered by the poststructural shift and linguistic turn in social scientific inquiry, specifically discourse analysis, to explore mothers’ talk about the placement of their child with autism outside of the home. By viewing mothers’ talk as data, I bring to light the discourses and interpretive practices that mothers drew on to organize their talk of placement. In doing so, I provide insights into how mothers gave meaning to processes of placement while also expanding on commonsensical discursive notions of “good” mothering, caregiving, and family. Implications of the findings are discussed.

The Positives of Caregiving: Mothers’ Experiences Caregiving for a Child With Autism

Most research in the field of autism focuses on the medical and psychological characteristics of the disability. Research that focuses on caregiving emphasizes the stresses and pathological features associated with having a child with autism. As such, the more positive aspects of caregiving have been left in abeyance, portraying caregiving and autism as characterized by only negative experiences, prognoses, and outcomes. Based on mothers’ reflections, this article reports on some of the positives of caregiving. The findings provide a glimpse into a seldom studied side of caregiving—events and experiences appraised by mothers in a positive and sometimes joyous light—and the impact they have on mothers’ experiences. Furthermore, practical implications for social service professionals and families are discussed.