Specialist home-visiting

The Building Blocks Trial

Chief Investigator: Prof. Mike Robling, Centre for Trials Research - Cardiff University

A randomised controlled trial (RCT) to evaluate the Family Nurse Partnership in England. 

Building Blocks was a study of how well FNP works in England. 1,645 pregnant teenagers joined the study between 2009 and 2010. Women were randomised into two groups. One group was offered FNP and one group had usual care from Health Visitors. All women in the study also had maternity care and any other extra support available to young families in their area. The study looked at how well the mothers and babies were doing up until the baby’s 2nd birthday.
Building Blocks

bb:0-2 trial results

Lay Summary

Our lay summary sent to all trial participants is available here:

Open here

Trial Report

Our trial report is available here:

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Main Results Paper

Our main trial results paper is available here:

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Key messages from this trial

Other findings:
  • About four in every 10 mothers in both groups breastfed their baby.

  • By two years of age around one in 10 children had needed a trip to A&E because of an accident or swallowing something they shouldn’t have.

  • Social services had been involved with 14% of children allocated to FNP and 8% of children allocated to usual care.

  • Mothers in the FNP group reported that their children had better language skills than children who got usual care only. 

  • Owen-Jones E, Bekkers M-J, Butler CC, Cannings-John R, Channon S, Hood K, Gregory JW, Kemp A, Kenkre J, Martin BC, Montgomery A, Moody G, Pickett KE, Richardson G, Roberts Z, Ronaldson S, Sanders J, Stamuli E, Torgerson D, Robling M. The effectiveness and cost-effectiveness of the Family Nurse Partnership home visiting programme for first time teenage mothers in England: a protocol for the Building Blocks randomised controlled trial. BMC Pediatr 13(1):114 06 Aug 2013 

  • Robling M, Bekkers M, Bell K, Butler CC, Cannings-John R, Channon S, Corbacho Martin B, Gregory JW, Hood K, Kemp A, Kenkre J, Montgomery AA, Moody G, Owen-Jones E, Pickett K, Richardson G, Roberts ZES, Ronaldson S, Sanders J, Stamuli E, Torgerson D. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. The Lancet, vol. 387, Issue 10014, pages: 146-155. 2016. 

  • Channon S, Bekkers M-J, Sanders J, Cannings-John R, Robertson L, Bennert K, Butler C, Hood K, Robling M. Motivational interviewing competencies among UK family nurse partnership nurses: a process evaluation component of the building blocks trial. BMC Nursing 2016 15:55. DOI: 10.1186/s12912-016-0176-0 

  • Stamuli E, Richardson G, Duffy S, Robling M, Hood K. Systematic review of the economic evidence on home visitation programmes for vulnerable pregnant women. British Medical Bulletin 2015 115:19-44 

  • Corbacho B, Bell K, Stamuli E, Richardson G, Ronaldson S, Hood K, Sanders, Robling M, Torgerson D. Cost-effectiveness of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial. Journal of Evaluation in Clinical Practice 2017; 1-8. 2017 doi: 10.1111/jep 

  • Bell K, Corbacho B, Ronaldson S, Richardson G, Torgerson D, Robling M. The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: A systematic review. Health Economics Review.  2018; 8: 2. doi: 10.1186/s13561-018-0186 

  • Robling M, Cannings-John R, Channon S, Hood K, Moody G, Poole Ria, Sanders J. What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting. BMJ Open 2018; 8:e020152. doi:10.1136/bmjopen-2017-020152 

  • Huang C et al. A validation and calibration process for self-reported tobacco use with participants’ cotinine levels: an example from the Building Blocks trial. Nicotine and Tobacco Research. 2018, 1-5, doi.org/10.1093/ntr/nty232 

  • Sanders J, Channon S, Gobat N, Bennert K, Addison K, Robling M. Implementation of the Family Nurse Partnership Programme in England: Experiences of key health professionals explored through trial parallel process evaluation. BMC Nursing. (2019) 18:13 https://doi.org/10.1186/s12912-019-0338-y 

  • Bell K, Corbacho B, Ronaldson S et al. Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial [version 1; peer review: awaiting peer review]. F1000Research 2019, 8:1640 (https://doi.org/10.12688/f1000research.20149.1)  

  • Moody G, Addison K, Cannings-John R, Sanders J, Wallace C, Robling M. Monitoring adverse social and medical events in public health trials: assessing predictors and interpretation against a proposed model of adverse event reporting. Trials 20,804 (2019). https://doi.org/10.1186/s13063-019-3961-8

  • Buchanan E, Cannings-John R, Lugg-Widger F, Hood K, Butler C, Robling M. Assessing predictors of respiratory tract infections in infants born to teenage mothers: secondary analysis of the Building Blocks trial data, Family Practice, April 2020 cmaa037, https://doi.org/10.1093/fampra/cmaa037 

  • Stamuli E, Richardson G, Robling M, Edwards M, Torgerson D, Hood K, Sanders J, Ronaldson S. A Discrete-Choice Experiment to capture public preferences on the benefits of home-visiting programme for teenage mothers [version 1; peer review: awaiting peer review]. https://f1000research.com/articles/9-677/v1  

ISRCTN 23019866 


This trial was commissioned and funded by the Policy Research Programme in the Department of Health & Social Care (reference 006/0060). The views expressed are not necessarily those of the Department of Health & Social Care.