Costs and effectiveness of community postnatal support workers

doi:10.1136/bmj.322.7281.301

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Researchers must now focus on effectiveness with specific groups of women

Jane Barlow, primary care career scientist (jane.barlow@dphpc.ox.ac.uk),
Sarah Stewart-Brown, director

Health Services Research Unit, University of Oxford, Institute of Health Sciences, Headington, Oxfordshire OX3 7LF
Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA
Mother and Infant Research Unit, University of Leeds, Leeds LS2 9LN

EDITOR—Evaluation of the effectiveness of home visiting programmes in the United Kingdom, as in Morrell et al's study, is much needed.1 Several systematic reviews of the effectiveness of these programmes have indicated that their success depends on the population selected, the extent to which the skills of the staff have been matched to the needs of the family, and the duration of the programme.2 The disappointing results of Morrell et al's trial might well be understood in terms of the first two of these factors in particular.

Perhaps most importantly, there is evidence of differential effects of home visiting programmes in subgroups of individuals. Several studies have shown that support of this nature that is offered to mothers who are already coping, or to mothers who are not experiencing adversity, can not only fail to produce positive outcomes but also lead to …