Workforce quality in early years interventions: evidence from a large-scale home visiting programme

14th June 2021 : 12:45 - 14:00

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Dr Gabriella Conti

Early intervention programmes can play an important role in improving children’s health and their cognitive and socio-emotional development. While existing evidence demonstrates the potential benefits that these programmes can have, particularly for the most disadvantaged, much less is known about the factors that drive effectiveness in scaled-up programmes.

In this paper, we investigate the important but under-researched question of workforce quality within the context of the Family Nurse Partnership (FNP). This is a large-scale home-visiting programme in England targeting first-time teenage mothers, which has previously shown benefits for children’s cognitive development (Robling et al., 2015). For identification, we exploit a unique feature of the assignment process of the family nurses to the clients within the FNP teams.

Conditional on a small set of variables governing the assignment process, nurses were assigned to clients to equalise caseloads within teams. We present evidence that, for a wide range of client and nurse characteristics, there is no systematic relationship between clients and nurses conditional on these assignment variables. We then present results on the effects of family nurse quality on the cognitive, socio-emotional and health outcomes of the child.

First, we find evidence of substantial heterogeneity. A one-standard deviation (SD) increase in family nurse quality leads to a 0.22 SD increase in birthweight, to a 0.25 SD increase in child’s cognition at age 2, and to a 0.29 SD increase in child’s socio-emotional development at age 2. We also show a strong correlation between nurse effectiveness for different outcomes; of the nurses who are in the top quintile of effectiveness in boosting cognitive development, almost half are in the top quintile for socio-emotional development. We also find evidence that nurses can improve maternal mental health and reduce unhealthy behaviours, potentially mediating their effect on children.

However, despite a very rich set of characteristics such as demographics, training, experience and qualifications, we can only explain between 10 and 15% of this variation in family nurse effectiveness. These results are reminiscent of the literature on teacher quality, where observable characteristics have little power in explaining variation in teacher’s value-added. Our results show that the quality of the workforce matters, and that we are just starting to understand its determinants.