Nobody Slips Through the Net
Note on provider involvement: This provider has agreed to EIF’s terms of reference, and the assessment has been conducted and published with the full cooperation of the programme provider.
Nobody Slips Through the Net (or Keiner Fällt Durchs Netz, KfdN) is a German home-visiting programme delivered by trained family midwives to parents identified as having multiple risks.
Visits start postpartum and end at the child’s first birthday. The frequency of visits varies according to the needs of the family.
EIF Programme Assessment
Nobody Slips Through the Net has preliminary evidence of improving a child outcome, but we cannot be confident that the programme caused the improvement.
What does the evidence rating mean?
Level 2 indicates that the programme has evidence of improving a child outcome from a study involving at least 20 participants, representing 60% of the sample, using validated instruments.
This programme does not receive a rating of 3 as its best evidence is not from a rigorously conducted RCT or QED evaluation.
What does the plus mean?
The plus rating indicates that a programme’s best available evidence is based on an evaluation that is more rigorous than a level 2 standard but does not meet the criteria for level 3.
A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of £100–£499.
Child outcomes
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Supporting children's mental health and wellbeing
Preventing crime, violence and antisocial behaviour
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Nobody Slips Through the Net
Key programme characteristics
Who is it for?
The best available evidence for this programme relates to the following age-groups:
- Infants
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Home visiting
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Home
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted selective
Where has it been implemented?
Germany
UK provision
This programme has not been implemented in the UK.
UK evaluation
This programme’s best evidence does not include evaluation conducted in the UK.
Spotlight sets
EIF does not currently include this programme within any Spotlight set.
Nobody Slips Through the Net
About the programme
What happens during delivery?
How is it delivered?
- KfdN is delivered by a family midwife or paediatric family nurse to individual families for an average of 19 sessions of approximately one to two hours' duration.
What happens during the intervention?
- During the visits, the mother and infant’s health needs are addressed and mothers receive advice and support on how to respond appropriately to their child’s needs. In particular, mothers are coached in how to understand and respond appropriately to their infant’s cues, including crying behaviours.
What are the implementation requirements?
Who can deliver it?
- KfdN is delivered by a family midwife or paediatric family nurse with QCF-2 level qualifications.
What are the training requirements?
- The practitioner has 160 hours of programme training. Booster training of practitioners is not required.
How are the practitioners supervised?
- Two QCF-6 qualified supervisors (one host-agency supervisor and one programme developer supervisor) are recommended to support delivery. There are no booster training recommendations for practitioners.
What are the systems for maintaining fidelity?
- Training manual
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Parents experiencing multiple hardships and/or an insecure attachment relationship in their own childhood are less likely to respond sensitively and appropriately to their child’s behaviour.
- Parents receive information about their children’s development, including support for understanding infant crying and strategies for implementing effective sleep routines, to increase their ability to provide a sensitive and nurturing home for their child.
- In the short term, parents respond more sensitively to their children.
- In the longer term, children will develop positive expectations of themselves and others, demonstrate improved self-regulatory capabilities.
Contact details
Dr Anna Sidor
[email protected]
Nobody Slips Through the Net
About the evidence
Nobody Slips Through the Net’s (or Keiner Fällt Durchs Netz: KfdN) most rigorous evidence comes from a QED which was conducted in Germany.
This study identified statistically significant positive impact on a number of child and parent outcomes.
This programme is underpinned by one study with a Level 2+, hence the programme receives a Level 2+rating overall.
Study 1
| Citation: | Sidor et al (2013) |
|---|---|
| Design: | QED |
| Country: | Germany |
| Sample: | 302 mother-child dyads, 225 from the original study and 186 from the original study |
| Timing: | Child age 4 months; child age 6 months; child age 12 months; child age 24 months; child age 36-48 months |
| Child outcomes: |
Improved social development
Reduced difficult child behaviour Increased compliance and regulative competence |
| Other outcomes: | Reduced dysfunctional parent-child interaction Reduced use of negative behavioural strategies |
| Study rating: | 2+ |
Sidor, A., Kunz, E., Eickhorst, A., & Cierpka, M. (2013). Effects of the early prevention program “Keiner FÄllt Durchs Netz” (“Nobody Slips Through the Net”) on child, mother, and their relationship: A controlled study. Infant Mental Health Journal, 34, 11-24.
Sidor, A., Fischer, C., & Cierpka, M. (2015). The effects of the early prevention program “Nobody Slips Through the Net”: A longitudinal controlled study in an at-risk sample. Mental Health & Prevention, 3, 103-116.
Available at
http://onlinelibrary.wiley.com/doi/10.1002/imhj.21362/full
http://www.sciencedirect.com/science/article/pii/S2212657015000240
Study design and sample
The first study is a QED.
152 KfdN families were compared to 150 families living in adjacent communities not receiving the intervention. The groups were not fully equivalent, with those in the comparison group being significantly less disadvantaged than those in the treatment group.
This study was conducted in Germany, with a sample of 302 mother-child dyads. The majority of the participants in the intervention group (69.7%) had an income below €1,000 per household, and more than a third (35%) of the comparison group.
Measures
Child development (communication, gross motor skills, fine motor skills, problem-solving skills, social development) was measured using the Ages & Stages Questionnaire (parent report). Child psychic disturbances (emotionally reactive, anxious/depressed, somatic complaints, withdrawn, sleep problems, attention problems, aggressive behaviour) were measured using the German version of the Child Behavior Checklist (parent report). Child language development (speech comprehension, semantic-lexical competence, phonetic-phonologic competence, morphologic-syntactic competence) was measured using the language development test SET-K 3-5 (direct assessment). Child self-regulation abilities were measured using the IMpulsManagement questionnaire (parent report).
Maternal sensitivity was measured using the CARE index (expert observation of behaviour). Postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (parent report). Maternal distress was measured using the German version of the Parental Stress Index-Short Form (parent report). Maternal parenting strategies were measured using the IMpulsManagement questionnaire (parent report). Maternal depressive symptoms were measured using Allgemeine Depressionsskala (ADS, General Depression Scale) (parent report).
Findings
This study identified statistically significant positive impact on a number of child and parent outcomes.
Child outcomes include:
- Improved social development
- Reduced difficult child behaviour
- Increased compliance and regulative competence
The conclusions that can be drawn from this study are limited by methodological issues pertaining to the lack of randomisation resulted in a comparison group that was not equivalent to the treatment group on a number of key demographics, hence why a higher rating is not achieved.
Other studies
The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies.
Sidor, A., Fischer, C., & Cierpka, M. (2013) Early Regulatory Problems in Infancy and Psychopathological Symptoms at 24 Months: A Longitudinal Study in a High-risk Sample. Journal of Child and Adolescent Behaviour, 1: 116 - This reference refers to a pre-post study, conducted in Germany.
Published April 2024