Family Nurse Partnership

“Changing the world – one baby at a time”

Introductions…

Alison Oxley – Family Nurse Supervisor

Ruth Taylor – Family Nurse

Hopes and aims of presentation

• To give you an understanding of the history of FNP in England and the evidence to support it

• To give you an understanding of the principles and approaches of FNP

• To give you the opportunity to hear about how FNP engages and works with the client

• To ask any questions you may have.

What is the Family Nurse Partnership Programme?• Intensive home visiting programme for 1st time parents

• Based on theories of Human Ecology, Attachment and Self-Efficacy

• Each visit covers 6 domains and uses materials and activities on relationships, attachment, life goals, care giving, behaviour change, social resources

• In depth relationship between nurse and client

Need, knowledge and evidence for FNP

• Poor outcomes for 2-5% of children with multiple disadvantages

• 2.9 million children are living in poverty in UK

• 5% of school leavers have no qualifications, 25% no GCSE passes above a grade D

• Evidence of what works

• Advances in neuroscience and infant development

• The need for a powerful intervention to bring about change

Trials of the NFP in USA

• Low-income blacks

• Urban

• Beginning data collection with the young adults age-17-years (2008)

• Large portion of Hispanics

• Nurse versus paraprofessional visitors

• Completed collection at age-9-years

• Planning the age-15-years (2010)

Elmira, NY1977

N = 400

Memphis, TN1987

N = 1,138

Denver, CO1994

N = 735

• Low-income whites

• Semi-rural

• Just finished re-visiting the children of the intervention mothers (28-years old)

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Consistent results across 3 trials in USA• Improvements in women’s antenatal health

• Reductions in children’s injuries

• Fewer subsequent pregnancies

• Greater intervals between births

• Increases in fathers’ involvement

• Increases in employment

• Reductions in welfare dependency

• Reduced substance use initiation and later problems

• Improvements in school readiness

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Why focus on young parents? Infant mortality rates are 60% higher for children of teenage mothers than

children of mothers aged 20-39

Smoking before or during pregnancy is estimated to contribute to 40% of infant deaths - teenage mothers are three times more likely to smoke throughout their pregnancy than older mothers.

Children of teenage mothers have a 63 per cent increased risk of being born into poverty compared to babies born to mothers in their twenties. They have lower academic attainment and at higher risk of inactivity later in life.

Children of teenage mothers are more likely to have accidents and behavioural problems.

Teenage mothers have three times the rate of post-natal depression of older mothers with 25% of teenage parents having mental health problems.

Teenage mothers are 50 per cent less likely to breastfeed than older mothers

Daughters of teenage mothers are more likely to become a teenage mother themselves, resulting in a repetitive cycle of poverty.

FNP GoalsConnecting with families to:

1.Improve pregnancy outcomes

2.Improve child health and development and future school readiness and achievement

3.Improve parents’ economic self-sufficiency

FNP approaches

• Strengths, potential• Intrinsic motivation• Guiding style• Relational• Emotional connection• Respectful curiosity• Learning and

understanding

• Structure and regularity• Modelling• Scaffolding• Committed• Agenda matching• Assertive engagement• Supervision

Comparison of problem and solution focused work

• Looks for ‘clues’ that will reveal deeper problems and diagnoses

• Tries to understand fixed problem patterns in client’s lives

• Elicits detailed descriptions of problems and unwanted memories

• Focuses on identifying ‘what’s wrong , what’s not working ‘ and on deficits in individuals , families and communities

• Looks for ‘clues’ that reveal hidden strengths and possibilities

• Tries to understand how positive change occurs in client’s lives

• Elicits detailed descriptions of goals and preferred futures

• Focuses on identifying ‘what's right and what's working ‘ on strengths , skills and resources in individuals, families and communities

Potential for impacts is promising• Many clients reported positive changes in their understanding of pregnancy,

labour, delivery and their infant.

• Clients had strong recall of the nutritional advice they had received.

• Reduction in smoking during pregnancy (20% relative reduction)

• Breast feeding initiation rate higher than national rate for same age group (FNP = 63% UK under 20s = 53% ).

• Clients more confident as parents, doing activities with children likely to enhance cognitive and social development.

• Many clients reported planning to return to education.

• Closer involvement of fathers with infants.

• Feel less judged and excluded, thinking about the future with more optimism, gives them an expectation that formal services could be helpful.

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FNP in England

• We can deliver FNP in this country• The materials work in this country• It seems to be acceptable to clients• We seem to be reaching those who benefit most• Fathers are involved• The nurses are highly committed• The clients value their nurses• The training is highly valued• Early impacts look promising

Liverpool and the FNP

Currently based in Yew Tree Centre

Team consists of:

Supervisor

Five Family Nurses

Administrator

FNP in Liverpool

Current trends are showing: • Number of clients returning to education• Excellent attendance for antenatal appointments• Large percentage of pregnancies reaching full term • Babies higher than average birth weight• Steady number of referrals to smoking cessation service• Involvement with young dads• High uptake of primary course of immunisations

Working with clients

• Innovative ways of working• Agenda match• Flexible hours• Text contact• Multi – agency approach• Work with all the family• Meet anywhere……

It is a great thing to be involved in. As a young mum I didn’t know what to expect. Now I’m ready for anything!

Focus on Strengths…

I Say: My family nurse Says: I would like to work on:

Domains

Personal HealthOne thing I do to keep myself healthy during my pregnancy is

I know my pregnancy is going well because

I follow my midwife’s instructions when I

One thing that helps my baby to be strong and healthy is

Environmental HealthThe thing I have done to make my house safer for me and my baby is

Life Course DevelopmentOne thing I do well is

I am proud of

Focus on Strengths…

I Say: My family nurse Says: I would like to work on:

Domains

Maternal RoleI am getting ready to be a mum by...

Something new I have learned about caring for my baby is

When I think about my baby I feel...

Family and FriendsOne way people I care about know that they are important to me is

Health and community ServicesWays I have been successful at getting help when needed are...

Clients thoughts…….

It really makes you think about everything

It has relaxed me about labour

From a young dad

Gives us times to express our feelings

From a young mum

I think the service is great because I learn a lot about pregnancy, babies and its

very interesting

Clients thoughts on the FNP

I love it! It helps me so much and its nice to be able to talk about everything…

I think it’s a great help, It has given me lots of information…

I think it will prepare me be a parent and to look after my baby well….

The programme has re-assured me throughout my pregnancy, with any

thoughts or worries I had.

Thank you for inviting us…Any Questions?