Southwark PCT Health Led Parenting Project Family Nurse Partnership

1. Southwark PCT Health Led Parenting ProjectFamily Nurse Partnership Barbara Hills � Project Lead Locality Director Rachel Bartlett - Supervisor Surjit Bhandal � Interim Project Manager

2. Family Nurse Partnership (UK programme) Based on Nurse Family Partnership which has been rigorously tested in USA over 30 year period. 10 pilot sites in UK. London has 2 � Tower Hamlets and Southwark. Supports families/young pregnant women who have a low income. First time parents Supported through pregnancy and first 2 years of life.

3. Social Exclusion Action Plan: �Reaching Out� We have seen reductions in child poverty, unemployment and crime, we now need to help those families caught in a cycle of disadvantage and exclusion by: Earlier and better identification of at risk families  Earlier and more effective intervention and prevention Building on the strengths of existing universal health visiting and midwifery services Builds on policy successes for children and families (Every Child Matters and the National Service Framework for maternity and children) Multi-faceted risks need multi-faceted but integrated responses

4. �Like it or not, the most important mental and behavioural patterns, once established, are difficult to change once children enter school�Nobel Laureate James Heckman (2005) Pregnancy and the first 3 years are vital to child development, life chances and future achievement Pregnancy and birth of a child is a �magic moment� of opportunity when parents are uniquely receptive to support Universal midwifery and health visiting services are ideally placed to identify children and families at risk Embedding the principle of �progressive universalism� into maternal services should be a priority to ensure that additional support is provided to those children and families at greatest risk

5. Emerging knowledge on neurological development Brain development depends on both genes and experiences Rapid brain development takes place in the first year of life Early interactions directly affect the way the brain is wired � �use it or lose it� Early relationships set the thermostat for later control of stress response (Shore R, Rethinking the Brain, 1997)

6. Why love matters� Looks and smiles help the brain to grow Baby looks at mother; sees dilated pupils (evidence that sympathetic nervous system aroused and happy); own nervous system is aroused - heart rate increases Lead to a biochemical response - pleasure neuropeptides (betaendorphin and dopamine) released into brain and helps neurons grow Negative looks trigger a different biochemical response (cortisol) stops these hormones and related growth (Gerhardt, 2004)

7. Differences in brain development following sensory neglect

8. Family Nurse Partnership Visiting Schedule Once every week for first month Every other week through Pregnancy Once every week for first 6 weeks after delivery Every other week until 21 months Once a month until child is 2 years old

9. Southwark PCT�s Programme Scope Aim to recruit 120 families - Equates to 24 families per home/health visitor CRITERIA All first time mothers under 20 years Between 16 � 28 weeks of their pregnancy No marketable education qualification Lack of meaningful social support May have other major issues, ie, mental health illness

10. What�s different? Programme outcomes are dependent on faithful replication of the original research Fidelity to the research model - responsibility of Supervisor Content prescribed but delivery tailored network for publicity Client centred, strength based and solution focused

11. Content of visits covers 6 domains Personal health � women�s health practices and mental health Environmental health � adequacy of home and neighbourhood Life course development � women�s future goals Maternal role � skills and knowledge to promote health and development of their child Family and friends � helping to deal with relationship issues and enhance social support Health and human services � linking to other services

12. FAQs Can anyone refer to the team? YES How long will this service be available? THE PROGRAMME IS RECRUITING UNTIL SEPTEMBER 2007 (TARGET OF 120 FAMILIES) What is the skill mix of the team? THEY ARE ALL EXPERIENCED HEALTH VISITORS (SOME ARE DUAL TRAINED) & HAVE RECEIVED ADDITIONAL TRAINING TO DELIVER THIS SERVICE What is the difference between the Family Nurse Partnership (FNP) and Sure Start Plus? THE FNP IS A PRESCRIPTIVE PROGRAMME WHICH ALL 10 SITES HAVE TO IMPLEMENT IN AN IDENTICAL WAY

13. There is no one model of Sure Start Plus. The implementation of Sure Start Plus has been left to local implementation and has become integrated /linked to the Teenage Pregnancy Strategy. Therefore it was difficult to evaluate and measure some of the objectives due to poor data recording/collection. (Example, repeat pregnancies, health targets � no significant differences on the breastfeeding and smoking cessation) The Sure Start Plus National Evaluation highlights the need to develop health services specifically targeted at meeting young people�s needs. Through partnership work, the teenage pregnancy/parenthood support service should take a lead within the Children�s Trust to influence mainstream services, such as maternity, health visiting and housing services.

14. Family Nurse Partnership Team in Southwark Supervisor: Rachel Bartlett ext 7836 FNP Team: Bernie Chambers ext 7839 Ann Cleary ext 7837 Margaret Wilkins ext 7838 Margaret Khumalo Dorothy Oseki Base: Gaumont House (Peckham & Camberwell Locality Offices), 95 Marmont Road,off Peckham High StreetPeckham, London, SE15 5SL Tel: 020 7138 7840 Fax: 020 7639 9290