The Family Nurse Partnership How does it protect babies and young children?

1. The Family Nurse PartnershipHow does it protect babies and young children?

2. Pip O’Byrne – Service Development Lead FNP National UnitNicki Jefferies – Supervisor FNP Buckinghamshire

3. To provide a brief overview of FNP – what it is and how it help to safeguard children & deliver improved outcomes To share reflections from the evidence and from practice: How does FNP protect babies and children? Presentation objectives

4. Changing the world – one baby at a time

5. A structured, intensive home visiting programme delivered by highly skilled Family Nurses and Supervisors A prevention programme - a psycho-educational approach - focussing on adaptive behaviour change A programme with strong theoretical underpinnings and evidence base – over 30 years 3 RCTs in USA – testing England began 2007 RCT reports 2014 A licensed programme with fidelity measures to ensure replication of original research A high degree of intensity and depth and skill – makes the difference Offered the families who will benefit the most – first time young mothers under 20 years of age The Family Nurse Partnership programme

6. 1. Improve pregnancy outcomes 2. Improve child health & development; helping parents provide more competent care; support child development to help achieve school readiness; break intergenerational low aspiration cycle 3. Improve parents’ economic self-sufficiency FNP Goals

7. Why an early intervention evidenced based programmed? To improve outcomes for 2-5% of children with multiple disadvantage – to first time young mothers often traumatised by own childhoods. Early experiences strongly influence whether a child’s developing brain architecture provides a strong or weak foundation for future health, learning and behaviours Learning from advances in neuroscience and infant brain development Scientific consensus that origins of adult disease often found in pregnancy and infancy Social and economic benefits of effective prevention and early intervention It is possible to make a difference!

8. What is the programme made up of? • The client & family • Early in pregnancy until child is 2 years old • The nurse - skills & personal qualities • The supervisor and in-depth supervision • The relationship – the vehicle for change • The approach, method, spirit – strength based, guiding style predominates, focus on engagement & agenda matching • Reflective & relational-based practice • The content of visits & schedule • Live data & evidence

9. Safeguarding children heart of FNP Evidenced based model used to inform practice, create learning environment & therapeutic strengths based practice…… Leading to improved outcomes for young parents and their babies, with significant improvements in parenting ability, attachment & attunement FNP helping to strengthen the system to better support vulnerable children (Cantrill 2011) Helping to create learning culture, authoritative & confident practice Chimes with Munro – child’s journey – early help – reflective, supportive practice Reflects ethos & requirements in Working Together To Safeguard Children (March 2013) esp. early help, child centred, evidence base Heart of FNP

10. Coherent evidence & research based model of practice for preventing maltreatment & intervening where there are safeguarding concerns Model beyond assessment, referral & monitoring to making a difference in outcomes How to support practitioners in the complex work of working with families with very young children Model of change that engages professionals with children & families, rather than using systems & processes & top down policy guidance Strengths based relational work Helping parents understand their babies – building empathy – what does your baby think/feel? FNP contribution to safeguarding

11. Strength based approach Engagement Supervision How does FNP protect babies and young children?

12. Being strengths based – different to being strengths focused!

13. Being strengths focused could lead to missing where the gaps are. If strengths are identified, the challenges and risks become clearer, being strengths based leads to becoming aware of where the gaps are. Identification of strengths - working with strengths, builds self efficacy Building self efficacy - build confidence, having success with the small things gives confidence to tackle the bigger ones. Being strengths based keeps us connected with our clients. Being strengths based – different to being strengths focused!

14. How does engagement help?

15. How does engagement help? • Connected, common interest – the best outcome for baby • Engaged in: • relationship • programme • change • Enhanced by FNP ethos, approach, communication style (rooted in motivational interviewing) • The engagement in the relationship and the programme, ultimately leads to the engagement in change with a move towards sensitive, responsive, protective parenting

16. Good supervision = Good safeguarding

17. “Frontline staff in each of the key agencies have a demanding task. Their work requires not only knowledge and skill but also determination and courage and an ability to cope with sometimes intense conflict. This must be recognised in their training, caseloads, supervision and conditions of service, and their managers must recognise that anxiety undermines good practice. Staff supervision and the assurance of good practice must become elementary requirements in each service. More should be done to ensure the well-being and confidence of staff who undertake such important work on behalf of us all.” Lord Laming 2009 Model of supervision in FNP - informed by evidence

18. “Supervision will be both educative and supportive and facilitate the supervisee to explore their feelings about the work and the family”. Working Together 2010 “It is as if the confluence of the search for certainty in detecting and eradicating abuse and neglect, combined with the belief (and management oversight) that following the rules will further reduce the risk of missing a case, has replaced the space of reflection on professional judgement which actually protects children and young people”. The Munro review of child protection: Part one: A systems analysis 2010 Model of supervision in FNP -informed by evidence

19. Educative (formative) To develop the skills, understanding, learning and capacities of Family Nurses Supportive (restorative) To explore practice and attend to the emotional impact of the work on family nurses Supervisor also responsible for managing and containing the emotions of the session Managerial (normative) Responsibilities for programme fidelity, quality of service provided to clients Responsibilities to the organisation including policies, procedures and safeguarding Model of supervision in FNP – what does it look like?

20. Model of 1:1 supervision in FNP – what does it look like? 6. supervisor 5. Supervisory relationship 4. Family nurse 7. Wider contexts 2. Methods and approaches used by FN 3. FN/client relationship 1. Client and child From: Hawkins and Shohet

21. Kolb’s experiential learning cycle Model of supervision in FNP – what does it look like? Concrete Experience “Experiencing” Reflection “Examining” Actions “Applying” Analysis “Explaining”

22. Nurse Client Child supervisor Nurse Client Model of supervision in FNP and the parallel process Parallel Process: The client’s relationship with her nurse and her interactions affects the client’s interactions with her child. Parallel Process: The nurse’s relationship with her supervisor and her interactions with others in the organisation affects the nurse’s interactions with her clients.

23. Good news for Baby Two good news stories!

24. Good news for Baby, Mum and Dad Two good news stories!

25. FNP is a programme that is evidenced to work FNP is a programme that protects by prevention, can’t promise it will stop abuse and neglect in all instances but the evidence is that it can Early engagement = early preventive work = time to change or early identification of challenges and risks alongside strengths, leading to early intervention of protective strategies  Family nurses are expert communicators , this supports therapeutic relationships and professional relationships The family nurse is working to bring about change in the care giving a baby and young child will receive by enabling the clients to have understanding, confidence and competence Summary / reflections 1.

26. Good analysis supported by supervision and team consultation from safeguarding specialist practitioners and psychologist Nurses just like the clients are valued and invested in – strengths based approach is used, increased self efficacy, reduced anxiety, containment & regulation = parallel process This time in the client’s life is a magic window of opportunity, every mother has the intrinsic motivation to do the best for her baby, the skill is in the nurse being able to harness and build on this with her Summary / reflections 2.

27. Changing the world – one baby at a time