Evidence into Practice

1. Using a Strength Based Approach in Family Nurse Partnership (FNP) Evidence into Practice Gail Trotter FNP Implementation Lead, Scotland

2. Aims of Family Nurse Partnership • To improve pregnancy outcomes and maternal health • To improve child health and development and future school; readiness and achievement • To improve parents economic self-sufficiency

3. Professor David Olds: Pioneer USA • Works with pregnant teenagers and their partners until the child reaches 2 years • Preventative intensive early intervention • Strength based, promotes “self efficacy” • Intensive home visiting manualised programme • Mandatory training for Family Nurses: Masters level • Role of Midwife remains the same • Intense relationship • Fidelity Requirements

4. Testing FNP City Edinburgh CHP • First time parents 19 years or under at LMP • Planning to stay resident in Edinburgh: 2 years • No plans for relinquishment of baby • Opt-in programme • “Entitlement”

5. Focus on Strengths

6. Traditional Way Strength Based • Looks for “clues” that will reveal problems • Looks for “clues” that reveal hidden strengths and possibilities • Tries to understand, fix problems or patterns in client's lives • Tries to understand how positive change occurs in client's lives • Elicits detailed descriptions of problems • Elicits detailed descriptions of goals and preferred futures • Focuses on identifying “what's wrong, what's not working” and on deficits that can be fixed • Focuses on identifying “what's right and working” and focus on strengths, skills and resources

7. Client Centred Principle The client is the expert on her own life

8. Client is the Expert They have the solution!

9. Being Client Centred Can Lead Towards “Self Efficacy” A person’s belief that they can carry out behaviours asked of them

10. Focus on Strengths Does not mean being unaware of risk.GIRFEC

11. Traditional to Strength Based • Learning a new way of supporting client • Unlearning an old style of working • Forget, borrow, learn principles • Avoiding advice giving: guiding approach • Agenda matching: finding the “hearts desire” • Exploring ambivalence with clients

12. Traditional to Strength Based • Seeing the world through the eyes of the client • Hard to reach, hard to engage • Eyes with a “dangerous filter” • Response to emotional danger

13. OPPOSITIONAL REJECTED DEVALUED DISTRUSTFUL INSECURE ASHAMED Angry FRIGHTENED CONFUSED Sad Responses to Emotional Danger

14. “Dancing not wrestling” • “Rolling with the blows” • Not giving up • Doing what you say you will do • Remaining compassionate Supporting the Practitioner to Respond

15. Appreciating it is hard! • Understanding and confident practitioners • Meaningful: educational and training • Appropriate supervision • Collecting and sharing the evidence • Trusting the client • Organisational support: parallel processing • Baby benefits most Key to Working this Way

16. But does it really work?

17. Impact How the Programme Works Behaviour Change Learning Experience Relationship

18. 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 Programme effects greatest among those most susceptible

19. UK Evidence So Far • England evaluations • It is a model that works in England • Acceptable to the client: very low attrition • Educational materials transferable • Early signs: higher breastfeeding rates, decreased smoking in pregnancy, high uptake AN care, low substance initiation • Nursing workforce feeling fulfilled • 18 RCTs England • Scottish Government evaluation, Scotland