FNP: Integration of a licensed programme

1. FNP: Integration of a licensed programme Improving Integrated Assessment, Interventions and Developing Integrated Pathways Sam Mason, FNP National Unit

2. What is FNP? • A structured, intensive home visiting programme delivered by family nurses • Offered to first time young mums (and dads) • Begins early in pregnancy, concluding when child reaches 2 years • Preventive public health programme, focussing on adaptive behaviour change • Evidence based programme proven to improve short, medium and long term outcomes and break the cycle of disadvantage

3. FNP Goals • To improve the outcomes of pregnancy by helping women improve their prenatal health • To improve children's health and development by enabling parents to provide more competent care for their children • To improve women's life course by planning subsequent pregnancies, finishing their education and finding employment.

4. Wide range of proven benefits forchildren and families Improved maternal pregnancy behaviours • Reduced smoking during pregnancy Improved parenting • Reduced child abuse and neglect • Reduced injuries and ingestions • More stimulating home environment Improved child development • Improved language and mental development, fewer mental delays; • More responsive to interactions with mother Improved school readiness and school achievement Fewer emotional and behaviour problems • Fewer mental health problems at age 12 • Reductions in clinical level behaviour problems (age 4, 6) • Reductions in risky behaviours – smoking, alcohol, marijuana • Fewer arrests, supervision orders by age 15, arrests and convictions for girls by 19 Improvement in parents’ life course development • Fewer subsequent pregnancies & births • More months employed • Less use of welfare • Improved mastery (self efficacy) • More months with partner/employed partner • Fewer arrests and convictions • Increased father involvement in child’s care

5. FNP in England:16,000 places by 2014/15 FNP coverage March 2014 Planned FNP coverage 14/15

6. Who is FNP for? • All first time young mothers to be aged 19 and under (and fathers/families) • Specialist universal service (Universal Partnership Plus) • Voluntary, at least 75% of those offered enrol • Early in pregnancy, enrol no later than 28th week of pregnancy • Current coverage approx 25% of eligible population, varies considerably between areas • FNP available in around 130 LAs by March 2015

7. Implementing a licensed programme • To ensure programme replicated as intended and expected benefits realised • Well defined intervention + well defined implementation model + effective replication and implementation = positive outcomes for intended consumers Attention to fidelity at levels • Intervention fidelity: programme model is delivered as intended • Implementation fidelity: programme implementation drivers are installed within a system to enable clinical replication

8. Replicating FNP with Fidelity • The license • Having a programme that can be described - what, when, why and how • Practitioner selection • Clear guidelines and content • Fidelity measures - core model elements and stretch goals • The learning programme and use of FNP methods in practice • Supervisor role - contributing to learning, reflection, coaching • Real time Information System and performance evaluation - nurse, team, site • Quality improvement measures • The Advisory Board

9. Replicating FNP with Fidelity • But… • The programme is being implemented within a pre-existing system, with its own norms, culture and expectations • The programme model is complex and every client and their circumstances are different • So in both instances consideration is needed about what has to remain fixed and what can be flexed

10. Effective replication:fixed and flexed For local leaders this means… • Understanding the science and the impact leaders have on outcomes • Maintaining implementation fidelity whilst being creative in flexing local systems for programme integration • Respecting clinical practice and actively supporting maintenance of intervention fidelity • Using data reports, clinical analyses and client feedback to guide efforts in continual quality improvement • Planning for sustainability and preventing implementation drift over time

11. Effective replication:fixed and flexed For family nurses and supervisors this means: • Absorbing all the learning – theoretical underpinnings, content and methods of the programme • Skilful practice – adapting to replicate programme methods with clients • Using the real time information on implementation and achievement of stretch goals to guide efforts in continual quality improvement • Sustaining clinical model over time and absorbing new augmentations • With individual clients, across caseload, over time, within team

12. Integration with local services • FNP well integrated in many areas • At individual practice and local system level: • FNP Advisory Board • Safeguarding • CAF, Pre-CAFs, Lead Professionals • Midwifery/maternity • Children’s Centres • Child and adult health services • Health visiting • Healthy Child Programme delivered as part of FNP • FNP clients handed over to universal services at age 2 • FNP supports client to access the other services they need • ‘Sharing the learning’ • Clients • Supervisor

13. Moving integration forward • How do we encourage more integration, in more places, more quickly, more consistently? • Further understanding of what is good practice re integration of FNP • What can be flexed and how, what can’t and how to keep it fixed • Understanding what works and doesn’t • Sharing approaches and best practice • What can FNPNU do to best support and stimulate integration?