Hertfordshire FNP Team

1. Hertfordshire FNP Team • The FNP is a preventive programme for young first time mothers. • It offers intensive and structured home visiting, delivered by specially trained Family Nurses • from early pregnancy until the child is two

2. How is the FNP Different? Research based programme- RCT Focuses on strengths and goals, not problems Starts in early pregnancy until 2 years of age Structured programme Universal service (with criteria) rather than referral based

3. How is the FNP Different? • Regular supervision for the family nurses • Psychology Sessions • Therapeutic relationship • Motivational interviewing techniques used to • facilitate behaviour change • Training programme

4. Scaffolding • Family nurse as a temporary scaffold to help clients become organised and self-regulated • Programme enables clients to learn, identify their goals and develop plans for reaching them • Clients in turn will become supporting frameworks for their children

5. Improved outcomes-short term • Reduced smoking and drug use during pregnancy • Fewer subsequent pregnancies and greater intervals between births • improved parenting practices and behaviour • increased maternal employment and reduced welfare use • Increased breast-feeding initiation

6. Programme outcomes – long term • Improved early language development, school readiness and academic achievement • Reduced child abuse and neglect, fewer childhood injuries • Improved behavioural and emotional development • Fewer arrests and convictions by age 15 and 19

7. Our Results So Far The project is well accepted by teenage parents with very few clients ‘dropping out’ An increase in the number of young mothers and fathers who stop smoking in pregnancy An increase in self-esteem of young parents in the programme A greater involvement from young fathers and other family members in the programme A willingness to develop a long term therapeutic relationship with their Family Nurse A willingness to learn about and try breast feeding A willingness to learn about the development of babies and health related issues.

8. February 2013

9. What difference does FNP make with 100 families? For a cost of £3000/yr/family the outcomes attributable to the FNP could bring us the following cost benefits: Year One: If we prevent 1 day in hospital for 10 pregnant women we save £10,000 If we prevent one overnight stay in SCBU for 10 babies we save £4,500 If we prevent a 10 day stay in intensive neonatal care for just one baby we save £10,000 Year One and Two If we prevent 5 emergency hospital admissions we save £3,750 If we prevent 20 A&E attendances we save £2,000 If we prevent 5 children going into foster care it will save £135,000 a year If we prevent the need for 10 core assessments by children's social care we save £6,500 Thereafter If we prevent 10 cases of serious conduct disorder we can save society £2.25m over their lifetime and £1.5m if we prevent 20 cases of moderate conduct disorder If we improve the outcomes of 50 children with multiple disadvantages we could help save local services over £5m by the time these children are 16 If we help 10 young women with no qualifications return to education and so gain employment we can save the state £70,000 in benefits alone If we contribute to improved literacy and numeracy in 80 children we could help save society up to £5m over a lifetime 8

10. How Families Have Responded a “I want the best for me, my partner and the baby” “My Family Nurse will help me to achieve this” “I feel part of the pregnancy, my family nurse involves me and values me as a DAD” “I feel happier, better about myself, not depressed growing up” “My Family Nurse doesn’t tell me off”

11. Next Steps • Positive end of first year Annual Review by the National Unit. • Expansion of FNP in Hertfordshire • Continue to use Information Data system and S1 to measure programme outcomes

12. EVERYBODY NEEDS A FAMILY NURSE