Family Nurse Partnership

1. Family Nurse Partnership Jayne Snell Family Nurse Supervisor Clare Brackenbury Family Nurse

2. The Family Nurse Partnership programme • Evidence based and structured early intervention prevention programme that, in US trials, improves the health and well being of the most at risk children and families • Part of government policy to deliver Every Child Matters outcomes and prevent social exclusion • Part of the intensive end of a progressive universal Child Health Promotion Programme • Health has the skills, legitimacy and responsibility to make a difference

3. Overview Of the Family Nurse Partnership: • Selected from an international review of early intervention and prevention • 25 years of development, testing and refinement by Professor David Olds in US • 3 large scale replicated clinical trials • Compared nurses with para-professionals

4. What is the FNP • Aims to improve the early health and development and future life course of disadvantaged children and their parents • Intensive home visiting by specially trained Family Nurses from early pregnancy until the child is 2 years old (caseload of 25 families) • Using evidence based methods and visit guidelines and materials • Underpinning theories: Self-efficacy, Attachment and Human Ecology

5. What is different? • Structured Programme • Therapeutic Relationship • Focus on strengths, not problems and deficits • Goal driven assist clients in achieving their ‘hearts desire’ • Intensive visits • Focus on behaviour change through motivational interviewing and self efficacy • Continuity of practitioner, starting in early pregnancy, • Emphasis on fathers • Six domains • Weekly supervision, two monthly case presentation

6. Challenges • Communication (verbal/non-verbal) • Engagement • Keeping clients attention • Peer pressure/clients inhibitions • Engagement with other services • Service availability locally

7. What works • Motivational interviewing to promote behaviour change • Strengths focused approach • Solution focused approach • Texting • Persistence and tenacity • Non-judgemental • Not making assumptions • Walking alongside of them rather than being in their shoes and ‘fixing it’ for them • Supporting them in engaging with other services and utilising Children’s Centres

8. History of the FNP in Berkshire East • Began in Slough April 2007- one of ten testing sites • Team = 1 Supervisor, 7 Family Nurses backgrounds midwifery and health visiting • Rolled out across Berkshire East In January 2009

9. Profile of WAM Clients • Currently working with 6 clients, still recruiting for RCT • 3 known to Social Care, 1 young mum subject to protection plan • 2 known to Mental Health • 1 under 15 at enrolment

10. FNP In England- what we know about implementation • FNP can be implemented successfully in England • The materials work and are well received by families • The programme is welcomed by hard to reach families and reaches clients likely to benefit most • Successfully engages hard to reach families from early in their pregnancy • Clients value the programme • Engagement with fathers is good • The programme has the enthusiastic support of the nurses who are seeing changes take place in health behaviour , relationships , parental role and maternal well-being

11. Can FNP make a difference? • Many clients reported changes in their understanding of pregnancy, labour, delivery and their infant • Clients had a strong recall of the nutritional advice they had received • Early findings show a reduction in smoking in pregnancy (40%-32%). • Breast feeding initiation rate higher than the national rate for the same age group (FNP 63% UK under 20’s 53%)

12. Current Situation • Berkshire East is one of eighteen RCT sites across England • Research Team is Building Blocks at Cardiff University • Research Nurse employed and currently recruiting clients • 2 Family Nurses within the team funded by the DOH to work with trial clients

13. Case Study • 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 • The relationship between the nurses and the family lies at the heart of the programme

14. Client Quotes ‘If it wasn’t for my nurse I really don’t know where I’d be, never mind my baby.’ ‘Because we have learnt it together we do it together’. 19 year old dad ‘Gives information then you can make your own decisions, you don’t feel forced e.g. breastfeeding and giving up smoking which for me means I am more likely to do it as I always do the opposite to what I’m told.’ ‘When I was having mine, it was about you or the baby, and that is it but this way we are all involved which makes us a stronger family and when the nurse isn’t around I can follow the same approach as it has changed from when I did it so I probably would have been giving her different advice.’ Grandma. ‘My nurse is the first person that has made me feel good about myself in as long as I can remember – I feel like I can take on the world now.’