Transcript Family Nurse Partnership programme in England: an introduction

 The
Team:
 Nicole
Hobson - supervisor
 Cheryl Hale – family nurse
 Jayne England – family nurse
 Juliet Keating – family nurse
 Lisa Lorenzen – family nurse
 Diane Bryant – family nurse
 Rachel Bradford – family nurse
 Emma Langdale - administrator
“Changing the world – one baby at a time”






Developed in US over 30 years of rigorous research and
evaluation that shows positive results from pregnancy through to
19 years;
Licensed programme with fidelity measures to ensure replication
of original research;
Preventive, intensive, structured home visiting programme;
Offered to first time mothers under 20 years from early pregnancy
until child 2 years ;
Testing in England since April 07 in the 55 UK sites. Government
commitment to double the expansion of FNP to 13,000 families by
April 2015;
Large scale RCT started April 09 with 18 sites (RCT results due
April 2013).

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




FNP can be implemented successfully in England
– programme can be delivered with fidelity to the
US model
The programme is welcomed by hard to reach
families and reaches clients who are likely to
benefit most
Successfully engages with hard to reach families
from early in their pregnancy – 87% of women
offered programme enrol, high levels of retention
through to end of programme
Engagement with fathers is good.
•Weekly, fortnightly,
monthly home visits from
early pregnancy until the
child is 2 years old
•Each visit includes
structured conversations
and activities to improve
self efficacy, change
behaviour and build
attachment







Therapeutic alliance - being ‘with’ the client, inviting the
client/family to work on the difficult issues;
Focus on bonding, attachment and emotional availability of
caregivers;
Utilises client’s primary motivation as expectant mother;
Strength based, positive and hopeful – belief in clients strengths,
talents, skills and resources, expectation that client will succeed;
Using motivational interviewing skills to explore ambivalence and
structure conversations about change and personal growth without
coercion;
Respectful agenda matching to align energy from clients’
aspirations with programme goals;
Setting goals with small steps and positive feedback.
The relationship between the nurse and the family lies at the
heart of the programme





By taking a whole family approach and working
on all the inter-related factors that lead to and
compound disadvantage, poverty and poor
outcomes for mother and child
Parents envisage a different possibility, a new
story of themselves understanding of their lives
and futures
They become a dependable figure for their baby
and better able to meet their emotional social and
developmental needs
Better health related behaviours
Improvements in the mothers life course –
subsequent pregnancies, education , training and
work
If we prevent:
 1 day in hospital for 10 pregnant women we save £10,000
 1 overnight stay in SCUB for 10 babies we save £4,500
 5 emergency hospital admission we save £3,750
 5 children going into foster care it will save £135,000 a year
 The need for 10 core assessments by children’s social care
we save £6,500
 Poor outcomes for 50 children with multiple disadvantages
we could help save local over £5m by the time these
children are 16
 10 young women staying in NEET and getting work we can
save the state £70,000 in benefits alone
 80 children having poor literacy and numeracy we could
help save society up to £5m over a lifetime
FNP is….
 Licensed
 Structured
 Interactive
 Grounded in theory
 Strength based
 Research based
 Based on a therapeutic relationship
 Teenage
parents
 Adolescent brain / expectations
 Complex life histories
 Lack of positive role models
 Socially isolated
 Juggling parenthood and schooling
 Pre-judged – stigmatising society
 Intergeneration disadvantage and poverty
 Irresponsible
 All
get a flat
 Uneducated
 Challenging
 Use pregnancy to get benefits
 They are kids themselves
•
•
•
•
•
•
•
•
•
•
•
Stroppy
Difficult
Unreliable
Challenging
Rude
Demanding
Ego centric
Selfish
Will not answer telephones…texts only
Lose phones / change numbers constantly
And many more……..
WHY?
•
•
•
•
•
•
•
•
Never being able to trust
No role models
Domestic violence
Physical abuse
Sexual abuse
Emotional abuse
Low expectations
Low self esteem
 Depression
– mental health problems
 History of social services in own childhood
 History of drug and alcohol abuse (and in
own childhoods)
 Highly negative and punitive parenting
 Trauma
 15
years old 26/40 gestation
 Lives with mum and younger brother.
 Dad in prison (no contact for approx 12
years).
 Mum recovering heroin user.
 Neglectful and physically abusive childhood.
 Poor school attendance.
 Services ‘throughout’ life.
 Separated from FOC (he wants involvement
with baby).
•
What are the risks?
•
What are the strengths?
 Why
is trust important for a mother and
child?
Need
Signals
comfort
TRUST
SECURITY
LOVE
Satisfaction
of need
Signals
discomfort
‘...a significant proportion of some of the most
difficult and costly problems faced by young
children and parents today, are a direct
consequence of adverse maternal health
related behaviours during pregnancy,
dysfunctional infant care-giving, and
stressful environmental conditions that
interfere with parental and family
functioning.’