1. Family Nurse Partnership programme in England: - replicating an evidenced based programme

2. FNP IN Great Yarmouth and Waveney
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

3. “Changing the world – one baby at a time”

4. Family Nurse Partnership Programme
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).
Preventive in that it works with both the client in pregnancy
Intensive- with regards the visiting programme as well as the depth of the visits
Structured in that we use guidelines for each visit to give the nurse and the client structure 4

5. 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

6. Early evaluation suggests FNP can be successfully transferred to England
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.

7. Visit Structure:
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

8. What families receive : Approach
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

9. FNP turns around life chances and breaks intergenerational disadvantage
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

10. Cost savings from FNP for 100 families at a cost of £3000/yr/family could be:
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

11. Key points: FNP is…. Licensed Structured Interactive
Grounded in theory
Strength based
Research based
Based on a therapeutic relationship

12. Vulnerabilities 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
So what makes the FNP clients more vulnerable than the rest of our clients within Universal Services?
Teenage parents – they are dealing with huge brain changes, their frontal cortex is not yet developed, they find it difficult to interpret emotions, they are full of hormonal changes themselves…they are teenagers about to become parents, with the expectations that parenthood brings….as well as dealing with parental clashes, boyfriend troubles, parenthood…..social stigma’s…………and trying to be the best mum they can!

13. Professional views on teenage parents from market place event October 2011
Irresponsible
All get a flat
Uneducated
Challenging
Use pregnancy to get benefits
They are kids themselves
Lead onto next slide
This is not unusual…
Here is a synophsis of a text received from a teacher about one of my clients…

14. Our findings Stroppy Difficult Unreliable Challenging Rude Demanding
Ego centric
Selfish
Will not answer telephones…texts only
Lose phones / change numbers constantly
And many more……..

15. HOWEVER
WHY?
Can anyone shout any reason why teenagers are like this?

16. Some reasons why……… Never being able to trust No role models
Domestic violence
Physical abuse
Sexual abuse
Emotional abuse
Low expectations
Low self esteem

17. Reasons why continued……
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

18. Case history 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).

19. Questions
What are the risks?
What are the strengths?

20. Trust
Why is trust important for a mother and child?

21. Need Signals comfort Signals discomfort Satisfaction of need TRUST
SECURITY
LOVE
Signals
discomfort
Satisfaction
of need

22. Olds (1993)
‘...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.’