Presentation on theme: "FNP IN Great Yarmouth and Waveney"— Presentation transcript:
1 Family Nurse Partnership programme in England: - replicating an evidenced based programme
2 FNP IN Great Yarmouth and Waveney The Team:Nicole Hobson - supervisorCheryl Hale – family nurseJayne England – family nurseJuliet Keating – family nurseLisa Lorenzen – family nurseDiane Bryant – family nurseRachel Bradford – family nurseEmma Langdale - administrator
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 pregnancyIntensive- with regards the visiting programme as well as the depth of the visitsStructured in that we use guidelines for each visit to give the nurse and the client structure4
5 Consistent results across 3 trials in USA Improvements in women’s antenatal healthReductions in children’s injuriesFewer subsequent pregnanciesGreater intervals between birthsIncreases in fathers’ involvementIncreases in employmentReductions in welfare dependencyReduced substance use initiation and later problemsImprovements 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 modelThe programme is welcomed by hard to reach families and reaches clients who are likely to benefit mostSuccessfully 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 programmeEngagement with fathers is good.
7 Visit Structure:Weekly, fortnightly, monthly home visits from early pregnancy until the child is 2 years oldEach 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 childParents envisage a different possibility, a new story of themselves understanding of their lives and futuresThey become a dependable figure for their baby and better able to meet their emotional social and developmental needsBetter health related behavioursImprovements 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 £10,0001 overnight stay in SCUB for 10 babies we save £4,5005 emergency hospital admission we save £3,7505 children going into foster care it will save £135,000 a yearThe need for 10 core assessments by children’s social care we save £6,500Poor outcomes for 50 children with multiple disadvantages we could help save local over £5m by the time these children are 1610 young women staying in NEET and getting work we can save the state £70,000 in benefits alone80 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 theoryStrength basedResearch basedBased on a therapeutic relationship
12 Vulnerabilities Teenage parents Adolescent brain / expectations Complex life historiesLack of positive role modelsSocially isolatedJuggling parenthood and schoolingPre-judged – stigmatising societyIntergeneration disadvantage and povertySo 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 IrresponsibleAll get a flatUneducatedChallengingUse pregnancy to get benefitsThey are kids themselvesLead onto next slideThis is not unusual…Here is a synophsis of a text received from a teacher about one of my clients…
15 HOWEVERWHY?Can anyone shout any reason why teenagers are like this?
16 Some reasons why……… Never being able to trust No role models Domestic violencePhysical abuseSexual abuseEmotional abuseLow expectationsLow self esteem
17 Reasons why continued…… Depression – mental health problemsHistory of social services in own childhoodHistory of drug and alcohol abuse (and in own childhoods)Highly negative and punitive parentingTrauma
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 QuestionsWhat are the risks?What are the strengths?
20 TrustWhy is trust important for a mother and child?
21 Need Signals comfort Signals discomfort Satisfaction of need TRUST SECURITYLOVESignalsdiscomfortSatisfactionof 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.’