1. Family Nurse Partnership “Changing the world – one baby at a time”

2. Introductions… Alison Oxley – Family Nurse Supervisor Ruth Taylor – Family Nurse

3. Hopes and aims of presentation To give you an understanding of the history of FNP in England and the evidence to support it To give you an understanding of the principles and approaches of FNP To give you the opportunity to hear about how FNP engages and works with the client To ask any questions you may have.

4. What is the Family Nurse Partnership Programme? Intensive home visiting programme for 1 st time parents Based on theories of Human Ecology, Attachment and Self- Efficacy Each visit covers 6 domains and uses materials and activities on relationships, attachment, life goals, care giving, behaviour change, social resources In depth relationship between nurse and client

5. Need, knowledge and evidence for FNP Poor outcomes for 2-5% of children with multiple disadvantages 2.9 million children are living in poverty in UK 5% of school leavers have no qualifications, 25% no GCSE passes above a grade D Evidence of what works Advances in neuroscience and infant development The need for a powerful intervention to bring about change

6. Trials of the NFP in USA Low-income blacks Urban Beginning data collection with the young adults age-17- years (2008) Large portion of Hispanics Nurse versus paraprofessional visitors Completed collection at age-9-years Planning the age-15- years (2010) Elmira, NY 1977 N = 400 Memphis, TN 1987 N = 1,138 Denver, CO 1994 N = 735 Low-income whites Semi-rural Just finished re- visiting the children of the intervention mothers (28-years old) 8

7. 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 9

8. Why focus on young parents?  Infant mortality rates are 60% higher for children of teenage mothers than children of mothers aged 20-39  Smoking before or during pregnancy is estimated to contribute to 40% of infant deaths - teenage mothers are three times more likely to smoke throughout their pregnancy than older mothers.  Children of teenage mothers have a 63 per cent increased risk of being born into poverty compared to babies born to mothers in their twenties. They have lower academic attainment and at higher risk of inactivity later in life.  Children of teenage mothers are more likely to have accidents and behavioural problems.  Teenage mothers have three times the rate of post-natal depression of older mothers with 25% of teenage parents having mental health problems.  Teenage mothers are 50 per cent less likely to breastfeed than older mothers  Daughters of teenage mothers are more likely to become a teenage mother themselves, resulting in a repetitive cycle of poverty.

9. FNP Goals Connecting with families to: 1.Improve pregnancy outcomes 2.Improve child health and development and future school readiness and achievement 3.Improve parents’ economic self-sufficiency

10. FNP approaches Strengths, potential Intrinsic motivation Guiding style Relational Emotional connection Respectful curiosity Learning and understanding Structure and regularity Modelling Scaffolding Committed Agenda matching Assertive engagement Supervision

11. Comparison of problem and solution focused work Looks for ‘clues’ that will reveal deeper problems and diagnoses Tries to understand fixed problem patterns in client’s lives Elicits detailed descriptions of problems and unwanted memories Focuses on identifying ‘what’s wrong, what’s not working ‘ and on deficits in individuals, families and communities Looks for ‘clues’ that reveal hidden strengths and possibilities Tries to understand how positive change occurs in client’s lives Elicits detailed descriptions of goals and preferred futures Focuses on identifying ‘what's right and what's working ‘ on strengths, skills and resources in individuals, families and communities

12. Potential for impacts is promising Many clients reported positive changes in their understanding of pregnancy, labour, delivery and their infant. Clients had strong recall of the nutritional advice they had received. Reduction in smoking during pregnancy (20% relative reduction) Breast feeding initiation rate higher than national rate for same age group (FNP = 63% UK under 20s = 53% ). Clients more confident as parents, doing activities with children likely to enhance cognitive and social development. Many clients reported planning to return to education. Closer involvement of fathers with infants. Feel less judged and excluded, thinking about the future with more optimism, gives them an expectation that formal services could be helpful. 38

13. FNP in England We can deliver FNP in this country The materials work in this country It seems to be acceptable to clients We seem to be reaching those who benefit most Fathers are involved The nurses are highly committed The clients value their nurses The training is highly valued Early impacts look promising

14. Liverpool and the FNP Currently based in Yew Tree Centre Team consists of: Supervisor Five Family Nurses Administrator

15. FNP in Liverpool Current trends are showing: Number of clients returning to education Excellent attendance for antenatal appointments Large percentage of pregnancies reaching full term Babies higher than average birth weight Steady number of referrals to smoking cessation service Involvement with young dads High uptake of primary course of immunisations

16. Working with clients Innovative ways of working Agenda match Flexible hours Text contact Multi – agency approach Work with all the family Meet anywhere…… It is a great thing to be involved in. As a young mum I didn’t know what to expect. Now I’m ready for anything!

17. Focus on Strengths… I Say:My family nurse Says:I would like to work on: Domains Personal Health One thing I do to keep myself healthy during my pregnancy is I know my pregnancy is going well because I follow my midwife’s instructions when I One thing that helps my baby to be strong and healthy is Environmental Health The thing I have done to make my house safer for me and my baby is Life Course Development One thing I do well is I am proud of

18. Focus on Strengths… I Say:My family nurse Says:I would like to work on: Domains Maternal Role I am getting ready to be a mum by... Something new I have learned about caring for my baby is When I think about my baby I feel... Family and Friends One way people I care about know that they are important to me is Health and community Services Ways I have been successful at getting help when needed are...

19. Clients thoughts……. It really makes you think about everything It has relaxed me about labour From a young dad Gives us times to express our feelings From a young mum I think the service is great because I learn a lot about pregnancy, babies and its very interesting

20. Clients thoughts on the FNP I love it! It helps me so much and its nice to be able to talk about everything … I think it’s a great help, It has given me lots of information… I think it will prepare me be a parent and to look after my baby well…. The programme has re- assured me throughout my pregnancy, with any thoughts or worries I had.

21. Thank you for inviting us… Any Questions?