1. Evidence into Practice Using a Strength Based Approach in Family Nurse Partnership (FNP) Gail Trotter FNP Implementation Lead, Scotland

2. Aims of Family Nurse Partnership To improve pregnancy outcomes and maternal health To improve child health and development and future school; readiness and achievement To improve parents economic self-sufficiency

3. Professor David Olds: Pioneer USA Works with pregnant teenagers and their partners until the child reaches 2 years Preventative intensive early intervention Strength based, promotes “self efficacy” Intensive home visiting manualised programme Mandatory training for Family Nurses: Masters level Role of Midwife remains the same Intense relationship Fidelity Requirements

4. Testing FNP City Edinburgh CHP First time parents 19 years or under at LMP Planning to stay resident in Edinburgh: 2 years No plans for relinquishment of baby Opt-in programme “Entitlement”

5. Focus on Strengths

6. Traditional Way Looks for “clues” that will reveal problems Looks for “clues” that reveal hidden strengths and possibilities Tries to understand, fix problems or patterns in client's lives Tries to understand how positive change occurs in client's lives Elicits detailed descriptions of problems Elicits detailed descriptions of goals and preferred futures Focuses on identifying “what's wrong, what's not working” and on deficits that can be fixed Focuses on identifying “what's right and working” and focus on strengths, skills and resources Strength Based

7. The client is the expert on her own life Client Centred Principle

8. They have the solution! Client is the Expert

9. Being Client Centred Can Lead Towards “Self Efficacy” A person’s belief that they can carry out behaviours asked of them

10. Does not mean being unaware of risk. GIRFEC Focus on Strengths

11. Learning a new way of supporting client Unlearning an old style of working Forget, borrow, learn principles Avoiding advice giving: guiding approach Agenda matching: finding the “hearts desire” Exploring ambivalence with clients Traditional to Strength Based

12. Seeing the world through the eyes of the client Hard to reach, hard to engage Eyes with a “dangerous filter” Response to emotional danger

13. Responses to Emotional Danger Angry Sad ASHAMED INSECURE FRIGHTENED CONFUSED REJECTED OPPOSITIONAL DISTRUSTFUL DEVALUED

14. “Dancing not wrestling” “Rolling with the blows” Not giving up Doing what you say you will do Remaining compassionate Supporting the Practitioner to Respond

15. Appreciating it is hard! Understanding and confident practitioners Meaningful: educational and training Appropriate supervision Collecting and sharing the evidence Trusting the client Organisational support: parallel processing Baby benefits most Key to Working this Way

16. But does it really work?

17. How the Programme Works Relationship Impact Learning Experience Behaviour Change

18. 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 Consistent Results Across 3 Trials in USA Programme effects greatest among those most susceptible

19. UK Evidence So Far England evaluations It is a model that works in England Acceptable to the client: very low attrition Educational materials transferable Early signs: higher breastfeeding rates, decreased smoking in pregnancy, high uptake AN care, low substance initiation Nursing workforce feeling fulfilled 18 RCTs England Scottish Government evaluation, Scotland