2. The Spirit of Wellbeing II ANFPP
This painting tells a story about physical and spiritual health for Anwernekehne (all the indigenous people of Australia) in modern times, living in two cultures. It’s about how we need and how we can still use our own culture to help us live happy and healthy lives. The centre circle shows two Ngangkere (traditional healers), a man and a woman, healing and passing on knowledge to a child. They are also caring for the child. The halos around their heads and hands show the power of traditional knowledge. Their hands are healing hands. The markings on the figures are the body paintings still used in ceremony today and they show that culture has survived and that the spirit of Anwernekenhe is alive and strong throughout the land. The band around the circle represents all the community, men and women, young and old, supporting each other. It is also about how the old Ngangkeres can teach the young Ngangkeres how to use their inner spirit for healing.
All the golds and reds represent the inland people. The blues and whites represent the people from the coastal and island areas. The blue of the big central circle also represents the coastal and island people coming into the centre and joining with the desert people to talk about the different kinds of bush tucker and showing the community that health is very important. There are elders in the circle who are passing on knowledge and health workers from the communities. The circle represents everyone working together for health including doctors and nurses who come to the communities to check up on us and our health and give us advice on health issues. The small circles show some of the bush tuckers we eat and represent all the good food we need to eat to keep healthy. In the bottom circles you can see alangkwe (bush banana) and awele-awele (bush tomato). And in the top circle are yerrampe (honey ants) which are like healthy bush sweets.
These days we need to show our children our cultural side as well as the European side of healthy food and exercising to have better growth in life and to keep strong. As well as buying food from the shops, we still go hunting and collecting bush tucker following in the footsteps of our ancestors and trying to keep our culture strong. This painting is about how our ancestors still teach us to eat good food and live healthy lives
Artist: Jane Kemarre Doolan
Title: ‘The Spirit of Wellbeing II’

3. About ANFPP
The ANFPP is an evidence based nurse home visiting program for mothers who are pregnant with an Aboriginal or Torres Strait Islander baby
Voluntary, over 2 years duration
Relationship based
Nurse Home Visitor supported by Indigenous FPW/ACW
The ANFPP is a partnership between implementing agencies, the ANFPP National Program Centre and the Commonwealth Department of Health to achieve:
Improved outcomes in pregnancy
Improved outcomes in child health and development
Improved parental life-course
Talk to the relationship nature of the program, the length of the program and the key team roles within the program

4. The Five Client-Centred Principles
Essential to the ANFPP is the five client-centred principles. The partnership relationship between the Nurse Home Visitor and the mother is fundamental to the program’s successful outcomes for the mother, child and family.
The NHV provides information and education to mothers using a strengths-based approach which builds the mothers’ capacity to identify solutions to problems. The mothers are thus empowered as they learn how to work with their strengths, realise the power of their own actions and gain a greater sense of control over their lives.
The ANFPP is based on the Nurse-Family Partnership model developed by Professor David Olds in the USA. Central to the success of the NFP in the 3 trials (Elmira, Memphis and Colorado) was the consistent focus on program fidelity to the model, this entails the nurses delivering a specific theoretically-informed and structured home visiting program. It involves explicit requirements in the training, supervision, reflective practice and monitoring that supports the nurse-led home visiting program, this structure formed the evidence base of the NFP and distinguishes it from other home visiting services.
Another essential element of the program model is the ability of the implementing agency to draw on strong community support to promote program quality and sustainability.
Prompt:
TALK TO RELATIONSHIPS within the program
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5. Background to the ANFPP
Based on the NFP program from University of Colorado in the USA
Significant outcomes of the NFP RCT trials:
Increased birth weights
Reduced maternal smoking
Reduced childhood injuries/child abuse
Improved parental skills
The program is now established in 7 countries
3 major theories underpin the content and service delivery in the program
In development since 1970’s and evaluated through 3 Randomised Control Trials
3 RCT – Elmira in New York – 1977
Memphis – 1986
Colorado – 1992
Significant outcomes:
- improved antenatal health – increased birth weight
Reduced maternal smoking
Improved infant cognitive ability
Reduced subsequent pregnancies and increased intervals between births
Increased use of community services
Improved parental skills
Increased maternal employment
Improved school readiness
International societies now running a version of the NFP Program include:
USA
Canada
England
Ireland
Scotland
Netherlands
Australia
Norway – coming on board
Prompt –
What do people know about NFP? Are there any other home visiting programs that are working in the maternal and child health space locally?

6. Program Fidelity Clients Voluntary
Context of program actions Intensive home visiting by a nurse
Qualities of nursing staff Minimum training standards to become a Nurse Home Visitor and Nurse Supervisor
Application of intervention Use of nursing framework and program theories to deliver program; caseload management
Reflection and clinical supervision Reflective practice and field supervision
Program monitoring and use of data Data collection and use of CQI
Implementing Site characteristics Strengths based philosophy; knowledge of prevention models; committed to supporting infrastructure for successful implementation
The program is based on 18 model elements – or fidelity elements. The implementing site has an important role in supporting program staff - Program Manager and Nurse Supervisor - to ensure that the program is conducted in accordance with such.

7. Australian Adaptation
Pregnant with an Aboriginal or Torres Strait Islander baby
Additional team role - Indigenous Family Partnership Worker or Aboriginal Community Worker (FPW/ACW)
May include multiparous women
Adapted materials to meet cultural context
Major adaptations:
In Australia, there is no eligibility criteria that relates to income
FPW/ACW role
Initiated from the initial implementation in 2008The Family Partnership Workers and Aboriginal Community Workers promote trust and respect between the clients and their family, the Aboriginal and Torres Strait Islander community, the wider community and health providers.
They help develop community awareness and acceptance of ANFPP and identify particular needs or sensitive issues that may hinder the uptake or delivery of the program to prospective clients.
Multiparous women:
The acceptance of multiparous women into the program at one ANFPP site, as agreed to by Professor Olds in 2010, has decreased the proportion of primiparous women enrolled in the program from over 90% to 80% across the reporting period.
This differs from international rates of 2% multiparous clients.
The vast majority of multiparous women in the program are at Central Australian Aboriginal Congress (CAAC). Recent research conducted by Gai Wilson at Congress identified that multiparous mothers reported gaining new information, skills and benefiting from the ANFPP.

8. ANFPP at a Glance ELEMENTS Development Implement Review
SUPPORT SERVICE
Theories
RESEARCH
Objectives
Outcomes
Workforce
Development
Long Term
↑ Pre-natal health
↓ Child Health Visit for injury
↑ Interval between pregnancies
↑ Participation in mother employment
↓ Family Reliance on Welfare
↑ In Child School Readiness
Human Ecology (Brofenbrenners 1979)
↓ Verified Reports of Child Abuse
↓ Arrests for Juvenile Offences
Improve outcomes in pregnancy
Improved child’s health and development
Improve parental life course
CQI
Self-Efficacy
(Bardura 1977)
Planning
Family
Mums & Bubs
Human Attachment (Bowley’s 1969)
ANFPP at a Glance
Data M&E
Program
Management
Review
Evaluate

9. ANFPP National Program Centre
National Coordination of ANFPP - Maintain national coordination and linkages across all stakeholders; national management of the Education Curriculum and Data Collection System (DCS) to support program fidelity
Establishment and implementation of the program – support development of plans, protocols/procedures; embedding of quality improvement processes; collaborate with international societies; coordinate and monitor ANFPP material adaptation
Workforce Development – provide core education, support recruitment and retention of team members, support professional development, support excellence in ANFPP practice
Monitoring and Evaluation - analysis of data and production of quarterly fidelity reports and Annual National Data report; assist with establishing the M & E infrastructure required to monitor the program

10. Local Implementation & Site Planning
ANFPP Program Integration
Establishing governance – policies, procedures, line management and information management procedures, including required data entry and reporting
Establishing Community Reference Group
Defining Service Partnerships
Determining Geographic Reach

11. ANFPP National Program Centre
Further Information
ANFPP National Program Centre
Level 2, 5 Gardner Close Milton, QLD 4064
PO Box 1874 Milton QLD 4064
phone (07)