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Family Nurse Partnership

Jayne Snell Family Nurse Supervisor

Clare BrackenburyFamily Nurse

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The Family Nurse Partnership programme

Evidence based and structured early intervention prevention programme that, in US trials, improves the health and well being of the most at risk children and families

Part of government policy to deliver Every Child Matters outcomes and prevent social exclusion

Part of the intensive end of a progressive universal Child Health Promotion Programme

Health has the skills, legitimacy and responsibility to make a difference

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Overview Of the Family Nurse Partnership:

Selected from an international review of early intervention and prevention

25 years of development, testing and refinement by Professor David Olds in US

3 large scale replicated clinical trials

Compared nurses with para-professionals

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What is the FNP

Aims to improve the early health and development and future life course of disadvantaged children and their parentsIntensive home visiting by specially trained Family Nurses from early pregnancy until the child is 2 years old (caseload of 25 families) Using evidence based methods and visit guidelines and materialsUnderpinning theories: Self-efficacy, Attachment and Human Ecology

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What is different?

Structured ProgrammeTherapeutic RelationshipFocus on strengths, not problems and deficitsGoal driven assist clients in achieving their ‘hearts desire’Intensive visitsFocus on behaviour change through motivational interviewing and self efficacyContinuity of practitioner, starting in early pregnancy,Emphasis on fathersSix domainsWeekly supervision, two monthly case presentation

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Challenges

Communication (verbal/non-verbal)EngagementKeeping clients attentionPeer pressure/clients inhibitionsEngagement with other servicesService availability locally

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What works

Motivational interviewing to promote behaviour changeStrengths focused approachSolution focused approachTextingPersistence and tenacity Non-judgementalNot making assumptionsWalking alongside of them rather than being in their shoes and ‘fixing it’ for themSupporting them in engaging with other services and utilising Children’s Centres

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History of the FNP in Berkshire East

Began in Slough April 2007- one of ten testing sites

Team = 1 Supervisor, 7 Family Nurses backgrounds midwifery and health visiting

Rolled out across Berkshire East In January 2009

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Profile of WAM Clients

Currently working with 6 clients, still recruiting for RCT

3 known to Social Care, 1 young mum subject to protection plan

2 known to Mental Health

1 under 15 at enrolment

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FNP In England- what we know about implementation

FNP can be implemented successfully in EnglandThe materials work and are well received by familiesThe programme is welcomed by hard to reach families and reaches clients likely to benefit mostSuccessfully engages hard to reach families from early in their pregnancyClients value the programmeEngagement with fathers is goodThe programme has the enthusiastic support of the nurses who are seeing changes take place in health behaviour , relationships , parental role and maternal well-being

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Can FNP make a difference?

Many clients reported changes in their understanding of pregnancy, labour, delivery and their infant

Clients had a strong recall of the nutritional advice they had received

Early findings show a reduction in smoking in pregnancy (40%-32%).

Breast feeding initiation rate higher than the national rate for the same age group (FNP 63% UK under 20’s 53%)

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Current Situation

Berkshire East is one of eighteen RCT sites across England

Research Team is Building Blocks at Cardiff University

Research Nurse employed and currently recruiting clients

2 Family Nurses within the team funded by the DOH to work with trial clients

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Case Study

Personal Health- women’s health practices and mental healthEnvironmental Health- adequacy of home and neighbourhoodLife Course Development- women’s future goalsMaternal Role- Skills and knowledge to promote health and development of their childFamily and Friends-helping to deal with relationship issues and enhance social supportHealth and Human Services- linking to other servicesThe relationship between the nurses and the family lies at the heart of the programme

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Client Quotes ‘Because we have learnt it

together we do it together’.19 year old dad

‘If it wasn’t for my nurse I really don’t know where I’d be, never mind my baby.’‘Gives information then

you can make your own decisions, you don’t feel forced e.g. breastfeeding and giving up smoking which for me means I am more likely to do it as I always do the opposite to what I’m told.’

‘My nurse is the first person that has made me feel good about myself in as long as I can remember – I feel like I can take on the world now.’

‘When I was having mine, it was about you or the baby, and that is it but this way we are all involved which makes us a stronger family and when the nurse isn’t around I can follow the same approach as it has changed from when I did it so I probably would have been giving her different advice.’ Grandma.