The Perinatal Mental Health Needs of Young Women

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The Perinatal Mental Health Needs of Young Women

• Family Nurse Partnership

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Family Nurse Partnership

The FNP Team
Supervisor Ruth Rothman Family Nurses Cassie
Moore Gina Rothwell Jo Rushman Terry
Fulton Administrator Wendy Woods
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What is the Family Nurse Partnership

• Joint DH and DCSF project .
• Intense comprehensive nurse led programme .
• Multiple intervention strategies
• Develop knowledge, skills and self efficacy.
• Improve pregnancy outcomes
• Improve future babys health and development
• Improve their economic self efficiency

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Where Does it Come From?

• Programme developed in America by Professor David
  Olds
• Solid clinical theoretical underpinnings
• Rigorously tested 30 years of development and 3
  large scale trials

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Trials of Programme
Elmira, NY 1977
Memphis, TN 1987
Denver, CO 1994
N 400
N 1,138
N 735

• Low-income whites
• Semi-rural

• Low-income
• blacks
• Urban

• Large portion of Hispanics
• Nurse versus paraprofessional visitors

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Research Based Outcomes in America

• Improvements in womens prenatal health
• Reduction of 50-70 child injuries neglect and
  abuse
• Fewer subsequent pregnancies
• Greater intervals between births
• Increase in fathers involvement
• Increase in employment
• Reduction in welfare and food stamps
• Improvement in school readiness

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National Teenage Statistics in UK

• Higher rates of pregnancy complications and
  maternal mortality (CEMACH U.K Why Mothers Die
  2002-2004)
• Babies 60 higher rate of infant mortality and a
  25 higher risk of low birth weight
• 40 depression within 1 year of birth and
  postnatal depression x3 more likely
• (Botting et al 1998)

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Local FNP Statistics

• Number of young women with history of depression
  in childhood
• 30
• Number of women with depression in antenatal
  period
• 29
• Number of women with depression in postnatal
  period
• 23
• Number of women referred for CBT
• 5
• Number of women referred to psychiatric services
• 6
• Number of partners suffering with
  depression/anxiety
• 15

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Remember or Imagine

• Your initial thought on finding out you are
  pregnant?

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Expressed Feelings

• Being judged
• Lack of confidence
• Abandonment
• Confusion
• Loss -identity- childhood

• Isolation
• Frustration
• Inadequacy
• Fear
• Resentment
• Anger

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Now Imagine

• Eviction/ Homelessness
• Infrequent Meals
• Poverty
• No Support Family Friends
• No Partner
• Domestic Violence
• Drug and/or Alcohol Misuse
• Mental Ill Health
• Bereavement
• Still at school
• Criminal record
• Foster Care
• Lack of Privacy

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The FNP Model in the UK

• 10 pilot sites in England since April 2007 to
  test implementation
• Targets most disadvantaged, vulnerable with
  greatest need, breaking Intergenerational cycle
  of inequality
• Voluntary programme
• For first-time mothers only
• Under 20 years old
• 20 to 24 years with additional factors NEET
• Visited by same Family Nurse
• Recruited by16th week of pregnancy - no later
  than 28th week
• Work with all family members particularly dads

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FNP Visiting Schedule

• Once a week for first month during pregnancy
• Every other week throughout pregnancy
• Once a week first 6 weeks after delivery
• Every other week until 21 months
• Once a month until child age 2

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Framework of FNP Visits

• Each 90 minute Visit Covers 6 Domains
• Personal Health
• Environmental Health
• Life Course Development
• Maternal Role
• Family And Friends
• Health and Human Services

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FNP Support for the Mental Health Needs of Young
Women

• Normalising expressed feelings
• Improving self worth and self importance
• Promoting self awareness
• Highlighting personal achievement
• Goal Setting
• Joint agenda setting
• Making early assessments and referrals

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Christine

• 19 years old
• In a heterosexual relationship for 1 year
• Volatile relationship with mother
• Family history of mental ill health and alcohol
  misuse
• History of self harm
• Anxiety and depression
• Left home aged 14 years
• Living in rented accommodation
• Financial issues
• Partner has past drug misuse
• Partner involved with probation services

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Christines Mental Health Needs

• Feelings of fear
• Self harm
• Vulnerability
• Isolation
• Anxiety
• Denial
• Resentment
• Anger

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Emotional Tugs

• Unconditional love
• Conditional love
• Personal space
• Over involvement

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Predicted Outcome

• Social worker to be notified at birth
• and emergency protection order
• Baby to go to foster placement
• Poor Attachment
• Separation anxiety
• Homeless, as no housing entitlement
• without baby
• Deterioration of mental wellbeing and
• suicidal threats

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Family Nurse Involvement

• Initially very difficult to contact
• Time
• Listening skills
• Empathy
• Support
• Involvement of partner

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The FNP Toolbox

• Solution focused approach
• Strength based
• Facilitators
• P.I.P.E.
• N.C.A.S.T.
• Motivational Interviewing

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Integrating With Other Services

• Midwife
• Crisis team
• Emergency psychiatrist
• Social Care
• Probation
• Peri-natal mental health consultant
• Community psychiatric social services
• GP
• Key worker from social care

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Christines Post-natal Mental Health

• Attunement
• Autonomy
• Interdependence

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Baby Sophies Mental Well being

• Socialisation-attends local Childrens Centre
• Attachment-in the making
• Developed trusting relationship with parents

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The Futures Bright
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The FNP Future

• 30m Boost for Family Nurse Partnership
  Programme Vulnerable babies, young children and
  their families will continue to benefit from
  improved life chances thanks to a 30million
  expansion of an initiative to help equip young
  people with parenting skills, Health Minister Ann
  Keen announced today. Wed, 31 Oct 2007
  165900

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The FNP Future
Service expanding to another 20 sites

• Sunderland
• Cumbria
• Liverpool
• Blackpool
• Leeds
• Hull
• Nottingham
• Islington
• Lambeth
• Hastings
• Coventry

• Milton Keynes
• Plymouth
• Cornwall
• Isles of Scilly
• Southampton
• Stockport
• North East Lincolnshire
• Calderdale
• Birmingham

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Family Nurse Partnership

• Family Nurse Partnership
• Shoebury House
• Ness Rd
• Shoebury
• SS3 9DL
• Tel [phone]
• Ruth.rothman_at_see-pct.nhs.uk