Family Nurse Partnership

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Family Nurse Partnership
Changing the world one baby at a time
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Introductions

• Alison Oxley Family Nurse Supervisor
• Ruth Taylor Family Nurse

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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.

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What is the Family Nurse Partnership Programme?

• Intensive home visiting programme for 1st 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

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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

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Trials of the NFP in USA
Elmira, NY 1977
Memphis, TN 1987
Denver, CO 1994
N 400
N 1,138
N 735

• Low-income blacks
• Urban
• Beginning data collection with the young adults
  age-17-years (2008)

• Low-income whites
• Semi-rural
• Just finished re-visiting the children of the
  intervention mothers (28-years old)

• Large portion of Hispanics
• Nurse versus paraprofessional visitors
• Completed collection at age-9-years
• Planning the age-15-years (2010)

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Consistent results across 3 trials in USA

• Improvements in womens antenatal health
• Reductions in childrens 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

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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.

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FNP Goals

• Connecting with families to
• Improve pregnancy outcomes
• Improve child health and development and future
  school readiness and achievement
• Improve parents economic self-sufficiency

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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

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Comparison of problem and solution focused work

• Looks for clues that reveal hidden strengths
  and possibilities
• Tries to understand how positive change occurs in
  clients 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

• Looks for clues that will reveal deeper
  problems and diagnoses
• Tries to understand fixed problem patterns in
  clients lives
• Elicits detailed descriptions of problems and
  unwanted memories
• Focuses on identifying whats wrong , whats not
  working and on deficits in individuals ,
  families and communities

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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.

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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

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Liverpool and the FNP

• Currently based in Yew Tree Centre
• Team consists of
• Supervisor
• Five Family Nurses
• Administrator

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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

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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 didnt know what to expect. Now Im
ready for anything!
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Focus on Strengths
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Focus on Strengths
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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
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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 its a great help, It has given me lots
of information
The programme has re-assured me throughout my
pregnancy, with any thoughts or worries I had.
I think it will prepare me be a parent and to
look after my baby well.
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Thank you for inviting usAny Questions?