The Family Nurse Partnership programme and learning for the CHPP

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(No Transcript)
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The Family Nurse Partnership programme and
learning for the CHPP

• Workshop C

Ann Rowe and Dave Webber(Robert Perks Room)
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• The Family Nurse Partnership programme -
• learning for CHPP
• Ann Rowe
• Dave Webber

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What is FNP?

• Developed by Prof David Olds in USA
• Preventive home visiting programme for hard to
  reach young first time parents
• Programme of structured, multi-faceted inputs,
  with sensitivity to clients
• and a therapeutic relationship at its heart
• Aims to influence behaviours of parents and so
  improve outcomes for them and their children
• Licensed, research based with fidelity measures
  to ensure replication of original research
• Intensive programme number of contacts/nature
  of client/nurse relationship
• Clinical and organisational requirements
  including regular supervision

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FNP in context of CHPP

• Universally offered to higher risk group (under
  20 year old, first time mothers)
• Preventive programme aiming to significantly
  improve outcomes for families and children
• Exemplar of new approach to CHPP for families
  with multiple deprivation

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Why is FNP being tested in England?

• Deprivation and social exclusion affect capacity
  to parent, so profoundly affecting outcomes for
  children
• Emerging evidence on neurological development
  parental behaviours in pregnancy and infancy have
  a profound effect
• Current services failing to reach and engage
  families with multiple disadvantages
• Evidence base for programme identified by the
  Social Exclusion Unit as most effective programme
  available following comprehensive review of
  international research studies.

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Delivery in English test sites

• Testing the applicability of FNP in 10 PCT/LA
  sites
• Delivered by family nurses who have had a new,
  intensive training programme
• Part of changes to wider universal services
  progressive universalism
• 20 new sites 08/09 (10 to be in randomised
  control study)

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FAMILY NURSE PARTNERSHIPSTHREE GOALS

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

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TRIALS OF PROGRAM
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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CONSISTENT RESULTS ACROSS TRIALS

• Improvements in womens prenatal health
• Reductions in childrens injuries
• Fewer subsequent pregnancies
• Greater intervals between births
• Increases in fathers involvement
• Increases in employment
• Reductions in welfare dependency
• Improvements in school readiness
• Most programme effects twice as strong when
  delivered by nurses rather than paraprofessionals

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Cumulative Cost Savings Elmira High-Risk
Families
Cumulative savings
Cumulative dollars per child
S O C I A L R E T U R N
Cumulative Costs
Age of child (years)
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Theoretical basis

• Human ecology theory ( clients social and
  material context)
• Attachment theory (client as a safe base from
  which her child can grow and learn)
• Self efficacy theory (ability to change behaviour
  by learning to draw on strengths and successes
  building skills and confidence)

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What do parents receive?

• Voluntary programme
• Weekly to fortnightly visits from same nurse
  from early pregnancy until child is 2 years
• Each visit has structure and planned content,
  covering 6 domains (personal and child health,
  parenting, personal goals, friends and family,
  environment, local services)
• Use of materials and approaches to learn and
  develop skills within a safe environment
• Interactive exploration of history, lifestyle,
  expectations, aspirations, risks
• Development of goals (exploring ambivalence/ goal
  setting/ taking steps/celebrations of success)
• Opportunity to learn new ways to behave and
  understand their importance (you don't know what
  you don't know)

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So what's different?
Professional problem solving/advice giving (fix
it)
Information giving
listening
FNP
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Approach

• Therapeutic alliance - being with the client,
  inviting the client/family to work on the
  difficult issues
• Focus on bonding, attachment and emotional
  availability of caregivers
• Respectful curiosity interested in their goals
  and what they want to achieve.
• Strength based , positive and hopeful belief in
  clients strengths, talents, skills and resources,
  expectation that client will succeed
• Using motivational interviewing skills to explore
  ambivalence and structure conversations about
  change and personal growth without coercion
• Respectful agenda setting to align energy from
  clients hearts desire with programme goals
• Setting goals with small steps and positive
  feedback

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Year one formative evaluation

• University of London Birkbeck commissioned by
  DCSF to conduct evaluation of the first two years
  of the programme. The first year interim report
  on the testing of FNP is positive with valuable
  learning for FNP and wider childrens services.
• The programme can be delivered in this country
• It seems to be acceptable to at risk clients
• 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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Learning for CHPP

• High skill level needed for powerful outcomes
• New approaches to achievement of behaviour change
• Possible to align personalisation and highly
  systematised
• Organisational context for delivery of intensive
  preventive programmes
• Importance of supervision
• Teaching and behaviour change
• Clarity for commissioners