Getting Started. Australian Nurse Family Partnership Program

Transcription

1 Australian Nurse Family Partnership Program Getting Started A user guide for organisations implementing the Australian Nurse Family Partnership Program Developed by the National Program Centre Version: 0.3 March i

2 Commonwealth of Australia, 2017 Any third party material contained in this publication remains the property of the specified copyright owner unless otherwise indicated. This work is copyright. It may not be used or reproduced by any process without prior written permission from the copyright owner. Enquiries should be addressed to The Director, Child and Family Health Section, Indigenous Health Division, Australian Department of Health. Edition: March 2017 Version: V0.3 This publication has been developed for a small-scale implementation of the Nurse-Family Partnership (University of Colorado) by the Australian Department of Health, through the Indigenous Health Division, and the Australian Nurse-Family Partnership Program National Program Centre. ii

3 CULTURAL ACKNOWLEDGEMENT AND RECOGNITION STATEMENT ANFPP National Program Centre (NPC) acknowledges the traditional custodians of the lands and waters on which we live and work. We pay respect to elder s past, present and future. We further acknowledge that Aboriginal and / or Torres Strait Islander people and community are diverse and dynamic and continue to evolve and develop in response to historical and present social, economic, cultural and political circumstances. Diversity includes gender, age, languages, backgrounds, sexual orientations, religious beliefs, family responsibilities, marriage status, life and work experiences, personality and educational levels 1 The ANFPP NPC team value your contributions and feedback. If you have any questions, feedback, or helpful tips to further improve the information provided in this implementation guide, please contact the ANFPP NPC team at <info@anfpp.com.au>. 1 Commonwealth of Australia. (2013). National Aboriginal and Torres Strait Islander Health Plan Canberra, Australia: Commonwealth of Australia.

4 ABBREVIATIONS AND ACRONYMS ANFPP ANFPP NPC DoH CEO CoP CQI CRG DCS HV Australian Nurse Family Partnership Program Australian Nurse Family Partnership Program National Program Centre Department of Health Chief Executive Officer Community of Practice Continuous Quality Improvement Community Reference Group Data Collection System [ANFPP] Home Visiting FPW Family Partnership Worker 2 M&E MI NCAST NFP NHV NPC NS OLE QI QRP PDCA PIPE PM Monitoring and Evaluation Motivational Interviewing Nursing Child Assessment Satellite Training Nurse Family Partnership [USA] Nurse Home Visitor National Program Centre Nurse Supervisor Online Learning Environment Quality Improvement Quality Review Process Plan, Do, Check, Act [Continuous Quality Improvement Cycle] Partners in Parenting Education Program Manager 2 A unique adaptation of the Nurse-Family Partnership program for Australia has been the inclusion of the Family Partnership Worker (FPW). FPWs promote trust and respect between the clients and their family, the Indigenous community and health providers. In many implementing organisations, the FPW position can be referred to by a title that is relevant to the local organisation including Aboriginal FPW, Aboriginal Community Worker (ACW) and Strong Women Worker (SWW). Where FPW is referred to in ANFPP documents, the term is inclusive of this role irrespective of the local title for the position. iv

5 RP RS RN TOR UoC USA/US WDE Reflective Practice Reflective Supervision Registered Nurse Terms of Reference University of Colorado United States of America/United States Workforce Development and Education

6 TABLE OF CONTENTS Cultural Acknowledgement and Recognition Statement... iii Abbreviations and Acronyms... iv List of Tables... vii List of Figures... vii 1 Introduction ANFPP at a Glance ANFPP and Aboriginal and / or Torres Strait Islander Culture ANFPP Program Model What forms the framework of the Nurse-Family Partnership model? Core Model Elements Program Domains Informed Consent ANFPP Performance Measures Program Governance and Support Leadership Group The National Program Centre Establishing ANFPP in your Organisation and Local Community Role of Implementing Organisations ANFPP Program Planning and Implementation ANFPP Program Planning Phase ANFPP Commencement Phase ANFPP Quality Phase Developing a Local ANFPP Health Education Resource Kit Your Local ANFPP Team Program Manager Nurse Supervisor Nurse Home Visitor Family Partnership Worker Other Local Team Members ANFPP Community Reference Group ANFPP Workforce Development and Education ANFPP National Quality Framework ANFPP Community of Practice activities ANFPP National Knowledge Access Program Integration with Local Information Systems vi

7 9 Tools and Templates NPC TEAM Nurse Family Partnership Core Model Elements Program Implementation Timeline Sample What you will receive from the National Program Centre ANFPP Core Education Schedule Initial Program Preparation Worksheet Tool - Sample Additional Reading - Trial outcomes LIST OF TABLES Table 1: ANFPP- Implementation Phases Table 2: ANFPP minimum qualification requirements LIST OF FIGURES Figure 1. The Five Client-Centred Principles... 3 Figure 2. Key consent terms... 8 Figure 3: Learning activities supporting ANFPP staff to achieve program outcomes Figure 4: Staff education and learning model the diagram illustrates the relationship between core education provided by the NPC team - and social learning (occurs at site) Figure 5: Core principles of the Quality Framework... 24

8

9 1 INTRODUCTION Australian Nurse Family Partnership Program (ANFPP) is a collaboration between implementing organisations, the ANFPP National Program Centre (ANFPP NPC), and the Commonwealth Department of Health (DoH). The program is in an expansion phase nationally and we are pleased to have your organisation join this national effort. This Getting Started guide has been developed to provide an overview of the ANFPP and to support the initial planning, delivery, and integration of ANFPP within your organisation. Team members from the National Program Centre will discuss this information further with your organisation in the coming months as you commence this journey of implementing ANFPP in your organisation. An implementation planning workbook and additional resources will be provided to your organisation at the implementation workshop. ANFPP is a complex program that requires commitment from all levels of your organisation, including the Board of Management; Chief Executive Officer; executive management; and all members of your ANFPP team. The demonstrated commitment and willingness of your organisation s team to integrate ANFPP into your primary health care service model is pivotal to its success. The theoretical model of ANFPP is guided by the principles of strengths-based, culturally-safe practice. ANFPP s Cultural Competence Statement aims to ensure that the overall program delivery and mechanisms for implementation acknowledge and respect the cultural identity, health, and emotional wellbeing of Aboriginal and/ or Torres Strait Islander mothers, children, families, and communities. Staff (refer section 9.1) from the ANFPP National Program Centre look forward to working in partnership and collaboration with staff from your organisation to support an ANFPP program implementation that is well-informed and robust. This guide provides useful information for your organisation s Board of Management and executive management team and will assist other staff from your organisation to better understand ANFPP. 2 ANFPP AT A GLANCE ANFPP is an evidence-based home visiting program with a focus on early intervention and prevention of physical and emotional risks and issues for women pregnant with an Aboriginal and/or 1

10 Torres Strait Islander baby. The program is voluntary for all eligible 3 women and involves home visits during pregnancy until the child s second birthday. ANFPP is a licensed adaptation of the Nurse Family Partnership (NFP) program, which was developed by the University of Colorado in the United States. ANFPP has 18 Core Model Elements (aligned to the original NFP) to ensure its implementation and service delivery achieve the same desired program outcomes as NFP. These include: Improved outcomes in pregnancy Improved outcomes in child health and development Improved parental life course. The key program adaptations developed to meet the Australian Aboriginal and/or Torres Strait Islander context include: ANFPP is delivered to women pregnant with an Aboriginal and/or Torres Strait Islander child in the target region The addition of the Family Partnership Worker position. It has been demonstrated that the inclusion of this position into the ANFPP team is integral to the success of the program ANFPP may include multiparous women, under specific circumstances The adaptation of NFP materials and staff education to address the unique Australian Aboriginal and/or Torres Strait Islander context and the health system in Australian jurisdictions. The ANFPP team in your organisation will be required to include a Program Manager, who is usually a current employee such as a Maternal and Child Health Manager or other senior manager, who will maintain overall responsibility for ANFPP, as well as a Nurse Supervisor, Nurse Home Visitors, Family Partnership Workers and administration support. An ANFPP home visiting team includes a Nurse Home Visitor and a Family Partnership Worker. ANFPP home visits are well defined within program materials (i.e. the Home Visit Guidelines), and adaptations for the Australian context recognise that ANFPP home visits do not replace standard clinical antenatal care provided by a midwife, doctor or child health services provided by a doctor or child health nurse. The prime objective is to develop a strengths-based relationship between the ANFPP home visiting team and mother/family, enabling a mother to recognise and make positive choices to meet the future needs of her child and herself. While the primary therapeutic relationship is with the mother, 3 Within the Australian context eligibility includes women pregnant with an Aboriginal and/or Torres Strait Islander child in the target region. 2

11 engagement with the father and other significant family members is also an intention of the program. 2.1 ANFPP AND ABORIGINAL AND / OR TORRES STRAIT ISLANDER CULTURE ANFPP has been designed to effect positive change for women and their families, which can continue long after completing the program. The program is underpinned by the Five Client-Centred Principles, as shown in Figure 1 below. The program acknowledges that when working with communities with an identified history of trauma and exclusion (such as the Roma of Bulgaria, Aboriginal and /or Torres Strait Islander people of Australia, Native American people or First Nations People in Canada) special care needs to be taken when considering how to introduce the program. This includes taking expert advice from the community on necessary adaptations to the program to show due respect to their history of trauma and cultural differences. A significant adaptation of ANFPP has been the inclusion of Aboriginal and/or Torres Strait Islander workers to foster cultural safety for clients, to facilitate acceptance of the program in the community, and to assist in adapting aspects of the program for local Aboriginal and /or Torres Strait Islander peoples. Figure 1. The Five Client-Centred Principles ANFPP places great importance on cultural competence and fosters this through: The inclusion of Aboriginal and/or Torres Strait Islander Family Partnership Workers in decision-making and advising on the development of therapeutic relationships with clients and their families Core education 3

12 Working within the Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 4 Clinical care decisions underpinned by the use of the Five Client Centred Principles Communication approaches using Motivational Interviewing Reflective Supervision using a Reflective Practice Continuous Quality Improvement activities and a culture of collaboration. Reflective practice is a way of studying your own experiences to improve the way you work. Reflective supervision is a collaborative relationship for professional growth that improves program quality and practice by cherishing strengths and partnering around vulnerabilities to generate growth (Shahmoon Shanok, 1991) 6. The ANFPP recognises the importance of cultural safety in the delivery of the program. It has been identified as a critical component in improving healthcare for Aboriginal and/or Torres Strait Islander peoples. All ANFPP personnel have a responsibility to recognise, respect, and nurture a client s cultural identity and to meet their needs, expectations, and rights in delivering the program. Culturally safe service delivery is crucial in enhancing personal empowerment and promotes more effective and meaningful pathways to self-determination for Aboriginal and/or Torres Strait Islander people. Culture is distinctive to regions and the delivery of the program in each discrete community requires consideration of needs and issues that may be specific to the individual community. Managing cultural safety is a continuous process. 5 Discrete considerations may include: Beliefs, values, and philosophies Stories, myths, languages, and traditions Lifestyle customs and desires Physical environment. 4 Commonwealth of Australia. (2016). Cultural Respect Framework For Aboriginal and Torres Strait Islander Health, A National Approach to Building a Culturally Respectful Health System. Canberra, Australia: Commonwealth of Australia. 5 Commonwealth of Australia. (2014). Quality Framework for National Aboriginal and Torres Strait Islander Flexible Aged Care Program. Canberra: Australian Government Department of Health and Aging. 6 Shahmoon Shanok, R. (1991). The supervisory relationship: Integrator, resource and guide. Zero to Three, (6)2, (Reprinted in Learning through supervision and mentorship to support the development of infants, toddlers and their families: A source book, pp.37 41, E. Fenichel, Ed., 1992, Arlington: Zero to Three.) 4

13 2.2 ANFPP PROGRAM MODEL The evidence base for the ANFPP confirms that maintaining program fidelity, that is, adherence to the NFP CME, is required to achieve program outcomes. It is important that each team member has a thorough understanding of the program materials and Core Model Elements to ensure your team is able to achieve its program objectives. Organisational senior management and the Nurse Supervisor have important roles to play in supporting the team to maintain model fidelity. A key strategy in achieving this is via regular reflective supervision using reflective practice for all team members. Reflective practice advances the ANFPP model and promotes development of cultural capacity and culturally safe practice. As such, each role within your ANFPP team is expected to participate in reflective supervision and adopt a reflective practice approach What forms the framework of the Nurse-Family Partnership model? The ANFPP model draws from three distinct strands of theory: human ecology, self-efficacy and attachment. These theoretical strands, woven together within a professional nursing framework, produce a unique program of great depth, breadth and vitality Human ecology theory This theory holds that parents care of their babies is influenced by the larger social context in which they live. This includes relationships with other family members, friendship networks, neighbourhoods, communities and cultures. The ANFPP model acknowledges the impact of these various elements while helping parents negotiate and regulate their environments Self-efficacy theory This theory is rooted in the notion that people are more likely to engage in a desirable behaviour if they believe the behaviour will produce a desired outcome. They must also believe they can successfully carry out that behaviour to achieve the outcome. The ANFPP model helps parents set realistic goals. It bolsters parents confidence in their ability to reach those goals. Examples include avoiding or stopping risky behaviours, engaging in healthy behaviours, and/or coping with challenging situations Attachment theory This theory proposes that children who receive sensitive and responsive parenting are more likely to grow up to become sensitive and responsive parents themselves. The ANFPP model promotes 5

14 nurturing parenting through a variety of direct teaching methods. Learning is further enhanced by the supportive and caring relationships the ANFPP home visiting team establish with families Core Model Elements ANFPP is used under licence from the University of Colorado, and implementation requires the maintenance of fidelity to NFP Core Model Elements, with the following adaptations: ANFPP is delivered to women pregnant with an Aboriginal and/or Torres Strait Islander child in the target region The inclusion of an Aboriginal and/or Torres Strait Islander Family Partnerships Workers into the ANFPP team is integral to the success of the program within the Australian Aboriginal and/or Torres Strait Islander context The inclusion of multiparous women under specific circumstances Adapted program materials to meet the Australian Aboriginal and/or Torres Strait Islander cultural context, the health system in Australian jurisdictions, as well as Australian standards and language usage There are 18 Core Model Elements outlined in Section 9.2 which are fundamental to implementing this program. All of the elements have been developed as a result of evidence of effectiveness based on research, expert opinion, field lessons and/or theoretical rationales (Nurse Family Partnership, 2008). It is important that staff from implementing organisations liaise with ANFPP National Program Centre staff to clarify any queries or challenges that may arise within their team s practice regarding program fidelity or Core Model Elements. 6 The 18 elements will be discussed in detail, relative to the adaptation of the model for the Australian context, during ANFPP core education, Community of Practice (CoP) (Refer Section 7), and Continuous Quality Improvement (CQI) activities (Refer Section 6). Refer to section 9.2 for more information Program Domains ANFPP has six Program Domains. These domains are addressed by the Home Visiting Team during each home visit. As part of the supervision and support process the Nurse Supervisor will monitor the team s progress in delivering content under these domains, which includes providing relevant information, education and interactive activities to the mother. The domains are: Personal health: addresses clients health practices; nutrition and exercise; substance use, involving cigarettes, alcohol, or illicit drugs; and mental health functioning Environmental health: addresses adequacy of home, work, school, and community settings for maternal and infant health 6 At an International level these 18 Core Model Elements are currently under review and due for completion in June

15 Life course development: focuses on clients goals related to childbirth planning; completion of their education; and their livelihood Maternal role: addresses clients acceptance of the maternal role and their acquisition of the knowledge and skills needed to promote the physical, behavioural, and emotional health and development of infants and toddlers Family and friends: focuses on supporting clients to engage in positive relationships; deal with relationship challenges; and enhancing support for their own goals and management of child care Health and human services: addresses linking families with access to community services and resources. The Nurse Supervisor must be familiar with the program domains to support the Home visiting teams and their clients as they move through the partnership together during Pregnancy, Infancy and Toddlerhood. The client (and child s father, boyfriend, partner, and/or family when appropriate) is visited throughout her pregnancy and the first two years of her child s life. A schedule of visits with proposed content has been developed for the program to: match the expected stage of program 7

16 delivery and public health issues; schedule assessments for maternal or child health and development; build the therapeutic relationship; and support achievement of three program goals. The standard schedule of visits is established as: Four weekly visits upon initial enrollment prenatally, then every other week until delivery Six weekly visits after infant birth, followed by visits every other week until the baby is 21 months of age Monthly visits from 21 through 24 months of age. The ANFPP home visit guidelines, covering all the domains are provided to the home visiting team which outline the visiting content. The Nurse Supervisor shares any successes and challenges with other ANFPP team members via client conferences, team meetings and through reflective supervision. This will assist program teams to learn from each other s experiences and enhance the team s confidence and become more proficient at tailoring the visits to meet the mother s goals and needs. Free means there is no coercion or manipulation to participate or not participate Informed Consent The first NFP Core Model Elements is that women s participation in the program is voluntary. In all situations, the client must sign a consent form agreeing to participate in the program voluntarily and there are no permissible variations to this element. The reason is that the services are designed to be supportive and build self-efficacy, and voluntary participation builds trust and empowers the client. 7 Prior means that consent should be sought and received before any activity is undertaken Consent in Australia is defined by the National Statement on Ethical Conduct in Human Research as a voluntary choice based on sufficient information and an adequate understanding of the conditions and implications for the participant (National Health and Medical Research Council, Australian Research Council & Australian Vice-Chancellors Committee, 2015). 8 The Guidelines for Ethical Research in Australian Indigenous Studies (Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS, 2012) outline under Principle 6 that consultation, negotiation and free, prior, and informed consent are foundational aspects with or about Aboriginal and Torres Strait Individuals understand what participation will mean for them and freely agree, understanding they may withdraw that consent at any time Figure 2. Key consent terms 7 Nurse Family Partnership. (2008). Guide to the utilisation of the program elements: Internal guide for staff. Colorado: Author. 8 National Health and Medical Research Council, Australian Research Council, & Australian Vice-Chancellors Committee. (2015, May). National statement on ethical conduct in human research 8

17 Islander peoples. Therefore, ANFPP views this as a critical aspect of the client consent process for free, prior, and informed consent (FPIC). Written documentation of this consent is retained for both the organisation as well as the client. For free, prior, and informed consent to be delivered in a manner that is clear, respectful, and understood, all persons involved must make efforts to provide information in a manner that is meaningful to potential clients so that it is clear what the agreement will mean for the client and their family. Careful consideration should be undertaken in the approach to consent visits. The core education provides specific training and discussion around informed consent and processes within ANFPP ANFPP Performance Measures Nurse Family Partnership (NFP) Objective: 100% of enrolled women are first-time mothers (Excluding sites with specific exceptions) 75% of eligible women referred to the program are enrolled 60% of pregnant women are enrolled by 16 weeks gestation or earlier. Program successfully retains participants in program through child s second birthday: Cumulative program attrition is 40% or less through the child s second birthday. Pregnancy phase attrition is 10% or less Infancy phase attrition is 20% or less Toddlerhood phase attrition is 10% or less. Home Visitors maintain established frequency, length and content of visits with families: Percentage of expected visits completed is 80% or greater for pregnancy phase Percentage of expected visits completed is 65% or greater for infancy phase Percentage of expected visits completed is 80% or greater for toddlerhood phase. 9

18 On average length of home visits with participants is >= 60 minutes. Home Visitors maintain established content of visits with families and reflects variation in developmental needs of participant s phases measured by the average time devoted to content domains. Domain Pregnancy Infancy Toddlerhood Personal health 35 40% 14-20% 10-15% Environmental health 5-7% 7-10% 7-10% Life course development 10-15% 10-15% 18-20% Maternal role 23-25% 45-50% 40-45% Family and friends 10-15% 10-15% 10-15% Health and human services Is addressed within each of the other domains so does not have a separate benchmark Nurse Home Visitors participate in specific supervisory activities including: One on one clinical supervision with reflection weekly, 1hr sessions between Nurse Supervisors and Home Visitors; fortnightly between Nurse Supervisors and qualified person Field supervision 2-3 hourly, 4 monthly joint home visits involving Nurse Supervisors Team meetings 1 hourly every fortnight Client Conference (Internal to ANFPP) 1 ½ hourly alternate weeks. 3 PROGRAM GOVERNANCE AND SUPPORT 3.1 LEADERSHIP GROUP The Leadership group consists of professionally recognised specialists with clinical and cultural knowledge. They provide advocacy, expert technical guidance and oversight to the Department of Health and National Program Centre to promote adherence to program fidelity and continuous quality improvement for the ANFPP program nationally. Membership of the Leadership group includes: Karen Harmon, ANFPP Director (NPC), Chair Professor David Olds, University of Colorado (NFP) Debbie Sheehan, International Consultant (NFP) Kate Wallace, Assistant Secretary, Health Programs & Sector Development Branch Indigenous Health Division, Department of Health Nick Pascual, Director, Child & Family Health Section, Health Programs & Sector Development Branch, Indigenous Health Division, Department of Health 10

19 Megan Saltmarsh, ANFPP National Program Manager (NPC) Louise Livingstone, ANFPP Program Technical Lead (NPC) Dr Mark Wenitong, External technical consultant Dr Paul Torzillo, External technical consultant Dr Claire Runciman, External technical consultant Professor Victor Nossar, External technical consultant Professor Roianne West, External technical consultant. 3.2 THE NATIONAL PROGRAM CENTRE Abt Associates is contracted by the Commonwealth Department of Health to provide the services of the ANFPP National Program Centre. Abt Associates for more than fifteen years, has worked at all levels of the Australian health sector bringing expertise in evaluation, research and analysis, policy inputs, specialist services and program management. The ANFPP National Program Centre is based in the Brisbane office of Abt Associates. Refer to Section 9.4 for further information. The role of the National Program Centre is to work in collaboration and partnership with each implementing organisation to achieve a sustainable, high-quality program, supported by a strong evidence base. The National Program Centre leads program innovation and adaptation to ensure the program is delivered in line with the CME to achieve improved outcomes for mothers of Aboriginal and/or Torres Strait Islander children and their families. The National Program Centre is responsible for the following functions and activities: Program Management: the National Program Centre supports the DoH in the implementation of ANFPP s established governance framework, and acts as a primary liaising point for key stakeholders (the University of Colorado (UoC), ANFPP National Leadership Group, ANFPP implementing organisations, and other stakeholders. Facilitating the execution of Memoranda of Understanding with Implementing Organisations, external service contract management, communications and engagement, and oversight of the Nurse Family Partnership licencing requirements with implementing organisations are core functions. The Program Management function coordinates the work of all ANFPP National Program Centre functions and is accountable for the delivery of all agreed program activities and associated stakeholder reporting. Implementing organisation support: the National Program Centre is responsible for providing a range of activities to support the implementing organisations in establishing ANFPP within their communities as well as providing ongoing support to ensure all implementing organisations and staff maintain their knowledge and skills and are competent and confident in implementing ANFPP with fidelity to the program model. The National Program Centre works closely with staff from implementing organisations on a daily basis, with a view to develop a highly skilled national ANFPP workforce. Some of the activities and support include: 11

20 Facilitating a series of service planning activities with each site during the initial planning and commencement phases Delivering the core ANFPP education curriculum and support learning experiences. Supporting the professional development of ANFPP staff (related to program outcomes) Facilitating and coordinate a Community of Practice approach including monthly meetings and online discussion forums for program staff nationally Supporting implementing organisations in relation to staff recruitment and retention Leading the revision of all education components to ensure they are contemporaneous and contextualised to the Australian Aboriginal and Torres Strait Islander setting and health care system and standards in Australia Providing Reflective Practice opportunities to staff in Nurse Supervisor positions Establishing and maintaining the national ANFPP Data Collection System Implementing and monitoring the ANFPP continuous quality improvement cycle including delivering data collection training and continuous quality improvement training and support to ANFPP staff at implementing organisations Working in collaboration with implementing organisations with the aim of ensuring that data reporting, monitoring, and evaluation is able to contribute to supporting the growing evidence base Facilitating and supporting the collection and management of high quality client and non-client data at implementing organisations, including defining a minimum data set Providing an ANFPP online learning environment for site staff to access educational material and program resources. Research and Development Projects: The National Program Centre manages new program developments that contribute to the improved delivery of the ANFPP, and contribute to the international knowledge base of the Nurse Family Partnership. These are either managed within the National Program Centre, or outsourced to qualified providers with Centre oversight. The National Program Centre may also provide support to implementing organisations who maybe undertaking ANFPP research activities. Please refer to Section 9.1 for details of NPC team. 4 ESTABLISHING ANFPP IN YOUR ORGANISATION AND LOCAL COMMUNITY 4.1 ROLE OF IMPLEMENTING ORGANISATIONS Support from the implementing organisation is important to ensure there is an underpinning understanding of the program model by senior staff. ANFPP is a complex model which sees team members become increasingly proficient over time. It is a dynamic program that continually creates new opportunities for your local ANFPP team to learn and improve performance. Implementing organisations promote the program outcomes by supporting an organisational culture that rewards ongoing learning and growth, in addition to the organisation s provision of effective, efficient, safe, 12

21 and quality primary health care services. Some of the key roles of the Implementing organisations include: Championing of CME (Section 9.2) and the integration of the program into the wider organisation, and in particular embedding Reflective Practice and program principles (e.g. Five Client-Centred Principles) within the organisational culture Commitment to activities as agreed in the Memorandum of Understanding, e.g. attendance at local cultural safety training, and domestic violence training Providing cultural mentoring and orientation to Indigenous Health and Primary Health Care services for your ANFPP team Ensuring implementing organisation staff participation in the range of Implementation activities throughout the program planning and commencement phases Ensuring your ANFPP team s participation in the required education (by the adequate allocation of time and equipment; coordination and funding of travel and accommodation; and access to adequate information and communication technology and support). This may also include the participation of key organisational staff in introductory education about the program Providing opportunities for your ANFPP team to participate in professional development, Nurse Supervisor job shadowing visits, clinical leadership (including Parallel Modelling, Reflective Practice) to ensure fidelity to the program model Working in partnership with the National Program Centre to ensure your program staff recruitment identify and secure suitable applicants Provision of program specific materials/resources (e.g. Partners in Parenting Education [PIPE], Nursing Child Assessment Satellite Training materials [NCAST], Ages and Stages Questionnaires and training resources, small preliminary library) Ensuring that all your ANFPP team members receive a comprehensive orientation to the Implementing organisation including: An overview of your organisation and how ANFPP is integrated into the organisation. An overview of the community your organisation services. An overview of your organisation s policies and procedures, in particular a focus on those that relate to home visiting programs. 4.2 ANFPP PROGRAM PLANNING AND IMPLEMENTATION The experience of implementing the program in many societies, in conjunction with the existing evidence-base, has led to the recognition that there are defined stages of the program s implementation For ANFPP, these stages are defined by three phases: Phase 1 - Program Planning Phase 2 Commencement; and Phase 3 Quality improvement which continues through the life of the program. Each new implementing organisation will progress through the program planning, commencement and quality phases at their own pace. The National Program Centre will provide structured support and guidance throughout these phases. A guide to these phases is shown in 13

22 Table ANFPP Program Planning Phase The purpose of the Program Planning Phase is to assist the implementing organisation s executive management, senior management, and your newly formed ANFPP team to define the organisation s local ANFPP service model and assist with establishing the systems and processes required to promote successful implementation and integration of the program. The planning phase varies depending on each site but usually occurs over a seven to twelve month period and integrates all aspects of ANFPP activity including service planning, program management support and core education. This phase is supported by implementation planning workshops, which occur in stages as the implementing organisation prepares to establish the program and is complemented by the commencement of the core education session at specific intervals. Community engagement and the establishment of a Community Reference Group is a key activity during this phase (Refer Section 4.5) ANFPP Commencement Phase The Commencement Phase commences when clients start being recruited and home visiting begins. This phase is characterised by the commencement of home visits, data collection, fidelity reporting, and the ongoing operation of the Community Reference Group (CRG). The Commencement Phase usually occurs over a 12 month period and follows the Program Planning Phase. Implementation planning and core education continues in this phase and introduces program tools relevant to the Infancy period. Teams are also introduced to the ANFPP Quality Framework during this phase ANFPP Quality Phase The aim of the Quality Phase is to review how the implementation is progressing and identify areas that require any additional support. The Quality Phase commences when the program becomes established and integrated within the implementing organisation while it continues to accept incoming referrals. At this stage the first group of clients will have children in the toddlerhood phase and some may be almost ready to graduate. During this phase the NPC continues to support the implementing organisation with annual service development and quality workshop sessions that focuses on how the implementation has been progressing within the organisation and identifies areas that may require additional support. The 14

23 implementation of the National Quality Framework will also enable a reflection on practice to date to inform ongoing quality improvement activities. Table 1: ANFPP- Implementation Phases PHASE TIMEFRAME DESCRIPTION INDICATOR Program Planning Approx. 7 to 12 months Activities that occur in the planning and preimplementation phase of the program From commencement of the contractual agreement with DoH to deliver the program until home visiting commences. Service planning workshops held and systems and processes for integrating program into the service are being developed Staff recruitment, orientation and education commences Community engagement and establishment of CRG Commencement 7 12 months to months This phase starts when referrals to the program are being accepted and home visiting commences Clients consent to be part of the program and home visitation is commenced Data collection being undertaken Community Reference Group operational Fidelity Reporting commenced Clients entered in Infancy Phase Quality Year 2 and beyond Program is well established and has moved into the quality phase Staff Program paarticipaate well established in reflective and maintaining incoming referrals Clients in toddlerhood phase and clients are graduating the program Core education is finalised 4.3 DEVELOPING A LOCAL ANFPP HEALTH EDUCATION RESOURCE KIT An important element of this home visiting program is for each local ANFPP team to develop a health education resource kit to support home visiting. This resource kit will include the locally 15

24 available health education and information resources to provide material that is contextualised and relevant for local women and families. These resources are often used with or given to women and families about a range of health and other topics raised in the home visits. Materials should be current, relevant and culturally and educationally suitable (for example, if required they are in local languages). The home visit guidelines will support the local teams in identifying resources that are required. 4.4 YOUR LOCAL ANFPP TEAM The ANFPP team at your site includes the following positions: Program Manager Nurse Supervisor Nurse Home Visitor Family Partnership Worker Administration Officer Program Manager In addition to the core ANFPP team members, each implementing organisation will identify a role within their organisation that operates as Program Manager for the ANFPP implementation. This role will have overall management of ANFPP within the organisation. While this position is usually a current employee such as a Maternal and Child Health Manager or other senior manager, there are specific ANFPP elements to be incorporated into the role. Program Managers are encouraged to attend the Introduction to ANFPP training with the Nurse Supervisor. These role elements include, but are not limited to: Work in collaboration and partnership with the National Program Centre and Nurse Supervisor to achieve successful implementation of ANFPP within the implementing organisation Support the Nurse Supervisor to maintain the required schedule of reflective supervision and promote reflective practice Maintain a strategic role in the development and advocacy of ANFPP with key stakeholders (internally and externally) to ensure successful integration of the program within the organisation and potential referral agencies Participate in and commit to all implementation workshops and planning meetings, and contribute to ongoing national Community of Practice activities as required Support and commit to the mandatory ANFPP education for every member of your ANFPP team, including education held off-site Commitment to acquire relevant ANFPP program skills and knowledge to offer high-level support to the Nurse Supervisor and your ANFPP team members as required 16

25 All ANFPP team members must hold qualifications that meet the basic requirements for performing their position roles, as described in Table 2 below. Each team member is required to keep the skills of their qualification current, e.g. Registered Nurses (RN) must maintain their annual registration. 17

26 Table 2: ANFPP minimum qualification requirements POSITION QUALIFICATIONS Nurse Supervisors Nurse Home Visitors Family Partnership Workers/Aboriginal Community Workers Masters of Nursing (or equivalent) Bachelor of Nursing (or equivalent) Certificate III in Primary Health Care, Community Services Work (or equivalent)* *Recommended but not essential The National Program Centre will work collaboratively with implementing organisations and provide assistance in the recruitment process. This will include: Sample Position Descriptions Sample information to include in program information packs to prospective applicants Sample position advertisements Participation in selection panel Nurse Supervisor The recruitment of a highly skilled Nurse Supervisor is necessary for the operational success of ANFPP within your organisation. The Nurse Supervisor plays a pivotal role in program implementation and success, and the most effective supervisors are those skilled at building and sustaining teams and relationships. In Australia, as well as internationally, experience in the program has identified the importance of the Nurse Supervisor role in creating team approaches conducive to the successful implementation of the program and creating program stability and excellence. Careful selection and support of this position is essential in ensuring positive program outcomes. The Nurse Supervisor s role is focused on the effective functioning and operation of the program within the organisation, through team building, collaboration, and supervision. The primary responsibility of the Nurse Supervisor s role is to work within the local community and the primary health care service (and with program staff) to ensure that ANFPP is implemented according to established CME (program fidelity). In some organisations the role may also be responsible for meeting contract requirements (or might liaise closely with a senior officer). The ANFPP Nurse Supervisor uses reflective practice in supervision, supervised home visits, and staff development, to provide primary support and appropriate oversight to your ANFPP team; as well as to model and build a strengths-based, culturally-safe, and client-centred program. In ANFPP, the Nurse Supervisor has supervisory responsibilities for the home visiting team and Administrative Officer. The Nurse 18

27 Supervisor also promotes ANFPP within the organisation and the broader community, as well as among other service agencies and professional networks to foster program integration. In keeping with international and national feedback 9, the National Program Centre strongly recommends organisations consider attributes over skill set. Internationally, the attributes (or characteristics) of a Nurse Supervisor whose program teams have demonstrated optimum program outcomes at their sites include: A strong, collaborative leadership and communication style Capacity for critical analysis, problem solving, and decision-making that flexes around the client and her world view Mentoring and coaching approaches to team management High level knowledge, skill, and experience in using the nursing process to guide patient centred care 10 In Australia, the Nurse Supervisor also needs to model practice that is culturally safe in Aboriginal and/or Torres Strait Islander contexts, in all aspects of their work. These represent an advanced practitioner, and a highly experienced leader and clinician who can provide guided mentoring and supervision to support the ANFPP team Nurse Home Visitor The ANFPP Nurse Home Visitors works with the Family Partnership Workers to foster a culturallysafe therapeutic relationship with women pregnant with an Aboriginal and/or Torres Strait Islander baby and their families, to promote high-level engagement and successful program outcomes. The Nurse Home Visitor is responsible for maintaining the highest standards in nursing practice and the use of the nursing process. This position maintains adherence to the ANFPP CME required for program outcomes (program fidelity), and to policies and procedures, guidelines, and standards of the primary health care service Family Partnership Worker The Family Partnership Worker position is integral to your ANFPP team and contributes to the successful implementation of ANFPP within the local community. A unique adaptation of the program for Australia has been the inclusion of the Family Partnership Worker. In implementing organisations, the Family Partnership Worker position can be referred to by a title that is relevant to that organisation including Aboriginal Family Partnership Worker, Aboriginal Community Worker and Strong Women Worker. Where Family Partnership Worker is referred to in ANFPP documents, the term is inclusive of this role irrespective of the local title for the position. This position is responsible 9 Beam, R. J., O'Brien, R. A., & Neal, M. (2010). Reflective practice enhances public health nurse implementation of Nurse Family Partnership. Public Health Nursing, O'Brien, R. A., Moritz, P., Luckey, D. W., McClatchey, M. W., Ingoldsby, E. M., & Olds, D. L. (2012). Mixed methods analysis of participant attrition in the Nurse Family Partnership. Society for Prevention Research, doi: /s

28 for providing advice and guidance to your ANFPP team on a broad range of cultural issues regarding local practice and cultural safety, which will inform the adaptation of program materials and the facilitation of culturally-safe home visits to participating mothers. This position has a key role in liaising with family members and community members. The Family Partnership Workers provides advice and feedback to the ANFPP National Program Centre team members, relating to issues of Continuous Quality Improvement and improved client outcomes. This position is also responsible for maintaining high-level standards of community practice and adherence to the ANFPP CME required for program outcomes, as well as to policies and procedures, guidelines, and standards of the primary health care service Other Local Team Members As the ANFPP integrates within your local organisations there are a wide range of other teams that may provide support to your ANFPP program. This may include members from your Quality Team, Health Information Team, and other corporate services areas in your organisation. Your organisation may wish to invite staff from these areas within your organisation to participate in the ANFPP implementation planning workshops as required. 4.5 ANFPP COMMUNITY REFERENCE GROUP Community readiness and involvement has been identified as a key element of successful introduction and maintenance of evidence-based programs and has been shown to have a direct impact on client attrition rates within NFP. The planning and establishment for the Community Reference Group, or similar structure commences during the Program Planning Phase. The Community Reference Group is the vital link for the local community to engage in active community participation within the program. While the Community Reference Group is not a decision-making body, it does have a significant role in informing the cultural context and acceptance of the program. The primary purpose of this group is to: Raise community awareness and understanding of ANFPP Increase engagement and support for ANFPP at a local community level Enable the local ANFPP team to gain knowledge of local services and build relationships with community service providers in order to help clients access needed services Help to assess and respond to challenges to program implementation Understand client resources and needs and identify gaps in local services Network with other local, regional and national bodies to generate the support needed to help sustain the ANFPP program over time Implementing organisations are encouraged to invite participation from Community Reference Group members in program activities, meetings, and celebration of milestones, where appropriate. It is important to establish the Community Reference Group in the planning phase, prior to progressing to the commencement phase so as to support the ANFPP team in engaging with the 20

29 community the implementing organisation services. The Community Reference Group membership is voluntary and it is suggested meetings be held on a quarterly basis. A group of supportive community leaders can offer long term support to the local program to ensure program quality and sustainability. 5 ANFPP WORKFORCE DEVELOPMENT AND EDUCATION The goal of ANFPP education is to develop highly skilled, advanced practitioners across all professional streams within the ANFPP workforce to achieve program outcomes (Workforce Development and Education Strategy ). To do so, the National Program Centre provides a significant amount of education for all your ANFPP staff. Much of a new program staff member s first 12 to 18 months of employment is spent learning and acquiring competency in the delivery of the essential components of the program and supporting program delivery with alignment to the CME. While your staff come into the program with the relevant qualification, and often significant clinical knowledge and local health service experience, they commence their role as a novice in the ANFPP model. The education program will build a staff member s ability to competently deliver the ANFPP program in your local community. The program s education curriculum is facilitated and delivered by the National Program Centre and is further supported by the Nurse Supervisor though ongoing participation in one-on-one reflective supervision, client conferences, team meetings and supervised visits (these activities are outlined further in the program s CME). Additional learning, networking and development opportunities are also provided by the National Program Centre using a Community of Practice approach, which is fostered through staff participation in: Online discussion forums National program staff teleconferences Participation in Community of Practice activities Continuous Quality Improvement activities ANFPP staff participation in further professional development is identified within the context of internal governing processes within each implementing organisation e.g. local professional performance appraisal processes that identify professional development goals for each staff member. Figure 3 graphically illustrates the multiple layers of learning activities that support driving program outcomes. 21

30 Professional development Community of practice Team meetings Case conferences One on one Reflective supervision & supervised visits Core education Figure 3: Learning activities supporting ANFPP staff to achieve program outcomes. Core education is specific to the program model and is currently delivered via tele/audio link ups, online, and face to face, with educational materials being provided in print or in electronic form. Flexible web-based modules are in development. Some education components are specific to program roles such as in the case of Family Partnership Worker Training, Nurse Home Visitor Unit 2 and Nurse Supervisor Unit 2. Nurse Home Visitors are required to attend Nurse Home Visitor Unit 2, prior to commencing home visitation with women. The National Program Centre welcomes all staff participating in educational modules as part of their own professional development, even though the module may not be essential to their role. In these cases, the decision to participate will be left to implementing organisations and the professional development goals for each staff member. As with all aspects of ANFPP, the core education curriculum is subject to Continuous Quality Improvement, which informs refinement and change while continuing to support program fidelity. Refinements and changes are elicited through staff feedback, staff participation in national level working parties, and international developments in the program. During the Program Planning Phase, when Nurse Supervisors are appointed to their positions it is recommended that they undertake the first two units of education prior to the further recruitment and establishment of the rest of your ANFPP team. The National Program Centre will liaise with the implementing organisation (via the Nurse Supervisor) on a regular basis regarding the delivery of ANFPP education. All experienced program staff play an important role in supporting new staff in developing skills and practice that is consistent with the CME. (See Figure 4: Staff education and 22

31 learning model the diagram illustrates the relationship between core education provided by the NPC team - and social learning (occurs at site) Core education Site-based social learning Skilled program staff Figure 4: Staff education and learning model the diagram illustrates the relationship between core education provided by the NPC team - and social learning (occurs at site) Developing professional skills and knowledge in ANFPP helps program staff focus in applying the principles and theories underpinning the program strategies, as well as mastering strategies to deliver content in the Home Visit Guidelines. Refer to section 9.5 for details. 6 ANFPP NATIONAL QUALITY FRAMEWORK The core principles identified in Figure 5 have been devised from the established literature for the ANFPP Quality Framework (2016), health delivery instruments within Aboriginal and/or Torres Strait Islander communities, evaluation reports on replicating home visiting programs and the past and future approach of the National Program Centre. 11 These principles encompass the collaborative nature of the program, that there are achievable and measurable outcomes for clients both individually and collectively, and that to achieve these outcomes the program must be delivered in a culturally sound and respectful manner. A continual 11 Daro, D. (2010). Replicating Evidence-Based Home Visiting Models: A Framework for Assessing Fidelity. Chicago: Mathematica Policy Research. 23

32 quality improvement process that encompasses these core principles will substantially enhance the sustainability and achievements of the program. Client engagement Cultural safety Program implementation Outcome achievement Universal responsibility Figure 5: Core principles of the Quality Framework 7 ANFPP COMMUNITY OF PRACTICE ACTIVITIES The National Program Centre coordinates a range of activities including learning and sharing opportunities using a Community of Practice approach. The Community of Practice is a model of learning based on collaboration among peers 12. A Community of Practice approach enhances Core ANFPP education. The goal of a Community of Practice approach is used to enhance support, collaboration and communication across teams as well as to build on each other s knowledge of clinical practice issues. To benefit from these learning opportunities, it is important that your ANFPP team participate in regular activities to share clinical practice and implementation lessons learnt through regular teleconferences and national meetings. Participation of staff from all ANFPP implementing organisations is encouraged and fostered. These activities include: Annual ANFPP Conference Online discussion forums National teleconferences for Chief Executive Officers, Program Managers and all ANFPP team members National Data group meetings; and National newsletters 12 Andrews, N., Tolson, D. & Ferguson, D. (2008) Building on Wenger: Communities of Practice in Nursing. Nurse Education Today. 28,

33 8 ANFPP NATIONAL KNOWLEDGE ACCESS The ANFPP is an evidence-based program that collects valuable information in order to monitor program implementation in alignment with the CME and importantly the outcomes for the women and their children. Recognising the importance of collecting quality information, the ANFPP National Knowledge Access (ANKA) system will provide implementing sites with a purpose-built web-based national system to allow the collection of both client and non-client data, reporting and program implementation monitoring at a local and national level. ANKA has a series of modules for recording information about the clients and their children, community engagement, maintenance of referral pathways, core education and provides tools for program staff to implement elements such as reflective practice. Currently under-development for implementation late 2017, this system replaces the previous forms-based collection methods and allows for streamlined collection, monitoring and reporting for the program. ANKA is designed to allow up-to-date, relevant information to be accessible at a local site on program information and client profiles. It is expected that Wave 3 and 4 sites will use the ANKA upon commencement of women being accepted into the program. In the unlikely event of visit commencing before the availability of ANKA, the NPC will work with individual sites on interim processes. Implementing organisations will receive training in ANKA as part of the Planning Phase, generally, after the establishment of resources and completion of initial core curriculum education and planning activities. ANKA does not impact on established data collection requirements within the implementing organisation s own client information system, but provides an enhanced method of collecting ANFPP-specific information that can then be used by ANFPP teams to support quality, monitoring and reporting requirements. Figure 6: ANKA logo The ANKA logo represents the important and vital work that the program undertakes. The coolamon is a visual representation of the gathering of knowledge and is traditionally used as a vessel for gathering foods. The coolamon was also used to cradle babies, reflecting the core business of ANFPP in assisting new parents through their pregnancies and in the child s first two years. 8.1 PROGRAM INTEGRATION WITH LOCAL INFORMATION SYSTEMS Implementing organisations utilise local patient information systems to register new clients to the program, and to record information that is relevant under organisational policies and guidelines. This encompasses, but is not limited to, mandatory reporting, client relationships (mother and child), 25

34 referrals, demographic information and progress notes. The use of ANKA does not eliminate the need to consider how the ANFPP will be integrated within the existing systems and health information processes. Access to these systems, aligning with local health information access procedures need to be considered within the planning phase. More information about this integration will be discussed during the Implementation planning sessions facilitated by the National Program Centre. 26

35 9 TOOLS AND TEMPLATES 9.1 NPC TEAM 27