FAMILY NURSE PARTNERSHIP (FNP)

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FAMILY NURSE PARTNERSHIP (FNP) Evidence Rating: Assessed By: Blueprints; OJP; NREPP; Commissioning Toolkit; RAND; Coalition for EBP Intended Outcomes: Improved parenting Prevent child maltreatment

visiting programme for young mothers expecting their first child.

s second birthday. During these visits, mothers learn about their young child s health and development and receive support for their own wellbeing.

1 FAMILY NURSE PARTNERSHIP (FNP) Evidence Rating: Assessed By: Blueprints; OJP; NREPP; Commissioning Toolkit; RAND; Coalition for EBP Intended Outcomes: Improved parenting Prevent child maltreatment Improved child mental health & wellbeing Prevent substance misuse Reduced likelihood of antisocial behaviour and conduct disorders Prevent teen pregnancy Family Nurse Partnership (FNP) is a home visiting programme for young mothers expecting their first child. Mothers enrol in the programme early in their pregnancy and receive visits from a family nurse on a weekly basis just before and after the birth of their child and then fortnightly until their child s second birthday. During these visits, mothers learn about their young child s health and development and receive support for their own wellbeing. FNP has established evidence of providing long-term benefits for young mothers and their children, including improved children s school readiness and a greater likelihood of mothers finding work and completing their education. Where has it been implemented? The UK, the USA and internationally Settings Home of mother Who can deliver it? Practitioner: QCF Level 4/5 in school nursing, health visiting, midwifery or other nursing background Who is it for? Age: Women aged 19 and under expecting their first child Classification: Selective Prevention Need: Moderate Contact Info FNP National Unit - enquiries@fnp.nhs.uk Samantha Mason - smason@fnp.nhs.uk

2 2 How it works What is the theory of change? The FNP model draws from three scientific theories of human development: selfefficacy theory, ecological theory and attachment theory. Self-efficacy theory assumes that people are more likely to engage in activities in which they perceive themselves as successful. FNP therefore helps young mothers set realistic goals and break them down into small, achievable steps. Mothers then gain a sense of accomplishment as they see themselves achieving each goal. This sense of efficacy, in turn, increases mothers motivation to pursue further goals, including positive lifestyle goals and higher education. Ecological theory assumes that the quality of support mothers give their children is influenced by the quality of support they receive from their family and community. FNP therefore helps young parents develop positive links with other family members and community resources. Attachment theory assumes that children are more likely to form positive expectations about themselves and others if they are raised in a warm and sensitive family environment. FNP therefore helps first time mothers respond sensitively to their child and create a warm and predictable environment. In the short term, young mothers are more likely to provide their infant with nurturing and sensitive care and make positive health and educational choices for themselves. In the longer term, children will be more likely to do well in school and complete their education and be less likely to engage in antisocial behaviour. A detailed logic model of FNP can be found here. What happens during delivery? How is it delivered? Family Nurse Partnership is delivered by a specially trained family nurse through up to 64 home-based weekly fortnightly or monthly sessions to first time mothers. Each session lasts minutes. Teams of up to eight family nurses are led by a supervisor What happens during the intervention? A series of structured home visits are delivered using a wide range of materials and activities that build self-efficacy, change health behaviour, improve care giving and increase economic self-sufficiency.

3 3 At the heart of the FNP model is the relationship between the client and the nurse. FNP builds on expectant mothers (and fathers ) intrinsic motivation to do the best for her child. A therapeutic alliance is built by specially trained nurses, which supports families to make changes to their health behaviour and emotional development and form a positive relationship with their baby. Clients learn parenting skills (e.g. holding baby, bathing baby) some using a doll, to demonstrate how to interact and play with the child and the nurse providing feedback as the mother interacts with the baby. What are the implementation requirements? Who can deliver it? Practitioners should be registered nurses with experience of community nursing and with babies and children e.g school nursing, health visiting, midwifery, mental health with a minimum of QCF Level 4/5. What are the training requirements? Family nurses and supervisors are provided with a bespoke mixed method learning programme, including both training events and individual and teambased learning materials. Once completed this learning provides nurses and supervisors with the range of programme-specific knowledge and skills they require for their roles. How are the practitioners supervised? Supervision is core to the FNP model. Practitioners receive one hour per week individual supervision and two hours per week team-based supervision with a supervisor that must have minimum of QCF 7/8 and considerable clinical experience in relevant nursing profession. What are the systems for maintaining fidelity? Regular review of programme fidelity data at multiple levels - nurse, site, national generated from a real time information system. National Unit regularly reviews site level fidelity data in line with license and offers quality improvement support to sites.

4 4 Projected Costs and Benefits Please click here for cost-benefit information. Evidence FNP has established evidence from several randomised controlled trials demonstrating significant benefits for the mother and child. Eckenrode, J., Campa, M., Luckey, D., Henderson, C., Cole, R., Kitzman, H., Anson, E., Sidora-Arcoleo, K., Powers, J., & Olds, D. (2010). Long-term Effects of Prenatal and Infancy Nurse Home Visitation on the Life course of Youths: 19-Year Followup of a Randomized Trial.Archives of Pediatric and Adolescent Medicine,164, 9-15 Fewer subsequent births (self-report) Fewer days on benefits (self-report) Fewer maternal arrests and convictions (self-report) Children less likely to be arrested or convicted for a crime (self-report). Olds, D.L., Kitzman, H., Knudtson, M.D., Anson, E., Smith, J.a., and Cole R. (2014). Effect of Home Visiting by Nurses on Maternal and Child Mortality Results of a 2- Decade Follow-up of a Randomized Clinical Trial, JAMA Pediatrics, doi: /jamapediatrics Maternal mortality (National Death Index) Preventable cause morality in children (National Death Index). Kitzman, H., Olds, D.L., Cole, R., Hanks, C., Anson, E.A., Arcoleo, K.J., Luckey, D., Knudtson, M.D., Henderson Jr, C.R., & Holmberg, J. (2010). Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Children, Archives of Pediatrics and Adolescent Medicine, 164, FNP mothers spent less time on benefits anxiety (ten year follow-up maternal self-report) FNP mothers were less likely to have another child and/or fewer children in their teens and twenties anxiety (ten year follow-up maternal self-report) FNP mothers reported a greater sense of self efficacy anxiety (ten year followup maternal self-report) FNP mothers were more likely to report a higher quality romantic relationship anxiety (ten year follow-up maternal self-report) FNP children were less likely to use cigarettes and alcohol when they were older anxiety (ten year follow-up maternal self-report) FNP children reported lower rates of depression and anxiety (ten year followup maternal self-report).

5 5 Olds, D. L., Robinson, J., Pettitt, L., Luckey, D., Holmberg, J., Ng, R.K., Isacks, K., Sheff, K. & Henderson Jr., C.R. (2004). Effects of Home Visits by Paraprofessionals and by Nurses: Age 4 Follow-Up Results of a Randomized Trial. Pediatrics, 114, FNP mothers waited longer before having their next child (maternal selfreport) FNP mothers experienced less domestic violence (maternal self-report) There were no differences between FNP children and the control group in this study.

Family Nurse Partnership

Published March 2017 Last updated June 2017 Downloaded from http://guidebook.eif.org.uk/programme/family-nurse-partnership Family Nurse Partnership Review: Foundations for Life, July 2016 Family Nurse