fnp: integration of a licensed programme

© Family Nurse Partnership 20131

FNP: Integration of a licensed programmeImproving Integrated Assessment, Interventions and Developing Integrated Pathways

Sam Mason, FNP National Unit


What is FNP?

• A structured, intensive home visiting programme delivered by family nurses

• Offered to first time young mums (and dads)

• Begins early in pregnancy, concluding when child reaches 2 years

• Preventive public health programme, focussing on adaptive behaviour change

• Evidence based programme proven to improve short, medium and long term outcomes and break the cycle of disadvantage


FNP Goals

• To improve the outcomes of pregnancy by helping women improve their prenatal health

• To improve children's health and development by enabling parents to provide more competent care for their children

• To improve women's life course by planning subsequent pregnancies, finishing their education and finding employment.


Wide range of proven benefits forchildren and familiesImproved maternal pregnancy behaviours • Reduced smoking during pregnancyImproved parenting• Reduced child abuse and neglect• Reduced injuries and ingestions• More stimulating home environment

Improved child development• Improved language and mental development, fewer mental delays;• More responsive to interactions with mother

Improved school readiness and school achievement

Fewer emotional and behaviour problems• Fewer mental health problems at age 12• Reductions in clinical level behaviour problems (age 4, 6)• Reductions in risky behaviours – smoking, alcohol, marijuana• Fewer arrests, supervision orders by age 15, arrests and convictions for girls by 19

Improvement in parents’ life course development• Fewer subsequent pregnancies & births• More months employed• Less use of welfare• Improved mastery (self efficacy)• More months with partner/employed partner• Fewer arrests and convictions• Increased father involvement in child’s care


FNP in England:16,000 places by 2014/15

FNP coverage March 2014Planned FNP coverage 14/15


Who is FNP for?

• All first time young mothers to be aged 19 and under (and fathers/families)

• Specialist universal service (Universal Partnership Plus)• Voluntary, at least 75% of those offered enrol • Early in pregnancy, enrol no later than 28th week of pregnancy• Current coverage approx 25% of eligible population, varies

considerably between areas• FNP available in around 130 LAs by March 2015


Implementing a licensed programme

• To ensure programme replicated as intended and expected benefits realised

• Well defined intervention + well defined implementation model + effective replication and implementation = positive outcomes for intended consumers

Attention to fidelity at levels • Intervention fidelity: programme model is delivered as intended• Implementation fidelity: programme implementation drivers are

installed within a system to enable clinical replication


Replicating FNP with Fidelity • The license• Having a programme that can be

described - what, when, why and how• Practitioner selection• Clear guidelines and content• Fidelity measures - core model elements

and stretch goals• The learning programme and use of FNP

methods in practice• Supervisor role - contributing to learning,

reflection, coaching• Real time Information System and

performance evaluation - nurse, team, site• Quality improvement measures• The Advisory Board


Replicating FNP with Fidelity

• But…• The programme is being implemented within a pre-existing

system, with its own norms, culture and expectations• The programme model is complex and every client and their

circumstances are different• So in both instances consideration is needed about what has

to remain fixed and what can be flexed


Effective replication:fixed and flexed

For local leaders this means…• Understanding the science and the impact leaders have on

outcomes• Maintaining implementation fidelity whilst being creative in flexing

local systems for programme integration• Respecting clinical practice and actively supporting maintenance of

intervention fidelity• Using data reports, clinical analyses and client feedback to guide

efforts in continual quality improvement• Planning for sustainability and preventing implementation drift over

time


Effective replication:fixed and flexed

For family nurses and supervisors this means:• Absorbing all the learning – theoretical underpinnings, content and

methods of the programme• Skilful practice – adapting to replicate programme methods with

clients• Using the real time information on implementation and

achievement of stretch goals to guide efforts in continual quality improvement

• Sustaining clinical model over time and absorbing new augmentations

• With individual clients, across caseload, over time, within team


Integration with local services

• FNP well integrated in many areas • At individual practice and local system level:

• FNP Advisory Board• Safeguarding• CAF, Pre-CAFs, Lead Professionals• Midwifery/maternity • Children’s Centres• Child and adult health services • Health visiting• Healthy Child Programme delivered as part of FNP• FNP clients handed over to universal services at age 2• FNP supports client to access the other services they need• ‘Sharing the learning’• Clients • Supervisor


Moving integration forward

• How do we encourage more integration, in more places, more quickly, more consistently?

• Further understanding of what is good practice re integration of FNP• What can be flexed and how, what can’t and how to keep it fixed• Understanding what works and doesn’t• Sharing approaches and best practice • What can FNPNU do to best support and stimulate integration?

fnp: integration of a licensed programme

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