FNP-Slides - Early Intervention Foundation

FNP: Integration of a
licensed programme
Improving Integrated Assessment,
Interventions and Developing
Integrated Pathways
Sam Mason, FNP National Unit
© Family Nurse Partnership 2013
What is FNP?
• A structured, intensive home visiting
programme delivered by family nurses
• Offered to first time young mums (and
• 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
© Family Nurse Partnership 2013
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
• To improve women's life
course by planning subsequent
pregnancies, finishing their
education and finding
© Family Nurse Partnership 2013
Wide range of proven benefits for
children and families
Improved maternal pregnancy behaviours
Reduced smoking during pregnancy
Improved 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
© Family Nurse Partnership 2013
FNP in England:
16,000 places by 2014/15
FNP coverage March 2014
Planned FNP coverage
© Family Nurse Partnership 2013
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
© Family Nurse Partnership 2013
Implementing a licensed programme
• To ensure programme replicated as intended and expected benefits
• 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
© Family Nurse Partnership 2013
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
© Family Nurse Partnership 2013
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
© Family Nurse Partnership 2013
Effective replication:
fixed and flexed
For local leaders this means…
• Understanding the science and the impact leaders have on
• 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
© Family Nurse Partnership 2013
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
• 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
• With individual clients, across caseload, over time, within team
© Family Nurse Partnership 2013
Integration with local services
• FNP well integrated in many areas
• At individual practice and local system level:
FNP Advisory Board
CAF, Pre-CAFs, Lead Professionals
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’
© Family Nurse Partnership 2013
Moving integration forward
• How do we encourage more integration, in more places, more quickly, more
• 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?
© Family Nurse Partnership 2013
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