FNP: Integration of a
licensed programme
Improving Integrated Assessment,
Interventions and Developing
Integrated Pathways
Sam Mason, FNP National Unit
© Family Nurse Partnership 2013
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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
© Family Nurse Partnership 2013
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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.
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Wide range of proven benefits for
children and families
Improved maternal pregnancy behaviours
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Reduced smoking during pregnancy
Improved parenting
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Reduced child abuse and neglect
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Reduced injuries and ingestions
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More stimulating home environment
Improved child development
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Improved language and mental development, fewer mental delays;
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More responsive to interactions with mother
Improved school readiness and school achievement
Fewer emotional and behaviour problems
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Fewer mental health problems at age 12
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Reductions in clinical level behaviour problems (age 4, 6)
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Reductions in risky behaviours – smoking, alcohol, marijuana
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Fewer arrests, supervision orders by age 15, arrests and convictions for girls by 19
Improvement in parents’ life course development
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Fewer subsequent pregnancies & births
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More months employed
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Less use of welfare
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Improved mastery (self efficacy)
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More months with partner/employed partner
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Fewer arrests and convictions
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Increased father involvement in child’s care
© Family Nurse Partnership 2013
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FNP in England:
16,000 places by 2014/15
FNP coverage March 2014
Planned FNP coverage
14/15
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Who is FNP for?
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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
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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
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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
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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
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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
© Family Nurse Partnership 2013
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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
© Family Nurse Partnership 2013
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Integration with local services
• FNP well integrated in many areas
• At individual practice and local system level:
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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
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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?
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