Family Nurse Partnership Julia Rosser Public Health Consultant Information and stories from: http://www.fnp.nhs.uk/

What is Family Nurse Partnership? Who? FNP is for first time young mums, aged 19 or under (and dads or other family members). It is delivered by specially trained nurses. What? FNP is a maternal and early years public health programme to provide intensive support to first time mums and their family, through regular home visits, using a psycho-educational approach. Where? As appropriate, including regular home visits When Mum will have support from early in pregnancy until the child is two.

What does FNP aim to do? To improve their pregnancy outcomes, so that their baby has the best start in life To improve their child’s health and development by developing their parenting knowledge and skills To improve parents’ economic self sufficiency, by helping them to achieve their aspirations (such as employment or returning to education) “The Family Nurse Partnership programme is underpinned by an internationally recognised robust evidence base, which shows it can improve health, social and educational outcomes in the short, medium and long term, while also providing cost benefits”.

FNP Clients Client participates voluntarily in the programme. Eligible clients include high-risk first-time mothers only. Sites enrol at least 60% of clients onto the programme by the 16th week of pregnancy and 100% no later than the 28th week. Each client has the same family nurse throughout her pregnancy and the first two years of her child’s life.

Enabling Build positive relationships with their baby and understand their baby’s needs Make the lifestyle choices that will give their child the best possible start in life Build their self-efficacy (belief and ability to plan and achieve their goals ) Build positive relationships with others, modelled by building a positive relationship with the family nurse​

FNP in Halton (1) Commissioned by NHS England Provider organisation is Bridgewater Community Healthcare Trust. Who are licenced to deliver FNP Have established a Halton FNP advisory board – representatives include NHS England, CCG, Bridgewater, Public health, Partner organisations Commissioning responsibility for FNP will transfer to Halton borough council in October 2015.

FNP in Halton (2) The FNP team includes a team leader, and 4 FNP nurses Based in a Halton children’s centre Started seeing patients in November 2014

Programme Impacts Improvements in school readiness Increases in employment Increases in fathers’ involvement Reductions in welfare dependency Fewer subsequent pregnancies Greater intervals between births Reduced substance use initiation and later problems Reductions in children’s injuries Improvements in women’s antenatal health Programme effects greatest among those most susceptible

Evidence based 30 years of research in the USA, 3 randomised controlled trials FNP improves the lives of vulnerable young children and mothers in the short, medium and long term: Improved pregnancy outcomes Reduced child abuse and neglect Improved school readiness Reduced youth crime Improved employment for mothers, and fewer subsequent pregnancies with bigger gaps between births

UK Evidence Stopped smoking in pregnancy or smoked fewer cigarettes 10 pilot sites in England found that mothers participating in the Family Nurse Partnership: Stopped smoking in pregnancy or smoked fewer cigarettes Initiated breast-feeding at a high rate Coped better with pregnancy, labour and parenthood Had increased confidence and aspirations for the future Were returning to education and taking up paid employment Were very positive about their parenting capacity and reported high levels of warm parenting. Large randomised controlled trial in England is due to report initial findings 2014

Outcomes from research Child abuse and neglect 48% reduction in verified cases of child abuse and neglect by the time the children were aged 15 in the Elmira trial (Eckenrode et al 1997) 56% reduction in A&E attendances for injuries and ingestions during child’s second year of life (Olds et al 1986) 28% relative reduction in all types of health care encounters during child’s first two years of life in the Memphis trial (Kitzman et al 1997) 79% relative reduction in the number of days that children were hospitalised with injuries or ingestions in child’s first two years of life, also in the Memphis trial. (Kitzman et al 1997) Nurse-Family Partnership has been identified by MacMillian and colleagues (2009) “as the strongest of one of only two programmes proven to prevent child abuse and neglect “

Improved pregnancy and health behaviours Decreases in cigarette smoking during pregnancy (Olds et al 1986, 2002) Fewer hypertensive disorders of pregnancy and fewer pregnancy related infections (Olds et al 1986) Improvements in prenatal diets (Kitzman et al 1997)

Improved school readiness 50% reduction in language delay at 21 months (Olds et al 2002) Better academic achievement in the first six years of elementary school (Kitzman et al 2010) Better language and emotional development at age 4 (Olds et al 2004)

Improved mother’s life course and economic self sufficiency Fewer subsequent pregnancies and births and greater intervals between first and second babies (Olds et al 2002) Greater maternal employment [Olds et al 1988] Reductions in use of welfare and other government assistance (Olds et al 1997) 61% fewer arrests and 72% fewer convictions of mothers by the time their child is aged 15 (Olds et al 1997) More stable relationships with partners and with their child’s father (Olds et al 2010)

The cost savings grow over time Based on Elmira High-Risk Families Cumulative savings Cumulative dollars per child S O C I A L R E T U N Cumulative Costs Age of child (years)

Economic returns Family Nurse Partnership programme results in financial benefits to participants, the public purse and wider society. Economic benefits increase over time as the children get older. The cost of the programme is recovered by the time the children are aged four for the highest risk families and certainly by age 12 Financial returns in the United States vary between $17,000 and $34,000 per child by the time they reach adulthood Long-term benefits of $23,000 per participant. (Washington State Institute for Public Policy)

For more information on FNP go to: http://www.fnp.nhs.uk/ Any Questions? Julia.rosser@halton.gov.uk For more information on FNP go to: http://www.fnp.nhs.uk/