1. National Implementation Lead (FNP)
Gail Trotter
National Implementation Lead (FNP)

2. Family Nurse Partnership programme (FNP)

3. Improve pregnancy outcomes
FNP Goals
Improve pregnancy outcomes
Improve child health and development and future school readiness and achievement
Improve parents’ economic self-sufficiency
LICENSED Early Intervention home visiting programme delivered by specialist trained family nurses delivered from early on in pregnancy until the child is 2 years of age.The three aims of the programme are ;
To improve pregnancy outcomes , To Improve child health and future school readiness and achievement and to improve economic self-sufficiency ; Economic self sufficiency meaning ; parents finding meaningful employment or returning or commencing education 3

4. Criterion for FNP… who is entitled to FNP?
First time pregnant teenagers aged 19 and under at LMP
Residing in the area for 2 years
Not planning to relinquish the baby
“Opt in” programme
Criterion for FNP… who is entitled to FNP?
First time pregnant teenagers aged 19 and under at LMP
Residing in the area for 2 years
Not planning to relinquish the baby
“Opt in” programme

5. We currently are testing FNP in NHS Lothian and NHS Tayside with a SG commitment to ‘roll out FNP’ across Scotland , starting with 5 further NHS Boards tripling the number of those currently in receipt of the programme by 2013.

6. The programme puts the child at the centre of care for the duration of the programme – the programme ‘ keeps the baby in mind ‘ constantly and embodies the principles of GIRFEC. It builds on a mothers intrinsic desire to care for her baby and pregnancy is an optimal time to to just that . It is delivered by the one Family nurse who offers continuity to a family a key fact in the success of this approach and develops a therapeutic relationship with the family over the 2.5 year period.
It is based on what we now know about neuroscience and the importance of brain development in pregnancy, the theories of human ecology – supporting parents as individuals to achieve what they want to achieve for themselves to be part of their new and exisiting family and to contribute to and be supported by the wider community . It is also based on the theories of attachment – helping young parents become close to their child and be able to recognise and respond to their childs needs.It is based on the theories of self efficacy ; supporting young teenagers to be the parents they aspire to be – it works alongside young parents ; does ‘with’ and ‘not to – embracing the key principles of co-production and is often referenced as an assets based approach .

7. Scotland's teenage parents
Under 20’s first time parents nine times more likely to live in deprived areas
66% (2,300 women) from the most deprived quintiles
Just 16% in the least 2 deprived quintiles
Obstetric immaturity
Young mothers higher increase of lbw babies
More likely to be smoking at booking and less likely to engage in Ante Natal care support
Less likely to breastfeed
LAC teenagers 25 % pregnant leaving care.
The national data across Scotland shows that first time teenager mothers under 20’s were almost nine times more likely to live in deprived areas compared to the least deprived. 66% of first time mothers, aged under 20, are in the 2 most deprived quintiles, a total of nearly 2,300 women. Whereas there are just 16% were in the 2 least deprived quintiles.
We also have strong evidence that young mothers are more likely to have a low birth-weight baby ( obstetrically immature from a physical, emotional and psychosocial aspect) and are more likely to report that they smoke at first booking. They are also less likely to attend antenatal services early in their pregnancy and less likely to initiate breastfeeding. Many of our FNP clients are from LAC , with 25 % pregnant on leaving care with significantly more months on....on top of all these challenges many have significant other vulnerability factors to contend with. This programme aims to change the potential of poor outcomes for these young parents and their babies.

8. It works in partnership with families , respecting their agenda and focussing on achieving jointly set goals working at their pace .It offers positive affirmation and feedback to families something many have never had before.
The programme does not work in isolation and in developing self efficacy encourages teenage families to link into and be supported by all the resources and services available to them in the community. From NHS Lothian we are seeing great links with SW,schools and Housing in particular.

9. Evidence Base 3 USA RCT trials
Improvements in women’s antenatal health
Reductions in children’s injuries
Fewer subsequent pregnancies
Greater intervals between births
Increases in fathers’ involvement
Increases in employment
Reductions in welfare dependency
Reduced substance use initiation
Improvements in school readiness
The evidence base for FNP is very powerful.
It is based on Three major trials Lead by David Olds and his team :
1st is the Elmira Trial in New York
2nd is the Memphis trial in Tennessee.
The 3rd was the Denver Trial, Colorado.
Despites High level encouragement to extend FNP nationally in USA , David Olds was not ready to assume that success in a white, rural region would automatically be duplicated in urban settings and in communities of colour. He also wanted to test out the model being delivered by para professionals as well as qualified Nurses. He found that the model did give the results across multi ethnic communities and that when delivered by qualified nurses the results for families were markedly better than when delivered by paraprofessionals. The findings across the three trials are listed in the slide you see. There has been a Major evaluation of FNP in England by Birkbeck University and A large scale RCT is underway in England – the largest ever funded by funded by DoH ; the results being of great interest here in Scotland. Our own evaluation about the transferability of FNP to Scottish context showing early very positive signs that FNP can be successfully implemented here too.

10. Overcoming barriers and constraints ; our families sign up and stay with the programme over 80% so far , we are seeing early signs of confident parenting amongst our families and Family Nurses report feeling equipped by the excellent education and training and supervision for the role , they say that it is the most rewarding but hardest job they have ever done .The hours are long and the clients can be challenging.

11. 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
Sustaining FNP requires us to collect and collate the evidence. The slide shows the cost benefits of FNP well after the programme has reached its course after 2.5 years.
Cumulative Costs
Age of child (years)

12. Unit Costs Comparisons
Last year the Scottish Government released the financial modelling of short term savings from investing in early years / early interventions from pre-birth to aged five. This slide shows the economic value of FNP in comparison to other programmes , and that with effective early intervention programmes we have the potential to save 131m per annum in Scotland.FNP is currently estimated to cost £3K per annum per client who completes the programme. The key note from this slide is ; The best financial return for investment across the lifespan is in the years pre birth to 5.Our challenge is to convince others of this.

13. ‘Families have a right to expect evidence based interventions’.
Evidence what we do.
Be confident to stop doing what does not make a difference
Involve clients in the feedback loop
Learn and share from what we are doing well
Lord Laming reminds us in his enquiry into the tragic death of Victoria Climbie that families have a right to expect evidence based interventions and in this economic climate the impetus has never been greater to evidence that what we do is also cost effective and the best use of public money.We DO need to research further the best way to support our vulnerable families and have the confidence to stop doing what is not working . Easier still we need to use the evidence already out there to enhance our support to families – FNP evidence and other bodies of research. NES review of parenting interventions is one good example of a tool kit to be available to assist us here.
What we also need to do is share with professionals and practitioners working with vulnerable and disadvantaged families what seems to work.
We need to listen to what clients tell us about what we do what works and what doesn’t. This is one of the underpinning successes of FNP ; genuine client involvement in shaping and continually developing the programme. We have always known how important this client involvement is, we just need to have it