1. © Family Nurse Partnership 2013 1 FNP: Integration of a licensed programme Improving Integrated Assessment, Interventions and Developing Integrated Pathways Sam Mason, FNP National Unit

2. © Family Nurse Partnership 2013 2 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

3. © Family Nurse Partnership 2013 3 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.

4. © Family Nurse Partnership 2013 4 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

5. © Family Nurse Partnership 2013 5 FNP in England: 16,000 places by 2014/15 FNP coverage March 2014 Planned FNP coverage 14/15

6. © Family Nurse Partnership 2013 6 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 28 th week of pregnancy Current coverage approx 25% of eligible population, varies considerably between areas FNP available in around 130 LAs by March 2015

7. © Family Nurse Partnership 2013 7 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

8. © Family Nurse Partnership 2013 8 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

9. © Family Nurse Partnership 2013 9 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

10. © Family Nurse Partnership 2013 10 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

11. © Family Nurse Partnership 2013 11 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

12. © Family Nurse Partnership 2013 12 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

13. © Family Nurse Partnership 2013 13 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?