A programme of one-to-one nursing support for teenage mums has achieved great results and is set to expand, writes Jennifer Trueland
The Rolls-Royce of family intervention
Family nurse Merry Patel delights in seeing young, nervous parents develop confidence in their new role. Now in her fourth year with the Family Nurse Partnership – an intensive support programme for first-time teenage mothers – she says it is a privilege to play a part in this transformation. ‘Families can be connected, fragmented, or trying to repair, but when a baby comes along it is a new start,’ says Ms Patel, who is employed by Oxford Health NHS Foundation Trust. ‘The joy of the job is watching as the young parents – together with their extended family – start out on a journey of transformation to become experienced parents. With our specialist skills, and the programme model, we can support that process.’ The Family Nurse Partnership (FNP), which was developed in the United States, has been running in England since 2007. It offers one-to-one nursing support for first-time mothers aged under 20, from early in pregnancy until their baby is two years old. The support
Evidence of success Independent evaluation of the Family Nurse Partnership (FNP) in England shows that it is being delivered well, young mothers and fathers like it, and there is good potential for positive outcomes and longer-term cost savings. According to FNP national unit director Ailsa Swarbrick, mothers participating in FNP: Stopped smoking in pregnancy or smoked fewer cigarettes. Initiated breastfeeding at a high rate. Coped well with pregnancy, labour and parenthood. Had increased confidence and aspirations for the future. Were returning to education and taking up paid employment. Were positive about their parenting capacity. A recent study by the Institute of Employment Studies (tinyurl.com/familynursestudy) found that family nurses and supervisors had a positive view of their work and found working in the FNP rewarding. Nurses were highly motivated by the opportunities to ‘make a difference’ through building strong therapeutic relationships with young mothers and fathers.
Teenage mothers who accept support from the Family Nurse Partnership receive visits from a dedicated nurse on a weekly or fortnightly basis. Evidence shows that this personal service improves health outcomes and parenting skills, as well as increasing the chances of young mothers returning to education and paid employment. Author Jennifer Trueland is a freelance journalist
16 june 5 :: vol 27 no 40 :: 2013
is intensive, involving weekly or fortnightly visits lasting up to an hour and a half as needed. It includes support with life skills, such as finances and housing, as well as parenting and health issues. The FNP, which has also been introduced in Scotland, is available across England in 91 local authority areas. In April, health minister Dan Poulter announced that the programme would be extended in England, backed by £17.5 million of government funding. A total of 11,400 families
have benefited from the service provided by 550 family nurses and supervisors; and there should be 800 staff working with 16,000 families by 2015. The roll-out is being taken forward by three organisations working in partnership: Tavistock and Portman NHS Foundation Trust, the Impetus Trust and the Social Research Unit.
According to the programme’s national unit director Ailsa Swarbrick, its evidence base is compelling. ‘It aims to improve pregnancy outcomes, child health and development, as well as improve the parents’ economic self-sufficiency. ‘US research shows that children helped by the partnership go on to perform better at school, are less likely to get involved in crime, experience fewer injuries in childhood, and have fewer mental health problems than children from similar backgrounds,’ she says. ‘The FNP can improve the health of vulnerable young mothers and increase the chances of them getting a job in the future,’ Ms Swarbrick adds. Independent evaluation in England shows a similar picture (see box). The roll-out of the FNP in England has been generally welcomed, albeit with some caveats about whether the ‘Rolls Royce’ service will eat too much into the community nursing workforce. RCN adviser in children’s and young people’s nursing Fiona
Family nurse Merry Patel with young mum Lizzy Melito and baby Ila
june 5 :: vol 27 no 40 :: 2013 17
‘iT gave me confidence To be a beTTeR mum’ Nicole Duester, from Oxfordshire, gave birth to Orly-Jack in June 2010. She was in the upper sixth form when she found out she was pregnant. When her school nurse told her about the Family Nurse Partnership (FNP), she was sceptical. ‘As a young parent you feel pressured to do a lot better and are quicker to feel judged by people. But you have to decide sometimes to do things that are not necessarily comfortable – I chose to take the opportunity because I only had something to gain from it.’ Nicole (pictured with her son) admits she was ‘stand-offish’ when she first met her FNP nurse, Merry Patel. ‘I deeply regret that now, because I was judging her in the same critical way that people were judging me,’ she says. ‘But she is amazing and has gone above and beyond what she needs to do as a family nurse. Not once have I felt talked down to, or that anything I am worried about is trivial.’ The programme has, she says, given her the confidence to be a better mum than she thought she could be. Being anxious about the birth itself, she appreciated the one-to-one support and information – and is sure that this is why she managed a drug-free water birth, and was able to breastfeed her son. Having someone she could ring, or text, when she was unsure about what to do – for example when she was worried that she would have to take Orly-Jack to A&E – was also reassuring. If she has a criticism about the programme, it is that the ending felt abrupt. ‘It is discussed about six months before the finish, but the fortnightly visits going to monthly visits is quite a shock to the system.’ Nicole is now looking forward to the future. ‘I am concentrating on my education so that I can be a role model to my son when he is older,’ she says. 18 june 5 :: vol 27 no 40 :: 2013
Smith says the resources being directed at the programme are justified. ‘The evidence demonstrates benefits for children and families – breaking negative intergenerational cycles, improving health and enabling young people and their families to achieve their potential. Early years are important – invest then and you reap the rewards.’ Nurses working in the partnership come from a variety of backgrounds, including health visiting, school nursing, young people’s mental health nursing and even midwifery. Elizabeth Duff, senior policy adviser with the National Childbirth Trust, the UK’s largest charity for parents, praises the FNP for providing families with ‘continuity of contact’ with a single healthcare professional. Her only reservation about the service is that it is restricted to disadvantaged teenagers. ‘Having a baby can be a difficult and frightening experience even for people in the best socioeconomic circumstances who appear to have a lot of family support,’ she says.
investment in public health and the ripples will spread out.’ So can the health visiting workforce in particular take the strain if many in the workforce opt to join the FNP? That is less of an issue than it was, says Dave Munday of the Community Practitioners’ and Health Visitors’ Association, who points out that the government’s commitment to employ 4,200 more health visitors by 2015 means there is a bigger pool for the programme to draw on. Extra support for some families does not mean having to move away from a universal health visiting service, insists Mr Munday. ‘Family nurses, combined with the expansion in health visitor numbers, have a big effect.’
Ms Swarbrick agrees: ‘This is about important services working well together. The programme complements and supports the work of existing universal children’s services, including the work of health visitors.’ According to Ms Patel, who formerly worked as a nurse with
IT IS AN INvESTMENT IN pUBlIc hEAlTh AND ThE RIpplES wIll SpREAD oUT ‘Fragmented care – and conflicting advice – do not help, especially where gaps might open up. If someone brings a baby home from hospital and only gets a call telling them to pop into the clinic if they have a problem, it can be daunting.’ Ms Duff says she knows a lot of health visitors who would like the family nurse programme to be less rigid. ‘They would like something that allows them to use their professional judgment, to give intensive support when it is needed and tail off a bit when it is not.’ That said, she is hugely impressed by the FNP’s results. ‘The success in smoking cessation and increasing levels of breastfeeding is great – it is a real
children and young people leaving care, the programme is far from rigid. ‘I love the ability to be innovative and creative within its structure,’ she says. ‘Working in partnership with parents is part of the creative jigsaw. You have no preconceived ideas of the final picture when you first meet, and they commit to a relationship with you for two and a half years. It is amazing seeing young women begin to make choices because they want the best for their babies.’ The FNP programme works towards a ‘graceful goodbye’ between the family and the nurse, explains Ms Patel. ‘Seeing them continue on their journey without me is rather a special accomplishment’ NS