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.

Brighter futures

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.’

Service integration

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


The Rolls-Royce of family intervention.

Teenage mothers who accept support from the Family Nurse Partnership receive visits from a dedicated nurse on a weekly or fortnightly basis. Evidence ...
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