Shared learning database

Bentley West End Youth Centre
Published date:
February 2011

Family Nurse Partnership [FNP] is an intensive preventive programme through pregnancy until the child is aged 2.

Specially trained nurses implement a 30 year, American evidenced based programme for first time pregnant teenagers, which benefits children and families who have the likelihood of poorer outcomes. The service engages pregnant women under the age of 20 onto a voluntary programme with the aim to build a therapeutic relationship between themselves and the family nurse to improve antenatal health, child development and parents' self-sufficiency.

All supportive evidence is available on line from the National Family Nurse Partnership website, DOH.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To reciprocate the licensed fidelity of an evidenced based home care programme for pregnant teenagers, to improve antenatal health and the best start in life for their baby. The programme is offered to first time vulnerable teenage mothers with the aim to build on small step changes into sustainable long term outcomes for both mother and child. The methods are based on theories of human ecology, self efficacy and attachment, which the family nurse supports through a strength based approach, building a therapeutic relationship. Family nurses utilize additional training and skills to engage young pregnant women and their partners in early pregnancy and until the child is two, in a voluntary programme by supporting individual's intrinsic motivation to be good parents and enable in depth work to achieve change.

Family nurses build the strengths based approach by utilizing motivational interviewing during home visits from 16 weeks of pregnancy until the child is two years, with a consistent approach by the same family nurse, to achieve improvements in antenatal health, preparation for labour, birth and early parenting skills.

The care during pregnancy aims to involve partnership working across agencies to support the clients' engagement and choice in meeting her needs. The service supports parents' expectations and understanding of their baby's needs to improve children's emotional and behavioral development; improve children's cognitive development, school readiness and academic achievement. The emerging neuro science of brain development is shared within the programme. The relationship is built on agenda matching which enables programme delivery in working towards better parenting, leading to prevention of child abuse and neglect and reduction in children's involvement in crime and ant-social behaviors in later life.

The care aims to review emotional wellbeing in pregnancy and provide additional care where required, and therefore improve postnatal emotional health, building resilience, family and community support.

The service aims to improve the mother's life course and economic self sufficiency by recognizing individual's aspirations and understanding barriers to access education, training and employment and influences other agencies in offering appropriate support.

The License and the fidelity measures ensure replication of research conditions; the programme aims to build evidence of new learning for service delivery in England.

Reasons for implementing your project

Doncaster population statistics provide the evidence of consistent high teenage pregnancy and the need to review the evidence of the FNP approach for potential outcomes with this client group. Implementation was supported from the FNP national unit, provider lead, commissioner lead and programme board. The set up costs were initially supported from the national unit.

Several young clients find access to services inappapropriate and service users inform us they feel judged and not valued. The outcomes from this client group remain poor and cycle deprivation evident. The teenage pregnancy midwife provides group based care with success for some clients, service gaps evident.

Doncaster is under review for safeguarding, which has placed immense pressures on the reactive service rather than early prevention. The universal service could not meet the demands of additional antenatal care for this vulnerable client group. The scarce evidenced base of present service delivery on outcomes emphasized the need to invest in a FNP evidenced base programme.

The programme offers a named family nurse that is consistent and follows the client through changes of addresses. This has improved efficiency of completed visits and clients frequently text family nurses of family changes. Engagement with other services is enabled, maintaining health contacts, which relates to NICE guidelines 110 with enhanced care delivery.

There is high risk that the difficult experiences of some of our clients may bring some fears for her baby, reveal her own anxieties', and provoke intense anxiety about the possibility of being like their own mothers. The therapeutic relationship that the client has with her family nurse, with the consistency of the same nurse, allows for the presence of an encouraging stance during pregnancy; which keeps the mother-to-be's vision of herself as a competent and loving mother to uphold the 'maternal ideal' in spite of many obstacles.

How did you implement the project

Doncaster succeeded on the 3rd bid to the DOH to test the programme for 100 clients, learning to 'never give up'. A good recruitment process, involving service users, experience of previous sites, national unit support and a multi agency panel for interviewing enabled the right team to be in place by time frame. Doncaster's 'can do' attitude and team support has supported resilience to overcome barriers and the required need to prioritize the right equipment to be in place quickly. Previous good relationships with multi agency working, with ease of communication for sharing information was necessary for family nurses to make contact with clients to offer the programme themselves. Support from community midwifery, an early booking's system, and particularly a teenage midwife was an important key to success. Full commitment from managers and front line staff was required to make it happen. Initial recruiting from the geographical area with high teenage pregnancy and children's centre support provided intimacy in partnerships, a knowledge base of named services and a managed step approach achieved recruitment within time frame. The local authority required additional evidence of outcomes, especially linked to present financial pressures and the empathic persistent approach. The links with the manager of the educational facility for pregnant teenagers, Connexions, youth workers and Barnados were valuable in identification of the client group within the care systems. Maintaining relationships with midwives, health visitors, school nurses and children's centres has been valuable in both present and future sustainability, as FNP is only one part of the picture. Initial, ongoing training, skills building and supervision enables replication, management and programme fidelity of the programme. The programme is delivered by weekly, fortnightly to monthly visits, following a prepared format which supports agenda matching, which relates to the NICE guideline on enhanced care.

Key findings

The support of the programme administrator has enabled the nurses to provide an electronic data base which provides the evidence of fidelity, monitors progress and the data return has enabled some identification of potential outcomes. The national evidence is that the FNP is adopted well in England from the previous implementation sites, benefits those who need it the most with greatest effects for young mothers, low income mothers and mothers with lowest psychological resources. The Programme sets a stretched target of recruitment of 60% under 16 weeks gestation, locally achieved 62% above national target. The voluntary engagement enables client choice, those declined were clients that had higher support systems which family nurses celebrated and agreed sharing of information with universal services. Doncaster client groups have high links to dependence on income benefits. The programme reviews fathers involvement, fathers have something in common with young mothers - they also share an overwhelming wish for a better life for their children. Local data demonstrates 90% of fathers were present for at least one preganacy visit and 67% for at least five pregnancy visits. The structured programme has enables nurses to engage clients in a meaningful and contained approach, many have difficult lives and the consistent approach supports stability. A positive change has been recorded with nutrition, reduction in alcohol, cigarettes, substance misuse and has influenced family support with increase in smoke free homes recorded. The relationships with other agencies have been influenced in their approach to our client group, enabling a respectful relationship and service user involvement in care delivery and opinions being sought. The family Nurse Partnership national unit is collating the data base and Birbeck University will continue with the evidence of the outcomes for clients in England.

Key learning points

The organization, both providers and commissioners need to support the programme and understand the commitment required to succeed. The need to reciprocate the programme delivery and believe in the programme for the small steps to be achieved. Time for planning and partnership working pays immense dividends to the service users and the FNP team. FNP is one part of whole care and the need for a different approach with pregnant teenagers is required to address the cycle of deprivation and risks of poorer outcomes. Additional communication skills such as practicing motivational interviewing and a modeling approach to parenting is accepted well with our client group and the commitment from our clients is immense. The true understanding of agenda matching and managing this in practice takes time to learn. Peer learning is really valuable and the supervisor role in modeling this within the team and supervision supports relationships. The delivery of this programme requires highly skilled experienced nurses from different nursing backgrounds with resilience and high commitment to overcome barriers. The client group is very complex and we have achieved a greater insight into relationships and containment through this service delivery. The continued service user involvement is really important and time for reflection on their expressed opinions is necessary to influence change. Ongoing training is necessary and the time to practice skills, nurses themselves exposing their fears, challenges and success in practice is good learning. The role of administrator is really important and cannot be underestimated to support the team. The support from community colleagues, managers of other services and the national unit are important parts of the jigsaw for implementation of FNP. Provision of national evidence and the link to early intensive preventive care and the cost recuperation when the child reaches 4 supports sustainability.

Contact details

Roz Morris
Family Nurse Partnership Supervisor
Bentley West End Youth Centre

Primary care
Is the example industry-sponsored in any way?