The Family Nurse Partnership programme in Scotland: improving outcomes for child, parents, and society

Change Management

FNP is aimed at first time pregnant teenagers (19-years and under). The are required to be resident for the 2.5 years that the programme is delivered ,  with no plans to relinquish the baby ( as it is an attachment programme)  It is optional for clients and those not wishing to be supported by FNP will receive the support from a Public Health Nurse/ Health Visitor. It is an intensive home visiting programme that focuses on the ambitions of the young parents; agenda matches with them and uses a variety of methods to work with them in a respectful and meaningful way.

© NHSScotland Photo Library 2012

The FNP is delivered by highly trained family nurses who hold a caseload of 25 clients open whole time equivalent. The partnership begins during very early pregnancy, ideally about 16 weeks and at the latest before the mother reaches 28 weeks, and lasts until the child’s second birthday. This is based upon the premise that pregnancy and the birth represent an opportunity when parents are especially open to receiving support and help (even if they have normally rejected help from public services). It works on a mother’s intrinsic desire to care for her baby and pregnancy offers a wonderful window to do just this. In the antenatal period, maternity care (screening and core antenatal appointments) is delivered by midwives, whilst the family nurse delivers the home visiting programme to the client. Family nurse visits are regular – initially every week and then a fortnight, the number of visits decreases as the young parent’s confidence develops towards the end of the programme - The programme is manualised but is adapted to meet the family needs. Each visit usually last for around an hour.

The FNP is a strengths-based approach and recognises the skills and resources that parents possess and that can contribute to improve their and their child’s outcomes. The role of the family  nurse is to ensure those skills come to the fore and develop confidence in the young parents .FNP focuses on an expecting mother’s natural motivation to do the best for their child, respecting that the parents are the experts of their own lives, and working to develop achievable goals for the family.

There are three theories that underpin the programme. They are:

• Human ecology; The importance of understanding the context in which people live their lives;
• Attachment; The formation of the bonds between parent and child as basis for subsequent positive child development, and the child’s learning from the responses it gets from its parents (be they negative or positive);
• Self efficacy; a belief that people can be supported to take control of their own lives and are the only ones who can really bring about change for themselves.

This premise requires a one-to-one alliance with the Family Nurse. This strong partnership aids the parents to change their behaviour to healthier habits (for more on behaviour change click here) and deal with the emotional problems that can prevent parents providing good care and forming a positive relationship with their child.

© NHSScotland Photo Library 2012

The capabilities of the mothers and fathers are realised through structured home visits in which the nurse will work with the parents to identify the resources they have and where needed signpost to further support that  the mother needs. Each of the visits is designed to provide guidance and support to the parents so that they are aware of how best to look after their child and how they can change their behaviour accordingly. These conversations also serve to allow first-time mothers to bring up the many questions that arise during pregnancy – ‘How do I know if my baby’s healthy?’, ‘what do I need to change in our house to make it best for my baby?’, ‘how big will my stomach get?’, ‘how does breast feeding work?’. The Family Nurse is able to address these questions and concerns to enable to the mother to take the healthiest route possible and prepare them for childbirth. The Family Nurse is also able to coach the mother and father about how they can realise their own goals and give them the confidence to do so. Watch this video which will give you an overview of the FNP and a illustration of what home visits are like

The Scottish Government holds the license with University of Colorado, Denver to implement the FNP. Implementation is supported by a consultancy agreement with the Department of Health FNP National Unit, which provides training, access to expertise and support.

The first Scottish FNP programme was funded £1.6 million by the Scottish Government and is being delivered by NHS Lothian during a three-year period. A second cohort of FNP families will be supported in Lothian later this year, with Scottish Government match funding NHS Lothian’s contribution to delivering the programme (approximately 800K). The NHS Lothian team consists of a supervisor, six family nurses, and an administrator/data manager. The delivery team is supported by a full-time local FNP lead to implement the programme locally and ensure that it is integrated with other services within Lothian and NHS Lothian. 

Over a nine month period beginning on 25 January 2010 148 clients who were eligible to be included on the programme were recruited.  Issues such as gender-based violence have been included in the FNP programmes delivery in Lothian. This included hosting an event to raise awareness of the issue during the ’16 Days of Action Opposing Violence against Women’ campaign – click here for more information.

A second pilot site for the FNP was established in January 2011 in NHS Tayside and its surrounding area. NHS Tayside’s area has the highest teenage pregnancy rate in Europe. The project received financial support of £3.2 million over three years from the Scottish Government and a contribution of £600,000 from NHS Tayside.  This pilot was staffed with 12 family nurses, supported by two supervisors –forming two teams. NHS Tayside is aiming to reach in excess of 300 families by summer 2012.

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