FNP-Slides - Early Intervention Foundation

Report
FNP: Integration of a
licensed programme
Improving Integrated Assessment,
Interventions and Developing
Integrated Pathways
Sam Mason, FNP National Unit
© Family Nurse Partnership 2013
1
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
© Family Nurse Partnership 2013
2
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.
© Family Nurse Partnership 2013
3
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
© Family Nurse Partnership 2013
4
FNP in England:
16,000 places by 2014/15
FNP coverage March 2014
Planned FNP coverage
14/15
© Family Nurse Partnership 2013
5
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 28th week of pregnancy
Current coverage approx 25% of eligible population, varies considerably
between areas
• FNP available in around 130 LAs by March 2015
© Family Nurse Partnership 2013
6
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
© Family Nurse Partnership 2013
7
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
© Family Nurse Partnership 2013
8
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
© Family Nurse Partnership 2013
9
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
© Family Nurse Partnership 2013
10
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
© Family Nurse Partnership 2013
11
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
© Family Nurse Partnership 2013
12
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?
© Family Nurse Partnership 2013
13

similar documents