Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland: 3rd Report - Infancy

1 Background and Introduction

About this report

1.1 The Family Nurse Partnership (FNP) programme is a licensed preventative programme which aims to improve outcomes for young first time mothers and their children. It does this through a structured programme of home visits delivered by specially trained Family Nurses from pregnancy until the child is two years old.

1.2 The evaluation of FNP in Scotland focuses on learning from the experience of implementing FNP in the first Scottish FNP test site, based in NHS Lothian, Edinburgh. It focuses on process and understanding how the programme works in a Scottish context.

1.3 This third evaluation report focuses on the delivery of the programme in the infancy period (specifically, the period from when clients' babies were 6 weeks old to their first birthdays). Two earlier reports (Martin et al, 2011 and Ormston et al, 2012) focused, first, on the early implementation and early pregnancy period and second, on late pregnancy to around 6 weeks post-partum. The next report (due spring 2013) will discuss learning from delivering the programme in toddlerhood (12-24 months). This report focuses explicitly on new findings emerging from the data collected for the infancy period. Findings already discussed in Martin et al (2011) and Ormston et al (2012) are not revisited in any detail here.

1.4 The remainder of this introductory chapter describes the FNP programme and its implementation in Scotland in more detail. Chapter 2 briefly outlines the evaluation methods and aims, while chapters 3 to 9 discuss the main findings from this phase of the evaluation, covering:

• Relationships between clients and their Family Nurses (chapter 3)
• Delivering programme content and its potential impact on client outcomes during infancy (chapters 4 to 6)
• Services, resources and referrals (including perceptions of working relations between FNP and other services) (chapter 7)
• Professional views of the main achievements and challenges of delivering the programme in the period since the last evaluation report, and their experience of training and supervision (chapter 8)
• Additional strategic learning from the experience of implementing FNP in Lothian (chapter 9).

The Family Nurse Partnership (FNP) programme

1.5 The FNP programme was developed in the USA (where it is called the 'Nurse Family Partnership' (NFP) programme) by Professor David Olds (University of Colorado, Denver). Based around a structured programme of home visits to the mother (and, after birth, the mother and child) delivered by trained Family Nurses, it is a preventative programme, aimed at first time mothers and their babies. The programme's goals are to improve pregnancy outcomes, the health, development and well-being of first time parents and their children, and families' economic self-sufficiency. For a summary of the key theoretical approaches underpinning FNP, see Olds, 2006.

1.6 FNP is a licensed programme, such that new sites are only permitted to run the programme and access the materials and training associated with it if they sign up to an agreement to implement it according to specified fidelity requirements. Referred to in the FNP Management Manual (Department of Health FNP National Unit, adapted for Scottish FNP sites, November 2010) as 'Core Model Elements', these licensing requirements cover:

• the visiting schedule (specifying the frequency of Family Nurse visits to clients throughout pregnancy until the child is two)
• staffing requirements (for example, the professional and personal characteristics of Family Nurses)
• client eligibility (for example, the point in pregnancy by which mothers should be enrolled), and
• the organisational structures and processes needed to support the programme (including training, supervision and administrative support).

1.7 In addition, the FNP Management Manual sets out various fidelity goals - described as 'stretch goals'^[1]. The fidelity 'stretch' goals cover client retention, visit 'dosage' (in terms of the numbers and length of visits to clients at different stages of their participation in the programme), and coverage of different 'domains' or topics during visits.

Testing FNP in Scotland

1.8 The background to and history of FNP's introduction in the UK is described in Martin et al (2011). The first FNP test site in Scotland commenced in NHS Lothian, Edinburgh, with the first clients enrolled from January 2010. Since then, additional Scottish FNP sites have been introduced in NHS Tayside (from July 2011), with further sites in Greater Glasgow and Clyde, Ayrshire and Arran, Fife, Lanarkshire and Highland preparing to start enrolling clients in 2012-2013. Matched funding has also been secured to enable NHS Lothian to move to small scale permanency (i.e. being able to offer the programme on an ongoing basis to every eligible client in the area, without a break in enrolment) starting from Autumn 2012.

FNP in NHS Lothian, Edinburgh

1.9 The NHS Lothian, Edinburgh FNP test site is based in Edinburgh Community Health Partnership (CHP) and delivered by NHS Lothian. The NHS Lothian FNP Edinburgh delivery team was initially comprised of a Supervisor, 6 Family Nurses, and an Administrator/Data Manager, supported by a local FNP Lead in Lothian. The team has subsequently undergone a number of changes reflecting staff departures, expansion, and new responsibilities among the existing team.^[2]

1.10 FNP was offered to all eligible women within Edinburgh CHP during the recruitment and enrolment period. 148 women who met the key criteria for participation (living within Edinburgh CHP, first time mothers, aged 19 or under at LMP, and under 28 weeks gestation) were enrolled with FNP in NHS Lothian, Edinburgh over a nine month period in 2010. The first clients delivered their babies in April 2010, so the first cohort of clients started to 'graduate' from April 2012 (when their children turned two years-old), with the full cohort due to complete the programme by the end of April 2013.