Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland: 4th Report - Toddlerhood

This report presents the key findings from the fourth of four evaluation reports on the individual phases of the Family Nurse Partnership programme implemented in NHS Lothian, Scotland. The evaluation focuses on learning from the delivery of the programme during the toddlerhood phase of the programme (the period when client’s children are 12 to 24 months old).


1 'Stretch goals' are goals which the programme aspires to achieve. Based on the US research evidence, these are the optimum goals for ensuring the success of the programme. However, they may be difficult to achieve when first implementing the programme.

2 These changes were discussed in previous evaluation reports. However since the infancy report, one of the original team has now left FNP and been replaced. The team's original Supervisor remains in place but, at the time of writing, was seconded two days a week to the Scottish Government as the National Lead Supervisor for Scotland. One of the original Family Nurses who had been acting up as Supervisor for two days a week is now a full-time supervisor as the team has expanded. A second team of eight Family Nurses and a new supervisor have also been recruited in NHS Lothian and at the time of writing were due to start in June 2013.

3 Initially by the NHS Lothian Local FNP Lead, and from March 2012 by the newly appointed FNP Research and Information officer, based in NHS Education for Scotland (NES).

4 One dropped out after their first evaluation interview and another after their second interview.

5 Three of the nominated significant others declined to take part. Two were unavailable or not contactable during the interviewing period.

6 Note that although the NHS Lothian, Edinburgh Family Nurse team has expanded since the second evaluation interviews (with three new Family Nurses), the evaluation interviews are with the original team, recruited in 2009, since the purpose of the evaluation is to capture learning from the first test phase of FNP in Scotland and to explore any changes in Family Nurses' experiences and views over this period.

7 Of the four clients who left the programme during pregnancy, one rejoined during infancy. This client is therefore included in the bases for infancy and toddlerhood attrition and explains why the cumulative total of clients leaving/inactive by the end of infancy and toddlerhood are less than the sum of the individual attrition figures for pregnancy, infancy and toddlerhood.

8 The figure in the third report was calculated using the total number of clients that received each phase of the programme (e.g. in infancy this was 145) as the denominator to calculate attrition. This is no longer the accepted method to calculate attrition. Instead, the denominator should be the number of clients who were ever enrolled in FNP (e.g. for infancy this would be 148).

9 Average dosage is the total number of visits completed divided by the expected number of visits completed.

10 Note that the form does not distinguish between these people.

11 Note: the Monitoring and Evaluation Framework originally asked 'Is the FNP structure useful/appropriate?' However, as the evaluation is focusing on the process of implementing FNP in NHS Lothian, Edinburgh, it was felt that it was more appropriate to reframe this in terms of how the structure was experienced in that site.

12 See http://www.immunisationscotland.org.uk/when-to-immunise/immunisation-schedule.aspx

13 Of the 120 clients that remained active until the end of the programme, 115 infant health care forms were completed. Additionally in 5 of these forms it was not stated whether or not the child was up to date with their immunisations. Of those clients for whom information was recorded, 67% of records were based on the client's self-report that their child's immunisations were up to date, 21% were based on a written record of immunisations and for 12% no basis for this information was stated.

14 See http://www.hps.scot.nhs.uk/immvax/vaccineuptake.aspx

15 A small number of clients had two or more subsequent pregnancies in the 24 months since the birth of their first child.

16 See also http://www.nursefamilypartnership.org/proven-results/Changes-in-mother-s-life-course for a summary of results. The increase in intervals between first and second babies for FNP clients compared with control groups was 3.7, 4.1 and 12.5 months across the three US trials of the programme.

17 This represents 96 out of 113 clients. Of the 120 clients that remained active until the end of the programme, 114 forms were completed. Additionally in 1 of these forms it was not stated whether or not the client had used some form of birth control in the last 6 months to prevent pregnancy.

18 This system meant that clients could present at a sexual health clinic and be seen more quickly without needing to have their contraceptive needs re-assessed (as the passport indicates that they have already been assessed by a Family Nurse).

19 Of the 120 clients that remained active until the end of the programme, 114 forms were completed. Additionally one form did not include responses to these questions.

20 That is, approaches which recognise that clients have existing strengths and are capable of drawing on these to solve problems.

21 This longer recruitment time 12 months compared to 9) was informed by the experiences of recruiting the first cohort, see Martin et al, 2011).

22 Getting It Right for Every Child

23 A specialist NHS Trust offering high quality mental health care and education. Tavistock are working with the Impetus Trust and the Social Research Unit at Dartington to support the delivery of FNP in England.


Email: Victoria Milne

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