This report has demonstrated that the majority of young parents that enter FNP have had significant complex challenges, with varying impacts on their lives. These experiences can impact on individual social, emotional and physical wellbeing, which can lead to inequalities of outcomes. FNP clients are young first time mothers, many of whom have experienced anxiety and depression (63%), social deprivation, parental separation and a high proportion have been care experienced or on the child protection register (22%). The prevalence of abuse and neglect, mental health issues, homelessness and poverty are found to be much more prevalent in the FNP client group than in the general population, which provides some insight into the competing demands faced by these young mothers as they enter their journey to parenthood and the support that family nurses seek to empower these young mothers to engage with, if needed.
Despite the challenges, FNP clients demonstrate determination to improve their lives and that of their children by voluntarily participating in FNP as a long term intervention, with the majority of clients completing the programme and graduating (80%). The commitment of clients and their partners to have regular home visits from a Family Nurse for two and a half years should not be underestimated.
Alongside their new parenting journey, FNP clients also take up or return to education and employment with those in work or education post-birth increasing across all age groups, SIMD quintiles and regions: from 20% in work and/ or education at 6 months post-birth to 40% at 24 months post birth. However, this is still lower than the proportion in work or education at enrolment onto the programme in pregnancy.
The FNP programme has been shown to have been well implemented across Scotland, maintaining adherence to almost all of the benchmarks. Enrolment and graduation rates remain high despite a shift in the profile, over time, of young women who become pregnant and go on to give birth to their child. The majority of client visits reach the benchmark of 60 minutes per visit and there are some findings that indicate longer visits for those that may need it. The data from FNP does evidence some of the changes seen in the Scottish Birth Data, with fewer young people maintaining their pregnancy to birth, and those that do largely being from the most deprived areas of Scotland.
Wider evidence demonstrates that behaviours such as smoking and drug and alcohol use are influenced by wider social environments and relationships. These behaviours are apparent among the FNP clients, however, there is a reduction in smoking rates at 36 weeks gestation and 12 months post-birth, although this is not always maintained.
The data shows an improvement over time in breastfeeding initiation and duration of feeding among younger mothers, evidenced in the FNP data but also echoed in national data in recent years, with young mothers showing the largest proportional increase in feeding rates at first visit and 6-8 weeks post birth.
Levels of concerns about child development within FNP are low. Similar to the findings of the Building Blocks trials in England, fewer FNP children have a concern recorded about communcation/speech and language at 14 months (1.0%) compared to the national CHSP data (4.2%) at 13-15 months.
There are also improvements to be made to the delivery of FNP however. There is variation in the point of gestation of clients at enrolment. Not all clients receive the optimal number of visits as outlined in the standard visiting schedule. Given that programme dosage has been shown in this report to be linked to outcomes, ensuring programme delivery continues to be monitored and improved going forward is essential to understanding the programme overall and delivering the best possible service for FNP families.
This report is the beginning of the reflective process of the implementation of FNP in Scotland. Consideration of data often leads to further questions; there is a need to understand more about the outcomes and impact of FNP. A deeper analysis into some aspects to more fully understand the contributing factors alongside a fuller understanding from clients themselves will be undertaken in due course. As the programme continues to be developed the role of data in measuring the outcomes alongside the lived experiences of FNP clients and the workforce will be vital. Effectively capturing and analysing data will be essential in ensuring that the programme continues to be delivered with quality within a culture of learning, adaptation and improvement. Furthermore, as the children of FNP grow and develop it is important to consider how the longer term impacts of FNP can be better understood.
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