Core Components

Family Nurse Partnership (FNP) is the UK implementation of the Nurse-Family Partnership® (NFP) which was developed, and continues to be widely delivered, in the US. FNP Scotland follows the same Core Model Elements as NFP, aside from the addition of Clinical Psychology supervision within Scottish implementation. In line with expectations for international replication of the programme by the founder Dr David Olds, some adaptations to the programme for local context have been made in Scotland. Consequently, the description of the programme which follows in this summary is specific to the Scottish context and may differ in elements from that delivered in other settings.

FNP works with parents age 19 and under (or up to 25 years old if wider risk factors are present in some NHS Board areas) with their first child, from as early in pregnancy as possible until the child turns two.

The three core aims of FNP are to improve pregnancy outcomes (by improving prenatal health and behaviour, such as reducing smoking in pregnancy), to improve child health and development (through scaffolding the parent-child relationship) and to improve parents’ health and economic self-sufficiency. The programme addresses these aims through a highly structured and operationalised approach, with core components detailed for the three key stages of pregnancy, infancy and toddlerhood.

The programme is delivered on a 1:1 basis, with one Family Nurse allocated to a family across their involvement with FNP; the collaborative, therapeutic relationship between parent and Family Nurse is an essential factor in achieving programme aims. Frequency of contact varies depending on the stage of the programme, with a suggested schedule of visits that are weekly over the engagement period and immediately postpartum, every other week through the rest of pregnancy and from six weeks-21 months old and then monthly for the final 3-4 months as they wind down towards FNP graduation.

Family Nurses use a strength-based approach to promote parents’ self-efficacy and affect incremental change towards their identified goals. Delivery of core materials is tailored to the needs of the individual parent and child, through an agenda matching process led by Motivational Interviewing techniques. FNP has incorporated specialist tools to support programme delivery, with DANCE (Dyadic Assessment of Naturalistic Caregiver-child Experience) providing a framework for guiding observations of the caregiver-child interactions, and PIPE (Partners in Parenting Education) as an interactive model to support positive caregiving, drawing on parents’ strengths, heightening their understanding of core concepts and supporting them to develop their caregiving skills . Engaging and accessible written handouts, known as ‘facilitators’, are interwoven with these tools, with the therapeutic relationship underpinning successful delivery of all elements.

Fidelity

FNP has embedded within the programme a rigorous data monitoring system that incorporates information on all aspects of programme delivery and fidelity to the Core Model Elements. Practitioners use a comprehensive set of data forms which are collated at a local and national level and linked to the identified key outcomes, providing an ongoing indication of maternal and child outcomes, and a foundation for guiding continuous quality improvement of the programme’s implementation in Scotland.

Fidelity monitoring ensures that the FNP programme is delivered in line with with the original NFP programme, and thus can anticipate the same key outcomes evidenced for NFP.

Modifiable Components

The programme is modifiable in its delivery, by tailoring the visit frequency, timing, and content to the individual mother and family’s needs, as long as all Core Model Elements are adhered to.

FNP in Scotland follows the same implementation protocol as the US NFP model, aside from the addition of Clinical Psychology group and 1:1 supervision.

The programme has been delivered across a range of populations internationally and across cultures within Scotland, with the use of interpreters where necessary.

The materials are designed to be used with participants at all literacy levels.

Training within Scotland is delivered on a rolling basis by NHS Education for Scotland for all Family Nurses and FNP Supervisors.

Support for Organisation / Practice

Implementation Support

There are clear implementation expectations of the FNP programme model through the Core Model Elements, with clear and robust guidelines for how the programme should be delivered, including integral support systems needed to ensure high-quality implementation. This begins with a data driven needs assessment, feasibility assessment and a clear implementation plan.
The programme is composed of Core Model Elements, based on research and theoretical rationales, the implementation of which are clearly outlined with comprehensive guidelines.
Data systems are an integral aspect of programme delivery, with data gathered across all domains of implementation and key programme outcomes. The collation and analysis of these data on a local and national level ensures high-quality implementation and identifies areas where supports need to be given should challenges be identified.

Licence Requirements

FNP is a licenced programme, developed to be delivered to families at specific stages of pregnancy and child development.

Start-up Costs

Given that implementation of FNP involves setting up a complete service, costs will vary significantly, and the developer should be contacted for further details.
Within Scotland, all FNP implementation is funded centrally by Scottish Government.

Building Staff Competency

Qualifications Required

Family Nurses must have a nursing or midwifery background with at least the educational equivalent of a Bachelor’s degree. Within Scotland, Family Nurses have been recruited from a wide range of nursing professions, including Health Visiting, Midwifery and Mental Health nursing.
FNP Supervisors are often, but not exclusively, experienced Family Nurses. They too must have a nursing or midwifery background along with extensive experience of management and supervision.

Training Requirements

All family nurses undertake comprehensive, in depth training across a period of eighteen months. Core training, which covers a wide range of topics related to programme content and delivery, including the theoretical underpinnings of the FNP model and Motivational Interviewing techniques, is delivered over three residential training blocks, each approximately six months apart. In addition, there are a number of single and double training days (including but not exclusive of Breast feeding and Child Protection), on line training and significant consolidation days in the local base. Each Family Nurse and Supervisor completes a learning needs assessment and competency framework upon which further learning and development is tailored at NHS Board level.

Family Nurses begin to engage families as soon as they have undertaken their initial Foundations training, with DANCE and PIPE training taking place over the following months.

Supervision Requirements

Reflective supervision is a core element of FNP delivery and a mandatory aspect of the Family Nurse role.

All Family Nurses are held within a team of 6-8 practitioners, with each team led by an FNP Supervisor. Teams meet as a whole on a weekly basis, with alternate Operational and Clinical meetings. Group Supervision is facilitated by a Clinical Psychologist once a month at a clinical team meeting, with Child Protection supervision contributing to three monthly clinical meetings.

In addition, all Family Nurses receive weekly 1:1 supervision with their team Supervisor along with regular joint home visits to families and the Supervisors themselves receive monthly 1:1 supervision with a Clinical Psychologist. The Family Nurses also receive 3 monthly tripartite (Family Nurse, Child Protection Nurse and FNP Supervisor) child protection supervision.

Theory of Change

The FNP (and fundamentally the NFP) model is grounded in the three core theories of ecological theory, attachment theory and self-efficacy theory. The interplay of these theories form the basis of the programme, in recognising that a parent’s own experience of being parented, their social context past and present, and their own beliefs and motivations are intrinsically linked with how they will parent their infant and the development of the relationship between them. Understanding of these theoretical underpinnings is what places the therapeutic relationship between Family Nurse and Client in such high value, recognising that this will both model and facilitate positive relationships for the parent and in turn, the child.

Values

The core values of FNP are to improve parent and child outcomes through a strength-based approach, with the therapeutic relationship that the Family Nurse develops with the family, and their skilful delivery of the programme tools and methods, forming the basis for facilitation of positive change. 

• Are these core values mirrored by your service, with the capacity to adopt an intensive, 1:1 strength-based intervention?

Priorities

FNP is targeted to first time parents, where the mother is 19 years old or younger (or 25 years old in some NHS Board areas if there are multiple risk factors identified) with the aims to improve pregnancy outcomes, child health and development and maternal economic self-efficacy. 

• Is working with young mothers and their first baby in an early intervention approach a priority for your organisation?
• Are these outcomes core priorities for your service?

Existing Initiatives 

FNP is delivered alongside existing services, with strong links with midwifery, health visiting and other professions. 

• Does FNP fit with other current policy drivers for your service?

Workforce

Family Nurses work exclusively within FNP, within a team of 6-8 Family Nurses supervised by an FNP Supervisor. Family Nurses must have a nursing or midwifery background and an educational standard of at least a Bachelor’s degree or equivalent, alongside a capacity for strength based working and reflective practice. FNP Supervisors have extensive management and supervision experience. 

• Are there suitable individuals working within your organisation, or do you have access to employing, sufficiently qualified practitioners to make up at least one FNP team?
• Do you have capacity to employ an appropriately qualified Supervisor for each FNP team?

Family Nurse training takes place over an extended period of up to eighteen months, alongside starting in their role, and is supplemented by CPD needs across their professional life, and thus they must have protected time to ensure their learning and development needs are fulfilled and maintained.  All Family Nurses must have at least one hour of 1:1 supervision each week, along with attendance at a weekly team meeting of 2-2.5 hours.

• Can your organisation protect the time needed for the Family Nurse to fulfil their ongoing training and supervision requirements?

Technology Support

FNP delivery does not require specific technology support, although it should have the technical capacity for entering and managing implementation and outcome data built into the programme model.

• Does your organisation have this capacity?

Administrative Support

Data Management and administrative support is necessary at each local site for the ongoing management of data entry and analysis as well as processing of referrals and preparation of materials. 

• Do you have capacity for data management and administrative support to carry out these roles?

Financial Support

Implementation of FNP requires the construction of a new service and organisations should contact FNP directly to discuss costs involved. 

Comparable Population 

FNP is targeted at, and the evidence based upon, intervention with first-time mothers 19 years old or younger (or 25 years old in some NHS Boards if wider risk factors present).

• Is this an identified population of particular concern to your organisation?

Desired Outcome

FNP aims to improve pregnancy outcomes, child health and development and maternal self-efficacy, and has been demonstrated to deliver positive change across these domains.

• Are these improvements priority outcomes for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?