Evidence into Practice

Using a Strength Based Approach in Family Nurse Partnership (FNP)

Gail TrotterFNP Implementation Lead, Scotland

Aims of Family Nurse Partnership

• To improve pregnancy outcomes and maternal health

• To improve child health and development and future school; readiness and achievement

• To improve parents economic self-sufficiency

Professor David Olds: Pioneer USA

• Works with pregnant teenagers and their partners until the child reaches 2 years

• Preventative intensive early intervention• Strength based, promotes “self efficacy”• Intensive home visiting manualised programme• Mandatory training for Family Nurses: Masters level• Role of Midwife remains the same• Intense relationship• Fidelity Requirements

• Testing FNP City Edinburgh CHP• First time parents 19 years or under at LMP• Planning to stay resident in Edinburgh: 2 years• No plans for relinquishment of baby• Opt-in programme• “Entitlement”

Focus on Strengths

Traditional Way

• Looks for “clues” that will reveal problems

• Looks for “clues” that reveal hidden strengths and possibilities

• Tries to understand, fix problems or patterns in client's lives

• Tries to understand how positive change occurs in client's lives

• Elicits detailed descriptions of problems

• Elicits detailed descriptions of goals and preferred futures

• Focuses on identifying “what's wrong, what's not working” and on deficits that can be fixed

• Focuses on identifying “what's right and working” and focus on strengths, skills and resources

Strength Based

The client is the expert on her own life

Client Centred Principle

They have the solution!

Client is the Expert

Being Client Centred Can Lead Towards “Self Efficacy”

A person’s belief that they can carry out behaviours asked of them

Does not mean being unaware of risk.

GIRFEC

Focus on Strengths

• Learning a new way of supporting client• Unlearning an old style of working• Forget, borrow, learn principles• Avoiding advice giving: guiding approach• Agenda matching: finding the “hearts desire”• Exploring ambivalence with clients

Traditional to Strength Based

Traditional to Strength Based

• Seeing the world through the eyes of the client• Hard to reach, hard to engage• Eyes with a “dangerous filter”• Response to emotional danger

Responses to Emotional Danger

Angry

Sad

ASHAMED INSECURE

FRIGHTENED

CONFUSED

REJECTED OPPOSITIO

NAL

DISTRUSTFUL

DEVALUED

• “Dancing not wrestling”

• “Rolling with the blows”

• Not giving up

• Doing what you say you will do

• Remaining compassionate

Supporting the Practitioner to Respond

• Appreciating it is hard!• Understanding and confident practitioners• Meaningful: educational and training• Appropriate supervision• Collecting and sharing the evidence• Trusting the client • Organisational support: parallel

processing• Baby benefits most

Key to Working this Way

But does it really work?

How the Programme Works

Relationship

Impact

Learning Experience

Behaviour Change

• Improvements in women’s antenatal health

• Reductions in children’s injuries• Fewer subsequent pregnancies• Greater intervals between births• Increases in fathers’ involvement• Increases in employment • Reductions in welfare dependency• Reduced substance use initiation

and later problems• Improvements in school readiness

Consistent Results Across 3 Trials in USA

Programme effects greatest among those most susceptible

UK Evidence So Far

• England evaluations• It is a model that works in England• Acceptable to the client: very low attrition• Educational materials transferable• Early signs: higher breastfeeding rates, decreased smoking

in pregnancy, high uptake AN care, low substance initiation• Nursing workforce feeling fulfilled• 18 RCTs England• Scottish Government evaluation, Scotland