A Unique Child: Inclusion: A guiding hand

The prospects of vulnerable babies, young children and their families are being improved by the Family Nurse Partnership (FNP) programme. The programme provides intensive home visits for young first-time parents, working with them from early pregnancy until the child's second birthday. Family nurses are paired with the mothers, known as 'clients', with the aim of building a close, supportive relationship and helping them to adopt a healthier lifestyle for themselves and their babies. They are also encouraged to provide good care for their child and set 'life goals' (see case study).

FNP was brought over from the US, where it is known as the Nurse-Family Partnership Program. It has been jointly piloted by the Department of Health and Department for Children, Schools and Families in ten areas in the UK since April 2007. A further 20 sites were announced last year. The licensed programme was developed by Professor David Olds at the University of Colorado over a period of 30 years. He recognises that the problems of poverty, violence, failure in school and crime are best confronted early in a child's life.

Evidence from three trials in the US has shown that the model has positive effects from pregnancy. These impacts include fewer and less frequent pregnancies, and better financial status of the family. Also, the likelihood of child abuse and accidents is reduced, while the children on the programme are likely to be more advanced when they reach school age and less likely to adopt anti-social behaviour in their teens.

The 'highly successful' programme has been endorsed by President Barack Obama, who has pledged to expand it to all 570,000 low-income, first-time mothers each year as part of his pledge to help families.

Improved outcomes

Clients tend to be recruited to the FNP through the NHS, although some programmes are also linked to children's centres. There are strict criteria: mothers must be aged under 20 and be pregnant with their first child; or aged 20 to 23 and be pregnant for the first time, and not be in education, employment or training, and not in a stable relationship with the baby's father.

The programme aims to:

- improve pregnancy outcomes

- improve child health and development, and future school readiness and achievement, and

- improve parents' economic self-sufficiency.

Central to the work is an in-depth relationship between the specially trained family nurse, who is supported by intensive supervision, and the mother. They meet weekly, often on home visits, for the first month of the programme; fortnightly for the rest of the pregnancy and until the baby is 20 weeks old; and then monthly until the child is two years old.

Each visit lasts between 60 and 90 minutes. Detailed guidance is provided for each visit, although this is used flexibly. During pregnancy, the family nurse discusses how the mother can improve her child's chance of good health at birth, such as reducing or eliminating her own exposure to tobacco, alcohol and illicit substances, and the importance of a good diet and antenatal care.

After the birth, the emphasis shifts to developing sensitive, competent care and secure attachment. Mothers are also given support to gain qualifications and prepare for getting a job. Attention is also paid to encouraging the father's involvement.

High regard

The FNP programme is being evaluated in its pilot sites by Birkbeck, University of London. The first-year evaluation was published in July 2008, with the next evaluation due this summer.

The main findings show:

- The programme is widely welcomed by vulnerable families and reaches mothers who are likely to benefit most. Enrolment was higher among the under-20s (88 per cent) than it was among 20- to 23-year-olds (81 per cent)

- Mothers value the programme. The average rating of the FNP's effectiveness was eight out of ten

- Mothers had high regard for their family nurses

- Engagement with fathers was good. Almost half the fathers and partners had been present for at least one FNP visit

- The programme has the support of the nurses, who are seeing changes in health, behaviour, relationships, parental responsibility and maternal wellbeing

- There are early signs that 'clients' are given aspirations and are better able to cope with pregnancy, labour and parenthood. CLIENTS' COMMENTS

'I thought (the nurse) was going to be nosey and look down at me because I'm a teenage mum. But no, she was really, really nice. I expected (the experience) to be a bad one, but I get on well with her.'

'Every week she leaves stuff for me to read and keep; it's nice to look back on them and go through them.'

'She gives you that bit of extra support - confidence that you are doing things right with your child. She makes you feel better.'

'I was expecting someone to come and treat me like I was thick, because of my age, like I don't know nothing (sic), but she was quite understanding about it really, you don't get a lot of people like that. She let me ask the questions.'

FURTHER INFORMATION

- 'The first-year implementation of the Nurse Family Partnership programme in England in ten pilot sites: Pregnancy and the Post-partum Period' (April 2008) can be found at: http://www.dcsf.gov.uk/research/data/uploadfiles/DCSF-RW051 v2.pdf

- US Nurse-Family Partnership site, www.nursefamily partnership.org

CASE STUDY

Meg (not her real name) was 17 years old and six weeks pregnant when she was referred to Linda, a nurse with the Family Nurse Partnership in Derby. It was Meg's first child, she was not living at home and was underweight because of an eating disorder.

Meg and Linda met every two weeks so that Meg could be given much-needed support and advice throughout her pregnancy. This resulted in her making significant changes to her life. 'I have moved back home so my mum can help a bit when I have my baby. I have stopped smoking. I am not underweight any more. I feel grown up,' she says.

Later, Meg and her baby moved into their own home after Linda referred them to Oasis, a housing support project for young parents provided by Derby Council. The nurse also put Meg in touch with Connexions, the Government's advice service for teenagers, and she is now thinking about pursuing vocational courses.

Meg says of her relationship with Linda, 'She helped me feel confident about myself and about being a mum. She helped me learn new things and gives me useful information, but doesn't tell me what to do. Rather than having lots of different workers, we get to know our family nurse, so it's easier to trust and talk to her. She is there when I need her.'

Linda adds, 'Meg has blossomed in confidence. There are so many others like her who have turned their lives around with help and support from a family nurse. An hour or so every two weeks doesn't sound like much, but we might have been the first people to have listened to them.'