The world’s most innovative healthcare: Family Nurse Partnerships
By Leonie Shanks
“It’s not just a programme where they come and tell you how to raise your child – they ask you about your goals, and support you to get in school and find a job…it’s just a really really wonderful programme… [My nurse] became almost like a mother to me.” (Jamila, Family Nurse Partnership client)
Co-production was the word on everybody’s lips this week at Innovation Unit, inspired by the excellent London Co-Production Roadshow event which a group of us attended on Monday. It therefore seems fitting that Family Nurse Partnerships – the third case study in this series about innovative healthcare around the world – demonstrate the great results that can stem from collaboration between frontline professionals and service users, within a preventative, joined-up healthcare model.
First developed in the US 30 years ago at the University of Colorado, Family Nurse Partnerships (known in America as Nurse Family Partnerships) started as a programme for young, first time mothers from low-income, high risk groups, offering intensive and structured home visits by specially trained nurses from early pregnancy until the child is two. Family nurses work on developing a strong and supportive relationship with first time mothers and their families, using behaviour change techniques to help them to overcome the social and emotional problems that may prevent them from looking after their child in the right ways. Through coaching on topics that range from nutrition and literacy to sexual health, employment and safety, mothers are supported to adopt healthier lifestyles, provide good care for their child and plan for their future. They also learn about how to take full advantage of the services that are available to them, such as children’s centres, which is particularly important in enabling parents to be independent once their participation in the programme has ended.
The broad objectives of Family Nurse Partnerships are to improve pregnancy outcomes, child health and development, and families’ economic self-sufficiency, and the benefits have included, amongst others, improved academic achievement of the child, reduced reliance on welfare, and reduced criminal behaviour of both child and mother. The US has in fact seen a decrease in child arrests by 57%, a 48% reduction in child abuse and a 67% reduction of behavioural difficulties at age six. It is moreover predicted that the cost savings amount to $15000 – $17000 by the time the child is six, with a $3-$5 return on every $1 invested in the programme.
Family Nurse Partnerships come to Britain
Family Nurse Partnerships were first piloted in the UK in 2007, and they are now supporting 6000 families across the UK, with the government wanting to increase this figure to 15000 by 2015. Working closely with existing healthcare and support services for mothers, including Sure Start centres, GPs and maternity services, early outcomes of the UK’s FNPs have included reduced smoking during pregnancy, increased aspirations amongst mothers, and increased confidence in caring for their children.
What is interesting about FNPs is that one criteria for involvement in the programme is that it must be voluntary, shifting away from top down, paternalistic structures that too often mean that users have little choice in the services that they receive, to respond instead to mothers’ desires and willingness to access and engage with the help and support that they need. The focus on building mothers’ capacities in conjunction with professional expertise exemplifies another key aspect of co-production, increasing and leveraging the intrinsic skills that people have and strengthening relationships – both within families, and between families and their local services – to ensure that the programme will have a sustainable and lasting impact.
You can view some great videos of mothers talking about their expereinces on the US-based FNP programme here.