Due to its inflexibility delivering help to first-time young mothers, the Family Nurse Partnership in Wolverhampton was replaced with a new tailored service. Jane Lawrence describes the process.
The Partnering Families Team (PFT) has replaced the previous Family Nurse Partnership (FNP), a nationally licensed programme for first-time young mothers aged 19 and under. In Wolverhampton, FNP proved to be too rigid in its eligibility criteria for the clients and did not meet levels of need in the population.
In the new 0 to 19 Healthy Child Programme reconfiguration, it was decided to end the licence with FNP and develop our own service. Thus PFT, an intensive service for first-time young mothers aged 25 and under with vulnerabilities, was born in January 2018, created by the author and the 0 to 19 team. The service also works with mothers of all ages who have had a previous child removed and are now pregnant again.
PFT is exclusive to Wolverhampton although there are similar services across the country.
Expertise and experience
The service comprises staff with backgrounds in general nursing, children’s nursing, midwifery, health visiting and school nursing. This skill-mix enables the service to build up a therapeutic relationship with the client, looking at their health and wellbeing, their environment, relationships, parenting and life-course development. This means the service does not judge or dictate to the client but goes on their journey with them, with a clear focus on building on their strengths. As former family nurses, we very much wanted to use those skills we had learnt in FNP but adapt them to meet the needs of the young women in Wolverhampton. Clients do not have a health visitor as PFT delivers the whole of the Healthy Child Programme.
The service we provide
PFT is tailored to meet the individual needs of the clients. The service works with them from early pregnancy, ideally from around 24 to 28 weeks’ gestation until their child is one or two years old before transferring to the health visiting service. We have ‘selection boxes’ where families can pick certain topics that they would like to cover, but our aim is to cover all relevant topics that are pertinent to the individual (see figure 1).
The team works closely and collaboratively with other agencies involved with the client, enabling a seamless approach to providing the best possible care. In particular, some strong relationships with colleagues in social care have been developed, and the service has received lots of positive feedback from them.
A key difference is that PFT works with mothers who have had previous removals, which FNP did not allow
Service specification and differences from FNP
PFT has been commissioned to work with approximately 120 women a year. The service regularly reports on cases that have been ‘de-escalated’ for example, from ‘child protection’ to ‘child in need’, or ‘child in need’ to ‘early help’. The service specification estimates a de-escalation rate of 10%.
Additionally, the service reports on when cases have escalated, for example from no social care involvement to ‘child in need’ or ‘child protection’. While this may result in additional demand on social care services, it is regarded as positive because it is only through the relationship developed with the client that they feel safe enough to disclose what is happening in their lives.
PFT allows for a lot more flexibility than FNP. With FNP, all clients had to be recruited by 28 weeks’ gestation at the very latest. There was a strict visiting schedule, and it was only open to first-time mothers aged 19 and under.
Although PFT ideally likes to take on clients at around 28 weeks, the service will also take on clients much later and there have been several concealed pregnancies.
The service tailors its offer to meet the needs of the individual client and this can be for a shorter time period than the two and a half years prescribed by FNP. As a result, the service can see many more mothers requiring intensive support. A key difference is that the service works with mothers who have had previous removals, which at the time FNP did not allow.
- Thank you for everything you have done for me
- You have made my life everything I wanted it to be with my daughter
- You have been the light at the end of the tunnel
- I have gained so much confidence in myself because of you
- Nice to know you are there
- I thought I couldn’t be a mother and you helped me
- You’ve helped me make the right decisions
- Changed my view on things
- You have been the only professional that has never given up on me.
At the time of writing, the service has 103 clients. Although the service endeavours to work with a mix of need, the demands on the service and increasing numbers of referrals means the service finds itself working with only complex or highly complex cases.
Of the current caseload:
- 9 are children or young people in care
- 19 are on a child protection plan
- 17 are on a child in need plan
- 4 are on an early help assessment
Results so far
The majority of clients are 18 and under and white British and NEET [not in education, employment or training]. Mental health problems, domestic violence and child sexual exploitation are common themes for the cohort served by PFT.
Since PFT started its work in January 2018, it has worked with 52 clients who had children removed and then became pregnant again. Of these 52 clients, 18 still have their children with them; two children have been placed with their birth father; 13 clients have had their babies placed or about to be placed for adoption; and the remaining clients still have their babies in foster care while court proceedings and assessments are being undertaken.
In relation to babies placed for adoption, this has been done in the knowledge that the mothers were given intensive support to make it work, but in the end it was not possible for the mothers and babies to stay together.
Since April 2019 the service has been able to transfer 119 clients to universal services, with 23 transferred once their child has turned one year old – again showing the flexibility of PFT compared to FNP, enabling a greater throughput of clients than before.
Helena* became pregnant at 17 and, as a result of her violent partner, had her son removed. Two years later she became pregnant again by the same man, who continued to be violent, and she was referred to the PFT. The PFT practitioner Tilly was also a midwife and knew Helena from her first pregnancy. Helena and Tilly already had an established relationship and Helena was keen to build on this.
Tilly delivered all of Helena’s antenatal care and Helena never missed a home visit. When Helena’s unborn baby was put on a child protection plan, it made her realise that this time she wanted things to be different and keep her baby. Helena was able to reflect on her past, that she herself had been removed at three months old and that she wanted to break that cycle.
Tilly and Helena talked about topics such as breastfeeding, safe and unsafe relationships, sudden infant death syndrome, shaken baby syndrome and contraception in those first few weeks. Helena then plucked up the courage to leave her abusive partner. Helena gave birth to Alicia and was able to take her home although she remained on a child protection plan. Alicia was fully breastfed and Helena loved her daughter dearly.
Tilly continued to visit Helena and Alicia every two to three weeks.
When Alicia was three months old the child protection plan was de-escalated to a child in need plan.
When Alicia was six months old, Tilly noticed a bruise on Helena’s face. Helena at first said she had knocked her face on the kitchen cupboard. Due to their relationship, Tilly was able to ask if Helena was in contact with her ex-partner. Helena broke down and told Tilly she had been seeing him again. Shortly afterwards, Alicia was put back on the child protection register.
Helena was adamant that it was now over between her and her ex-partner and she said she felt ready to go on the Freedom programme (something she had always refused before). Tilly continued her visits and Helena was able to discuss with her what she had learnt on the Freedom programme and how she could
relate to it.
Alicia was a happy, sociable baby who was meeting all her developmental milestones. There was lovely bonding and attachment between her and Helena. Alicia was de-escalated to a child in need plan and shortly after her first birthday this was closed.
Alicia will be coming up to her second birthday and there have been no further safeguarding concerns. Helena is in a new property and has a part-time job. She has now also met a new partner, Rob, and says for the first time ever she knows what a proper loving relationship with a man feels like.
Tilly will stay involved until Alicia is two years old and then plans to transfer her over to the generic health visiting service. Helena and Tilly continue to have a good relationship – Helena feels Tilly is the only person she has had in her life that has been consistently there for her and feels this has helped her change her life.
Jane Lawrence is senior matron (interim) at the 0 to 19 and Children’s Community Services, Royal Wolverhampton NHS Trust.
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