Blogs from the FNP Community

We’re working with 11 FNP sites from around the country and Dartington Social Research Unit to co-design a number of adaptations to the FNP programme which we will put through rapid-cycle testing over the next year. The ADAPT project (Accelerated Design and Rapid Programme Testing), is part of the wider FNP Next Steps programme.

In the fourth of our clinical adaptations blog series, Edwina Lintin, Supervisor of the Bradford team, outlines the adaptation they’re developing. Their focus is on developing maternal sensitivity and responsivity using Video Intervention to Promote Positive Parenting (VIPP).

Being asked to be part of the ADAPT process was very exciting. Our adaptation, which focuses on improving how new mums interact with their child, came after listening to nurses in supervision and feedback from clients. It is based on the idea that, if a parent is able to understand what his or her child is thinking and feeling, the parent becomes more sensitive and responsive to their child. This, in turn supports the development of a more secure attachment between parent and child, which can impact positively on both their behaviour and development in the long term.

We had been using DANCE (Dyadic Assessment of Naturalist Caregiver Experience) but we know that feedback from family nurses is mixed. Although in the majority of cases DANCE has positive results, interactions are also seen by the family nurse that can vary in quality between the same parent and child. Also, DANCE does not allow clients to see for themselves the quality of their interaction with their child.

By introducing a video element through VIPP, we’re able to capture, in one overall assessment over a number of visits, the mum’s responsivity and sensitivity to her child, which we can then show her. This way she gets to see her actual interactions with her child, enabling us to focus on positive interactions and highlight and reinforce the sensitive parenting that is taking place, through the voice of the child. This helps link the mother’s own thoughts and feelings to those of her child, helping her to understand her child and to ensure his/her emotional needs are being met.

What does the clinical adaptation look like and how will this be delivered in practice?

Along with the video element, we’ve designed a new set of facilitators for the pregnancy phase, aiming to stimulate clients to think about their child’s thoughts and feelings – which is known as ‘mentalising’, having their child ‘in mind’ – while they’re still in the womb. The facilitators also encourage the mother to think about how some things may affect her emotional state and this can effects on the developing foetus.

The new assessment tools are:

• The MAAS (Maternal Antenatal Assessment Score) - to be completed at 36 weeks pregnancy

• The MPAS (Maternal Postnatal Assessment Score) - to be completed at four months and 12 months

• Two points of the Ainsworth Sensitivity Scoring Tool, to be used in supervision between the supervisor and each family nurse. Commences when the child is six months old (and at other specified time points), so they can think together about how sensitive and responsive the mother has been over the first six months. This will then identify which clients need the VIPP intervention.

What does success for this adaptation look like?

This clinical adaptation should make both mum and child feel more secure in their relationship, which should lead to:

• More positive ASQ-SE measures
• Fewer behavioural issues
• Better language skills
• Greater ability for the child to make himself/herself understood.

These positive developments will impact on school readiness, improving the child’s ability to listen and concentrate and therefore benefit more from education. This could also positively impact on a child’s mental health in the long term.