FNP is a relational intervention: the intimate bond between nurse and young mother is central to its impact. Any relational intervention is, by definition, personal: a successful relationship is reliant on interactions which are shaped by genuine empathy, sensitivity and responsiveness. Yet FNP is also a manualised intervention, shaped by a comprehensive set of evidence-based guidelines relating to participation, visit frequency, and content and length of programme.
These two aspects of FNP – personalisation and fidelity – have sometimes been in tension with each other. And, in the roll-out of and scale up of FNP across England since 2007, the FNP community has sought to achieve a balance between a strong focus on nurses and teams achieving fidelity to programme guidelines while “agenda matching” to meet client needs.
Through the ADAPT Personalisation stream we will be testing the impact of swinging the pendulum further towards personalisation of the programme. There are three key reasons for this:
So what does a more personalised FNP ADAPT look like? Changes are being tested along three dimensions:
Eligibility builds on recent changes to eligibility criteria based around age, ADAPT also looks at the effect of changing criteria aound vulnerability, accepting clients later within their pregnancy period on the basis that these are likely to be among the more vulnerable clients who could benefit most from FNP
Flexing the content means supporting nurses to focus the content of client visits around areas where their client has the most pressing needs, while still reflecting the core theoretical underpinning of FNP and existing guidance on supporting clients to plan ahead
'Dial down, dial up' mirrors this, but in terms of intensity, supporting the nurse to calibrate the intensity of visitation - as occured in the Memphis trial
Finally, early graduation will support clients to leave FNP before their child's second birthday, if they are doing well and their nurse feels they can be supporting sufficiently by universal services and their own networks.
We know that this is a significant shift, which is why it’s necessary to test carefully as we go forward. Initially we’ll be looking at how the nurses, supervisors and clients react to the new approach, then how much they are changing their practice, finally looking at the impact of these changes on outcomes. We’re excited about the various strands of personalisation and the co-production workshops have been full of energy and ideas. All this, together with the evidence underpinning the changes we are making and our approach to iteratively testing and developing personalisation, makes us really hopeful that it will improve the way FNP is delivered, its impact and cost effectiveness, and, ultimately, the support it provides to parents and babies.
By Jason Strelitz, Assistant Director for Public Health and Senior Visiting Research Fellow for Dartington Social Research Unit