"Internationally, FNP is known to be a programme that prevents child maltreatment; and in this country we hear from local areas that support for safeguarding is one of the reasons FNP is most valued. Here, the FNP National Unit Head of Clinical Implementation and Learning, Ruth Rothman, offers an insight into some key elements of FNP’s approach to safeguarding – how family nurses gain the trust of a high risk population and support them working with other services, how supervision helps maintain a clear focus, supports programme delivery and keeps the child at the centre as well as the importance of work in partnership with other services."
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Ailsa Swarbrick, Director, FNP National Unit
When looking at the last eight years of FNP in England, a question many ask is around how FNP works to safeguard children. It’s a huge issue – one thats at the top of the debate within our society at the moment and not an easy one to answer, but what we do know is that a crucial starting point will always be trust.
Viewing young mothers with respect, recognising their potential and offering appropriate empathy is often the best place to start when attempting to keep young families safe. For many, a therapeutic relationship with a family nurse brings not only the delivery of the FNP programme, but a consistency and a positive role model that many may not have experienced before. Mothers tend to open up and share their feelings and experiences honestly with their family nurse very early on, and often nurses know more about them than any other professional. Crucially, this can enable a referral to be made to safeguarding services, early enough to make a difference. Often as a result of the honest, two-way relationship family nurses build with their clients, when a referral to social care is made, mothers understand the reason for the referral and are therefore better able to work alongside their family nurse, as well as being able to engage effectively with other services during this time.
In addition to this positive relationship, FNP can prevent young families from slipping through the net because of the reflective, restorative supervision each family nurse receives. Family nurses discuss every individual on their caseload on a regular basis, in addition to presenting and debating some cases with their team in a safe and supportive way. This helps to share experiences and truly consider everything the family nurse knows and doesn’t know about each family. It ensures they have sufficient time to reflect on discussions in their entirety, analysing what they mean and make robust plans to move forward. Supervision also helps to stretch each family nurse’s thinking to avoid what some researchers call “early evidence bias”. It’s often human nature to accept your initial thoughts of a situation but supervision can prevent this from happening. Supervisors support family nurses to consider how their feelings could possibly influence decisions. Much evidence is placed on practitioners becoming subjective when they have strong relationships with mums, and a key aspect of an FNP supervisor’s role is to be able to challenge this.
Family nurses and supervisors also meet with their team’s named nurse every three months for a three-way discussion of any children or young women with safeguarding concerns. The named nurse brings another dimension to the supervisory relationship and supports decision making. The final component of this safe supportive framework is a psychological consultation which allows deeper reflection of the emotional issues within families. Teams build close working relationships with a variety of other local professionals to encourage families to access other services, as well as ensuring all are kept in the loop.
I hope this blog offers an insight into the in-depth, challenging, thoughtful work that family nurses do every day to safeguard children while balancing the delivery of a service that works positively with families.
Megan, a mother who recently completed FNP, was known to local services as a victim of domestic violence. She was in a relationship with her baby’s father, Jake, who was a known perpetrator and during her pregnancy, her family nurse worked closely to raise awareness, helping Megan understand the effect violence can have on children. It was obvious that both Megan and Jake saw domestic violence as the ‘norm’ in a relationship. Their unborn baby was seen as being ‘in need’ and Megan and Jake both attended ‘Child in Need’ meetings, supported by their family nurse.
Megan gave birth to a baby girl, Daisy, at full term. When she was four-months-old, Jake was arrested after assaulting Megan so badly that she was hospitalised. Megan disengaged with all services, including FNP, and stopped caring for daughter. Daisy was subsequently placed into the care of Megan’s mother and it took Megan’s family nurse two months to reengage with her.
Megan improved after a few months, and Daisy was returned to her care. It was around this same time that Jake was tragically killed in a motorbike accident. As Daisy’s only parent, Megan realised that it was her responsibility to provide the best care possible. She worked hard with her family nurse to explore her feelings, learn about child development and parenting techniques, to be the best mum she could be. Megan engaged with the Freedom Programme and worked with an independent domestic violence advisor to consider the effects of domestic violence on children. Together, she and her family nurse addressed developmental needs, and put positive parenting strategies in place. Megan began to manage her anxiety with support from a mental health worker, using cognitive behavioural therapy.
Over time and at every visit, her family nurse would use Partners in Parenting Education (PIPE) activities to discuss things like love, nurturing, patterns and expectations and boundaries to support positive discipline. After a year of being with FNP, Megan enrolled in college to undertake a child care course which she completed. Her case was closed by social care.
Throughout the two and a half years, her family nurse was guided and supported by regular supervision as well as liaison with all services, including the named nurse.