Since 2017, the Family Nurse Partnership team in Norfolk have developed and supported a teenage parent pathway. Every young mum-to-be aged 19 and under at conception is eligible for an enhanced service and is offered either Family Nurse Partnership or Teenage Parent Programme.
This approach is designed to widen access to evidence-informed practice in the county for young parents and to enhance the developmental progress of their babies.
Teenage parent practitioners provide 16 visits beginning in pregnancy and until the child reaches two years of age, including Ages and Stages Questionnaire assessment visits completed every six months. Ages and Stages Questionnaires provide a way to measure child development from age zero to six. The caseload is held by named health visitors.
The Family Nurse Partnership team supervisor provides clinical triage, assessing the needs of teenage mums-to-be notified by midwives and ensuring the appropriate service is offered according to their needs. Clinical triage is based on their life experiences, including Adverse Childhood Experiences (ACEs), and factors such as: current or previous involvement with children’s services, being locally authority care experienced, having a learning disability or with a history of mental health services input. The Family Nurse Partnership cohort in Norfolk have an average ACEs score of six and a half, where four ACEs are thought to be detrimental to longer-term health outcomes. Family nurses also provide skills and knowledge training for teenage parent practitioners, as well as group and one-to-one supervision. In addition, the Family Nurse Partnership team provides case discussion supervision sessions for staff across Norfolk who deliver the Healthy Child Programme (The Health and Social Care Act 2012 sets out a local authority’s statutory responsibility for commissioning public health services for children and young people aged 0 to 19 years. The Healthy Child Programme aims to bring together health, education and other main partners to deliver an effective programme for prevention and support.)
This approach expands the impact of Norfolk’s Family Nurse Partnership team, from the intensive direct work with 180 teenage parents enrolled in the local FNP programme, to a total of 794 young families who were supported through Norfolk’s Teenage Parent Pathway in 2023/24.
Due to the changes made within Norfolk in 2017, the Family Nurse Partnership Programme is delivered with a focus on urban areas of Norfolk, where there are the highest rates of conception to under 18s. Consistently, these urban areas feature within the relatively most deprived 10 per cent and 20 per cent Lower-layer Super Output Areas (LSOAs) nationally.
Despite the increasing vulnerability of the young parents-to-be recruited to FNP within Norfolk, outcomes continue to be positive, with developmental progress of babies and infants evidenced through the use of Ages & States Questionnaires (ASQ: 3 & ASQ: Social & Emotional).
Lessons learned
- A skill-mix approach to working with young parents has been accepted and valued by service-users. However, the framework of support provided to skill-mix staff is key to success. The governance framework provided by family nurses; in sharing of skills, knowledge and providing coaching, supervision and on-going training is imperative to ensure the quality of service delivery through this skill-mix approach.
- Co-production of new pathways, with services-users and stake-holders is a necessity, to ensure true ‘buy-in’ and subsequent success of new pathways and initiatives.
- New Pathways should be designed from the outset to focus on outcomes achieved by service-users and systems and data-sets aligned to evidence these. Historically, there has been a tendency to focus on outputs rather than outcomes within early intervention/prevention services. Data on outcomes provides assurance to Commissioners and to front-line staff that the work is of value and is truly a preventative measure. Qualitative data should also form part of these data-sets.