Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland: 3rd Report - Infancy

7 Services, Resources and Referrals

Key questions and outcomes

7.1 Specific outcomes from the monitoring and evaluation framework of relevance to this chapter include:

• Referrals to other services, and
• Use of community resources and supports.

7.2 Both of these are intended to support the higher level outcome of mothers feeling more supported and less anxious or depressed. As noted in Ormston et al (2012), the relationship between FNP and other services is also of wider interest in terms of understanding how the programme is being implemented in a Scottish context.

Key findings

• Family Nurses referred clients to a wide range of services during infancy. Clients reported benefiting particularly from FNP's support in linking them with housing and benefits services and in helping them access grants.
• The availability and perceived suitability of services for young mothers and their needs can be a barrier to clients either taking-up or benefiting fully from the services they are referred to by FNP. This was discussed specifically in relation to mother and baby groups and domestic abuse support. However, it was suggested there were often issues around the suitability of generic services for young mothers.
• Clients felt that their relationship with their Family Nurse made it easier to report problems to them and easier for Family Nurses to assess those problems accurately in comparison with other health professionals with whom they had a less 'personal' relationship.

Introduction

7.3 'Human ecological theory' highlights the importance of the social and community, as well as family context, in influencing parenting. As such, a key role for FNP is in linking clients with other services and resources that may be able to support them. This chapter summarises the number and types of referrals made by Family Nurses during the infancy phase of the programme and discusses client and Family Nurse perspectives on the impact of those referrals.

Referrals to other services during infancy

7.4 In comparison with the pregnancy phase, during which 166 referrals were made for 87 clients, Family Nurses made a greater number of referrals (more than 400) during infancy. Referrals were also made to a wider range of services, in part reflecting the greater number of services that are relevant once clients' babies arrive (e.g. childcare, breastfeeding support, injury prevention, child health care services). There were also more referrals to financial assistance and job training support in infancy.

Table 7.1: Numbers of clients referred to services

	Pregnancy phase	Infancy Phase
Health-related services
Smoking cessation	17	<5
Mental health services	7	9
Sexual health services	-	8
Antenatal classes	24	NA
Health care services (client)	84	70
Injury prevention	NA	6
Health care services (child)	NA	53
Other services
Financial assistance	15	34
Social care (including child protection/child in need and adult disability services)	10	20
Community Support	<5	11
Job training	-	14
Housing services	9	12
Legal Services	<5	<5
Childcare	-	<5
Breastfeeding support	NA	<5
Educational programmes	-	<5
Development referral	-	<5
Other *	13	48

* Other services included: Adult learning, adult literacy, HPV Vaccine appointment, autism support, No.6, Avenil Trust Charity, baby massage, child benefit, child tax credit, children's clothes, Children's Reporter, couple counselling, Crossreach, EVOT, EVOT (grant), fire brigade (safety), fuel poverty advice, Healthcare Academy, Kids Love Clothes, Princes Trust, Sighthill Young Mums, other mother's groups, Sisters of Mercy, Stepping Stones, stop smoking (partner), Sure Start Parent Group, Tax Credits, Womens Aid, Working For Families.

Perceived impact of FNP referrals on clients

7.5 Clients' accounts of FNP referrals during infancy suggest the potential for these to have a positive impact on client outcomes via:

• Facilitating more rapid access to services (particularly health services) than might otherwise have occurred
• Linking clients to services they were unsure about how to access on their own, and
• Linking clients to services they were unaware of and may not have accessed on their own.

7.6 Linking clients with services they were unsure about how to access was discussed particularly in relation to housing and benefits. Clients described their Family Nurses playing a key role in explaining processes and what they were entitled to, putting them in touch with the right people, and in some cases supporting them by attending meetings with them.

I wouldn't know where to start. I was phoning like everybody and they were just telling me there was nothing I could do. And then when she found out the place that I could go to, they were just, like, saying the people that I had been phoning weren't the right people anyway. So that was great, that was a good help.

(Client 13)

7.7 Clients identified benefits and financial grants as an area where their knowledge had been particularly limited prior to receiving information from their Family Nurse. Without the support their Family Nurses had provided, clients suggested that they might not have purchased essential safety equipment, applied to college, or accessed the money they needed to support themselves and their child.

That was one of the things that was holding me back from applying to college, because I wasn't sure about nurseries - like how much I would pay - … and (Family Nurse) said that you apply for the nursery fund and I was like 'oh right', so I didn't know about that.

(Client 9)

I had to give up my job and stuff and I just … I didn't know where to go from here. I didn't know what to apply for. I didn't have a clue what I was entitled to. So she kind of helped me out with that. And so I was quite pleased that I did have her, because if I didnae have her I'd probably still be sitting there twiddling my thumbs, with nae money, living off my mum and dad.

(Client 6)

7.8 Of course, it is not possible to say based solely on clients' accounts that they would not eventually have accessed these resources without support from FNP. However, their views provide evidence that FNP can facilitate timely engagement with services when they are needed.

7.9 Comments from both clients and Family Nurses also highlight that the impact of Family Nurse referrals may also sometimes be limited by the availability or perceived suitability of services to refer clients to. For example, clients who had not taken up Family Nurse referrals to mother and baby groups discussed the reasons for this, including: feeling shy; not liking groups or feeling the group was not welcoming; the timings being inconvenient (particularly where they were early morning, but also where clients worked and reported difficulty fitting them in); waiting lists for spaces; and feeling they did not need to attend a 'formal' group as they had enough contact with other parents.

She helped me find some baby groups about the area - not that I've went, but we did have a look. I'm quite a shy person, so I dinnae like going myself, and a lot o' the groups are like first thing in the morning, and it takes me a while to get organised and get myself moving, so I'm like, "Well .. Oh well. We'll just go to the soft play instead"

(Client 12)

7.10 As noted in Ormston et al (2012), there appeared to be a perception among clients that some mother and baby groups were more suited to older women, underlining the need for groups to cater specifically to younger mothers. However, even where such provision is available, these comments indicate that some younger mothers may still need considerable encouragement and support to attend group-based support.

7.11 One view among the NHS Lothian, Edinburgh Family Nurse team was that generic services often do not meet teenagers' needs particularly well. For example, the NHS Lothian, Edinburgh Family Nurse Team also identified a specific issue around the availability of appropriate domestic violence support services for their client group. While FNP was felt to cover domestic violence well, it was suggested that clients had 'found a lot of the support programmes are not for them' and that because their approach is different to FNP they can be less effective. The team suggested that there may need to be some further work with other services around supporting young mothers.