Family Nurse Partnership in Scotland: revaluation report

1.  Executive Summary

This report provides a summary of the methods and findings of the Revaluation of the Family Nurse Partnership (FNP) in Scotland. Through the stories of clients, service providers and other stakeholders, it focuses on identifying and understanding the perceived value of FNP in Scotland, providing a useful contribution to the broader evaluation of the impact of Family Nurse Partnership

The key points emerging from the Scottish Revaluation are:

• Family Nurses and FNP clients see positive outcomes as deriving from the specially-designed structure of FNP which is based on the development of a close, trusting relationship between clients and Family Nurses, and a holistic, agenda-matched and strengths-based approach. Together, these features of the programme are seen as central to Family Nurses’ aim of fostering meaningful, long-lasting improvements in young women’s lives, and in the lives of their children.
• FNP clients, Family Nurses and other stakeholders see FNP as valuable for the way in which Family Nurses are able to help clients reflect on aspects of their lives that may be negatively affecting them, supporting them to make decisions and take actions that will improve their situations. This includes, but is not limited to: client’s mental and physical health; safety; self-efficacy and confidence; social and intimate relationships; and housing, education and employment.
• FNP clients, Family Nurses and other stakeholders see FNP as valuable for the role they see it playing in helping to ensure that potentially vulnerable babies are not exposed to harmful situations, and encouraging positive child development through well-informed, sensitive and positive care giving.
• Client enrolment in FNP is seen as valuable by a range of other professionals who work with young mothers. Family Nurses are viewed as important facilitators and enablers of positive relationships between clients and other services, and as having a role in reducing stress in these relationships. Family Nurses are also credited by some professionals with reducing the workloads of other services.
• An effort was made to link perceived value of FNP with hypothetical cost savings through beliefs about the costs saved as a result of the FNP programme averting greater service-use among clients. FNP is perceived to reduce costs, but it is not possible to establish or monetise savings from this data. 
• The exploratory work conducted on profiling client vulnerabilities by Family Nurses has provided an illustration of the complex and at times extensive vulnerabilities that are experienced by clients entering FNP. It is intended that this will be used to inform the development of a validated tool to be used uniformly across FNP in Scotland which will provide high-quality, accurate data on client vulnerabilities and potentially resilience factors.  
• Revaluation enables us to better understand whether an action or policy is acceptable, feasible and valued by those affected. Whilst it cannot prove a causal relationship between FNP and outcomes, the value attributed to FNP is consistent with the learning, action and programme outcomes identified in the FNP logic model.

This report concludes that those involved consider FNP to add value through:

• The supportive nature of the Family-Nurse and client relationship
• A holistic approach to breaking inter-generational cycles of poor care-giving, reducing the risk of abuse and bringing intra-generational equity to this segment of the population
• Supporting maternal outcomes including mental health, confidence and self-efficacy and education and employment. 
• Supporting children’s development and positive parenting approaches
• Improving inter-agency working and reducing the workloads of other services.