Medway FNP Annual Report 2011

Safeguarding vulnerable children

Challenge

• How to protect and improve the outcomes for children whose parents have had a very poor parenting experience

• Preventing the rising costs of safeguarding and supporting children

FNP contribution

• Intensive, in depth intervention that improves emotional and physical care giving

• Increases mental capacity of mothers

• Known to reduce maltreatment

Young parents

Challenge

• The poor outcomes for the children of teenage mothers and fathers

FNP contribution

• FNP offered to first time young parents

New science

Challenge

• The new science that tells us of the neurological damage done to children as a result of poor attachment, stress and toxic substances

• Long term diseases that result from poor childhood experiences

FNP contribution

• Starts in early pregnancy

• Focus on attachment and responding to infant cues

• Changes health behaviour in early pregnancy

Workforce

Challenge

• Ensuring professional practice that can be trusted to make the right decisions and work effectively to support change in the care of children

• Non-bureaucratic ways of improving front line work with vulnerable families

• Recruiting and building a motivated and enthusiastic workforce

FNP contribution

• Family nurses and supervisors receive a transformative learning programme acquiring new skills and knowledge

• Receive weekly supervision• Quality monitoring, management

and learning takes place within the team and integrated with programme delivery

• FNs highly motivated because they see change taking place and are well supported

1.2 Current Medway FNP Caseloads

StageTotal ever enrolled

Currently active Leavers Inactives Returners Completers

Inactive Completers

Pregnancy 9 7.4%6

4.9%1 0.8%

0 0.0% 0 0

Infancy20 16.4%

5 4.1%

5 4.1%

2 1.6% 0 0

Toddlerhood73 59.8%

0 0.0%

2 1.6%

0 0.0% 0 0

All 122102 83.6%

12 9.8%

8 6.6%

2 1.6% 0 0

Data downloaded from FNP information system (Open Exeter) on 15th September 2011

1.3 FNP Client Characteristics at Intake - Age

Type

% Less than 14

years old when

enrolled

% 14 years old

when enrolled

% 15 years old

when enrolled

% 16 years old

when enrolled

% 17 years old

when enrolled

% 18 years old

when enrolled

% 19 years old

when enrolled

% Over 19 years old

when enrolled

Medway FNP3 2.6%

11 9.6%

30 26.3%

34 29.8%

33 28.9% 3 2.6%

Wave 3A64 6.5%

148 15.1%

236 24.1%

273 27.9%

223 22.8% 36 3.7%

FNP Programme

595 8.5%

1233 17.6%

1801 25.7%

1758 25.1%

1313 18.7% 305 4.4%

data downloaded from FNP information system (Open Exeter) on 15th September 2011

1.4 Ethnicityo93.1% of clients enrolled at Medway FNP are white, in comparison with the Wave 3A average 80.0% oThis reflects the population in Medway and previous statistics for teenage parents in Medway.

Type % White % Asian % Black % Chinese % Mixed % Other Ethnicity

Medway Medway 108 93.1%  2 1.7%  1 0.9%  0  3 2.6%  0

Wave 3A  792 80% 29  2.9%  65 6.7% 2 0.2%  73 7.4%  13 1.3%

FNP Programme 81.2%  2.9%  6.9%  0.2%  5.5%  1.4%

Data downloaded from FNP information system (Open Exeter) on 15th September

1.5 Education and Employment

• Recent publication of GCSE results in Medway show that 66% received 5 or more at A* to C and 93% achieved 5 A* - G levels

• 36.5% of FNP clients were recorded as having 5 or more A* - C GSCES this is slightly higher than the wave average. With 17.5% of clients having no GCSE recorded.

Section 3 - Short-term child and maternal outcome indicators

• 3.1 Breastfeeding – initiation and continuation at 6 weeks• Medway has one of the lowest rates of breastfeeding in the south east, in the last quarter 67% of general

population initiated breast feeding.• Medway FNP - All clients • 64.4%of clients in Medway initiated breastfeeding• 11.8% continued to breastfeed at 6 weeks infancy• These figures are higher than the programme average for initiating but below for continuing at 6 weeks. (where

some significant ethnic minority populations in some sites increase the overall breastfeeding rate) and below the overall FNP programme average for clients breastfeeding at 6 months.

• All the team have attended the three day breast feeding training and one day updates. The team have discussed strategies to support continued breastfeeding in the next cohort, such as even earlier contact and encouraging attendance at breastfeeding peer support groups.

• Two clients started breastfeeding peer support training.

3.2 Maternal smoking at intake and late pregnancy

• Medway has an incidence of smoking that is well above the national average. Prior to the launch in 2009 two thirds of teenage mothers were recorded as smoking in pregnancy (125 out of a possible 191 recorded) and in two of the health centre areas in which the FNP now operates 100% were recorded as smoking.

• Overall• 62.5% of FNP clients reported smoking at any time during pregnancy including prior to intake.• There was a -2.1% reduction in the number of women smoking between intake to the programme and 36 weeks

pregnancy. • 71.1% of clients were smoking fewer cigarettes at 36 weeks infancy than at intake in Medway FNP; this

reduction is higher than the Wave 3A and programme average. • Only a small number of women started smoking again immediately after the birth of their baby with a 9.5%

increase between 36 weeks pregnancy and 6 weeks postnatal. This is higher than the Wave 3A and overall FNP programme averages.

• Team have all attended Level 2 Stop Smoking training and are able to issue NRT under a voucher scheme.

• 3.3 Maternal alcohol and drug use• The number of clients using illegal drugs and drinking excessively at 36 weeks pregnancy was very low and

lower than at intake to the programme.

• 3.4 Birth Statistics• All clients ever enrolled • LBW – 2.2% of full-term single infants born in Medway had a low birth weight• 5.8% of single infants born in Medway were born prematurely• 8.8% of infants in FNP Medway spent time in SCBU between birth and 6 weeks• The median number of days infants spent time in SCBU in Medway was 6 days (range of 1 to 34 days)

3.5 Child Health and Development

• 3.5.1 Immunisations• 88.7% of infants had up to date immunisations at 12 months in Medway. This is consistent with the Wave 3A

average. • Data downloaded on 17th October 2011 gives the figure of 90.7% up to date with immunisations at 12 months.• 3.5.2 A&E Attendances• 0.0% Medway infants had multiple visits A&E attendance in each of the 6 month periods • 3.5.3 Hospitalisations• Very small numbers were admitted to hospital due to ingestion or injury• Between birth and 6 months, 1 infant (1.1%) was admitted to hospital once due to ingestion or injury.• Between Birth to 12 months, 1 infant was admitted to hospitals• No infants at any time point were admitted to hospital more than once due to ingestion or injury.

3.5 Maternal Health and Life Course Development

• 16.4% of clients in Medway have been pregnant at least once in the 12 months since birth of their first child – this is similar to the Wave 3A average.

• 0.0% of clients had had a subsequent live birth within 12 months of birth of their first child, this is lower than the Wave 3A average.

• The proportion of clients with quick repeat pregnancies (in first 6/12 months) was very low – 93.2% had not had a subsequent pregnancy in the 6 months following the birth of their index child.

• The majority of FNP clients in Medway were regularly using contraception and using reliable forms of contraception.

• The proportion of clients using LARCS increased from 32.5% (at 6 months) to 34% at 12 months. (as a % of all active clients who used contraception).

• Nurses have been working closely with the sexual health outreach nurse, arranging joint visits when appropriate and sharing contact details.

• Medway Teenage Pregnancy Board has an action to increase the LARC services available as there is currently a shortage of trained LARC fitters in Medway.

• Team have all attended HYP HOP updates for sexual health and contraception updates and are C Card registration and access point.