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Theme: CLAHRC - Evidence for Policy and Practice
Family Nurse Partnership is an evidence-based programme for young mothers. Trials in the US have demonstrated its efficacy in improving a range of maternal and child outcomes. However, following its introduction in England, eventually in over 130 sites, a large randomised controlled trial found no effect on primary outcomes and small effects on only a handful of secondary outcomes.
These results, together with a greater emphasis in health and social care on personalisation, a need to reduce costs in the context of austerity policies, and a desire to update the programme in line with the evidence, led to the ADAPT (Accelerated Design and Programme Testing) project.
The project involves working with stakeholders to co-produce system-wide and clinical adaptations. The system-wide adaptations allow nurses to personalise the programme according to client need by adjusting visit intensity, flexing visit content and enabling early graduation for clients who no longer need the service. These changes are informed by the development and introduction of a new assessment tool, the New Mum Star, for completion by nurse and client working together. The clinical adaptations, which focus on areas where it was agreed that outcomes needed to improve, and are informed by local priorities, a review of the relevant evidence, expert opinion and the views of nurses and FNP clients. They are attachment, breastfeeding, healthy relationships, maternal mental health, neglect and smoking cessation. Adaptations are being implemented in a sub-set of FNP sites and subjected to rapid cycle testing, meaning that quantitative and qualitative data are gathered on acceptability, implementation and outcomes and analysed and fed back to co-production teams rapidly so that adaptations can be further adjusted as part of an iterative process.
The research has the following aims:
1. to co-produce adaptations to the FNP home visiting programme, focusing on (a) personalisation and (b) clinical content in selected subject areas
2. to test adaptations in terms of their acceptability (to nurses and clients), implementation and outcomes
3. to further refine the adaptations in the light of test results as part of a rapid and iterative process
The development of system and clinical adaptations involves synthesising relevant evidence in the literature, consulting subject experts, soliciting the views of nurses and clients and reviewing existing programme content, and then working together with stakeholders to co-produce adaptation designs.
The rapid cycle testing of adaptations involves gathering minimally sufficient quantitative and qualitative data on a regular basis from nurses and clients on adaptation acceptability, implementation and outcomes, analysing the data rapidly and feeding it back to stakeholders so that further adjustments to adaptations can be made as part of an iterative process.
The first phase of ADAPT began with 10 sites in 2016 and has grown to involve 20 FNP teams in a second phase, which began in June 2018.
Collectively the project will generate a series of outputs, including a collection of the clinical adaptation designs, an interim report, an overview of the rapid cycle adaptation and testing method, a protocol for the testing method, and results of the analyses.