In order for group members to have the confidence to raise any issues or concerns they might have, they need to be able to trust the group and the facilitators. To this end, at the beginning of the programme FNs try to create a ‘safe container’ by setting boundaries and laying down ground rules about confidentiality and information sharing. In this way group members are able to ask about sensitive issues with confidence and share what they understand about a topic whilst making sense of new ideas that have been introduced in
163 the session. High levels of client engagement within a group tend to go hand in hand with early development of a ‘safe container’ within that group.
FN04: I think it did give them confidence to try out new things within the group, and they knew they were safe
FN05: I think that is part of getting your group dynamics right at the very beginning. If you have made that safe container and you have group rules, they know they are free to talk and you give them open questions they just go with it.
Providing a varied curriculum
Programme content, focusing on pregnancy and early parenthood, is based on a number of themes ranging from the development of maternal bonding and attachment related concepts to consistency of care. Engaging clients in the programme is a skilful process especially where they have had poor school experiences. Thus FNs adopted a mix of delivery methods to suit different learning styles; while there was some teaching and paperwork involved there were also ‘hands on’ activities to maintain interest and enjoyment. Informational leaflets are given out during sessions, to be kept and taken home, but there are also many creative activities which enable group members to actively engage with topics in a different way such as craft type activities, particularly useful to engage clients who have lower literacy levels or poor educational experiences.
FN04: The labour time line… all the sessions are interactive… and also the other one was the home safety, interactive materials are better than just… talking through materials.
FN08: We had to look at how we offered the programme not to re-invent but just how to offer it…we did a lot more crafty things because we found that worked and they loved it.
Agenda matching
Within the context of delivering the curriculum, a key aspect of gFNP is that the group facilitators listen and respond to issues raised by individual group members whilst at the same time delivering the programme content for that session, this is referred to as agenda matching. This is also something that is encouraged when delivering home-based FNP but is more challenging when there are a number of agendas to be matched.
164 FN02: …we’ve always said to them if they have something they want to ask
about a particular topic to let us know…They raised something about feeding so I said next week’s session is about feeding… but if you feel you need an answer today then we can make time for that at the end…we always had time for them at the end to ask us anything if they wanted to on their own.
FN06: … agenda matching, picking up on your audience essentially, so it is useful having a programme but being able/confident enough to move it slightly if that needs to happen as well.
FN08: It was hard at times and at times probably if a client needed something straight away that did interfere but what we tended to do was if I was
managing the programme x [the other FN] would step in and we would manage it that way.
Able to observe progress over time
A particular advantage of being able to observe the impact of gFNP over time was to see the progress of individuals as they interacted in the group. For example, some women who were initially shy and lacking in confidence at the beginning of the programme were observed to become more confident over time, contribute to discussions. FNs believed that their self-esteem increased they became more sociable in successive sessions.
FN04: I supported her because she was really quiet, made her come out of her shell, kept asking her ‘what do you think?’ So she felt able to
contribute…she was able to give them pointers on breastfeeding because her baby was born first and I think that boosted her self-esteem.
FN09: …there was one client in particular who was naturally a shy person to begin with, social services were involved with her, she has quite low self- esteem, she didn’t engage at the beginning of group…x took a lead, worked with her, hand held her to come and that girl’s journey has been incredible! I think being in the group setting and seeing the positive role models of the other parents had brought her on in her journey and she is a wonderful mummy now. Without her peer group she would still be isolated, she now sees the other girls socially as well as in group…social services closed the case a long time ago…So I think it has changed her life…