Family Nurse Partnership – ADAPT

Working alongside the Family Nurse Partnership to develop and refine systemic and clinical adaptations to the programme via a process of rapid cycle innovation and testing.


The Family Nurse Partnership is provided by NHS trusts or social enterprises who are commissioned by local authorities to provide parenting support and healthcare to young first-time mothers as part of public health provision. The programme is delivered by highly skilled and experienced family nurses who deliver 60 home visits to first-time mothers aged under 19 (or under 24 with additional vulnerabilities in most areas). The family nurses work with, and support the mothers to be the best mum they can be.

“Guiding and supporting eleven sites across the UK to implement and test systemic changes to the way they deliver FNP using a rapid cycle innovation and testing methodology.”

Our role

The Dartington Service Design Lab has two roles in this project. First, the Lab is part of the consortium board that governs FNP, alongside the Tavistock and Portman NHS trust and Impetus PEF. Second, the Lab provides research input. This is in the form of a rapid cycle innovation and testing project called Accelerated Design And Rapid Programme Testing (ADAPT). This involves guiding and supporting eleven sites across the UK as they implement and test systemic changes to the way they deliver the programme, and in addition working with eight of these sites to design, deliver and test clinical adaptations in six different areas.

Once adaptation designs have been completed, the Lab conducts rigorous data collection. This data is regularly analysed and presented to the practitioners and stakeholders to inform decisions about subsequent changes to the programme at so-called ‘cycle points’. These cycle points trigger further rounds of implementation, testing and reflection.

Our partners

The Lab forms part of the Consortium board of FNP, alongside the Tavistock and Portman NHS trust and Impetus PEF. The work of the Lab with FNP is commissioned by the FNP National Unit

For more information, contact: Keira Lowther


From miracles to logic models. A blog by Nick Axford

Personalisation in FNP: testing changes as part of ADAPT. A blog by Jason Strelitz



Project Timeline


AugustTen focus groups with nurses and three with clients within two months. Reflections on getting out there to hear from users in a blog post from Keira Lowther.

JuneFirst cycle point for personalisation. FNP site supervisors came together in London to discuss the findings of the analysis of data collected so far and to consider what changes should be made at this point to ease implementation and increase the likelihood that we will see improvements in outcomes.

JuneSign off for all clinical adaptations. Eight sites designed adaptations to the programme in six different clinical areas based on evidence of what works and client and nurse views of what might address local need. All sites produced a logic model, logic model narrative, a dark logic model and a context map of all stakeholders and contextual factors that might affect implementation.


JanuaryLaunch of implementation of personalisation in ADAPT. Due to the hard work of the ADAPT team at the National Unit and in the Lab, led by Jason Strelitz, sites began to implement the changes to the FNP programme. This coincided with the launch of the online data collection system that nurses and supervisors use to report activity - the FNP ADAPT data system or FADS. This system was designed and built by researchers and analysts from the Lab.

AugustSix-month design process for clinical adaptations at sites. FNP sites embarked on a process of designing clinical adaptations to the standard FNP programme. They chose clinical areas in collaboration with their commissioners, provider leads, and clients, and worked on four key documents: a logic model, a logic model narrative, a dark logic model, and a context map to detail what their adaptation consisted of and how it would be implemented.

JuneSite meetings to begin co-production process for clinical adaptations. The FNP National Unit staff travelled to all sites who had been invited to participate in the ADAPT project to meet all stakeholders and governance figures and to decide how they might engage with ADAPT in their region. Sites decided which aspects of personalisation they would implement and whether they would adapt clinical content at their site.

MayCollating evidence for what works in the clinical areas selected for adaptations at sites. Researchers at the Lab reviewed the published literature and previously completed rapid reviews of relevant academic literature to find out what the latest evidence of effectiveness was in each of the clinical areas identified by the sites as areas for adaptation. This evidence was summarised and presented at the site days to help the teams consider what kinds of things they might do that could improve effectiveness.

Designing system changes to FNP through Personalisation. This work was led by Jason Strelitz, in close collaboration with The Lab and the FNP National Unit. Changes in personalisation were defined as changing the frequency of visits, flexing the content to match the needs of the client and considering whether a client would do just as well if they received less of the programme and graduated early. Sites also considered changing some of their eligibility criteria - most often to reach a more vulnerable group of clients. This was assisted by development of an assessment tool - the New Mum’s Star.

AprilFNP ADAPT project launch. The FNP ADAPT project was launched in London in April 2016, in the company of the commissioners, providers and supervisors from the sites chosen by the National Unit to participate in the ADAPT project.