Nurse-Family Partnership (NFP)

1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: First time, low-income mothers (adolescents and adults, with no set maximum age) and their infants ages birth-2 years

For children/adolescents ages: 0 – 2, 12 – 17

For parents/caregivers of children ages: 0 – 2, 12 – 17

Program Overview

Nurse-Family Partnership® (NFP) is an intensive, strengths-based, trauma- and violence-informed community health program whose goals are to improve the health and lives of first-time moms and their children living in poverty. Specially trained registered nurses regularly visit first-time moms-to-be (adolescents and adults), starting early in pregnancy and continuing through children’s second birthday. NFP nurses aim to leverage their clinical expertise in applying behavior change and human ecology theories to deliver this client-centered program. Ideally, NFP participants develop close relationships with their nurse. It is hoped that the nurse becomes a trusted resource for advice on everything from safely caring for their child to taking steps to provide a stable, secure future for their family. In addition to living in poverty, NFP moms also often are experiencing, or at risk of experiencing, homelessness; addiction or substance misuse; involvement with child welfare or juvenile or criminal justice systems; intimate partner violence; severe developmental disabilities; behavioral or mental health needs; or a high-risk pregnancy.

Program Goals

The goals of Nurse-Family Partnership (NFP) are:

For children:

  • Improve safety.
  • Improve health and development.

For parents:

  • Enhance economic self-sufficiency and life-course development.
  • Develop a vision for future.
  • Plan future pregnancies.
  • Continue education and find work.
  • Improve pregnancy outcomes.
  • Engage in good preventive health practices including thorough prenatal care from healthcare providers.
  • Improve diet.
  • Reduce use of cigarettes, alcohol, and illegal substances.

Logic Model

The program representative did not provide information about a Logic Model for Nurse-Family Partnership (NFP).

Essential Components

The essential components of Nurse-Family Partnership (NFP) include:

  • Clients:
    • Voluntary
    • First-time expectant mothers (adolescents or adults)
    • Low-income
    • Enrolled early in pregnancy
    • Experiencing or at increased risk of experiencing:
      • Housing instability
      • Addiction or substance misuse
      • Involvement with the juvenile or criminal justice systems
      • Child welfare
      • Intimate partner violence
      • Severe developmental disabilities
      • Behavioral and mental health needs
      • Clinically diagnosed high-risk pregnancy
  • Intervention context:
    • Within a 1:1 therapeutic relationship with personal nurse
    • Visits occur at the client’s home or at an alternative location based on the needs of the client and may include virtually through telehealth
    • Visit schedule per NFP program guidelines and client’s needs
  • Nurses and Supervisors:
    • Complete all NFP core education
  • Application of the intervention:
    • Nurses use their judgment to apply the NFP visit guidelines across 6 domains:
      • Personal Health
      • Environmental Health
      • Life Course Development
      • Maternal Role
      • Family and Friends
      • Health and Human Services
    • Nurses apply the three theories through current strategies:
      • Self-Efficacy
      • Human Ecology
      • Attachment
    • Nurses carry manageable caseloads, between 25 and 30 families
  • Reflection and Clinical Supervision:
    • 1:1 weekly clinical supervision for each nurse with the nurse supervisor
    • Case conferences are structured around reflective practice and occur at least 2 times a month
    • Nurse supervisors conduct joint home visits with each nurse three times a year
  • Program Monitoring and Use of Data:
    • Nurses collect data as specified by the Nurse-Family Partnership National Service Office (NFP NSO), and all data is entered through various data collection platforms and uploaded to the NFP NSO’s data warehouse
    • NFP NSO reports data to agencies to assess and guide program implementation
    • Agencies use these reports to monitor, identify and improve variances, and assure fidelity to the NFP model
  • Agency:
    • Is networked with other services in the community
    • Has community support for sustainability

Program Delivery

Child/Adolescent Services

Nurse-Family Partnership (NFP) directly provides services to children/adolescents and addresses the following:

  • First child of a mother, both adolescents and adults, with a low socio-economic status

Parent/Caregiver Services

Nurse-Family Partnership (NFP) directly provides services to parents/caregivers and addresses the following:

  • Pregnant with first child, low socio-economic level

Recommended Intensity:

Registered nurses begin regular visits with pregnant mothers early in their pregnancy (about 16 weeks gestation but not later than 28 weeks). While nurses typically visit weekly for the first month after enrollment, every other week until the baby is born, weekly for the first six weeks after birth, every other week until the child is 20 months, then monthly until the child’s 2nd birthday during the standard visit schedule, the NFP model allows alternate visit schedules based on client need.

Recommended Duration:

Clients are able to participate in the program for two-and-a-half years and the program is voluntary.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Languages

Nurse-Family Partnership (NFP) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Office space that facilitates confidentiality related to clients and health care records
  • Computer and telecommunication capabilities
  • Cell phones
  • Nurses with a Bachelor of Science in Nursing (minimum of 2 nurses at a location)
  • 0.5 FTE Nurse Supervisor per 4 FTE nurse home visitors
  • 0.5 FTE clerical/data entry support for each 4-nurse team serving 100-120 families
  • Adequate travel expense reimbursement (mileage) for home visitors

In addition, a community advisory board and strong, stable, and sustainable funding for agency operations is recommended.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Nurse home visitors:
Registered Nurse with a Bachelor's Degree in nursing, as a minimum qualification

Nurse Supervisor:
Registered Nurse with a Bachelor's Degree in nursing, as a minimum qualification, and a Master's Degree in Nursing preferred

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Core education includes distance self-study through an online education platform plus training provided at the headquarters in Denver, which also includes distance-learning strategies

Number of days/hours:

For Nurse Home Visitors AND Supervisors:

  • Unit One: 20 hours of study (22 for supervisors)
  • Unit Two: 27 hours over 3 ¾ days in Denver of face-to-face education and experiential practice
  • Unit Three: Approximately 10 hours of additional distance education and a series of team-based, supervisor-led topical professional development modules
  • Advanced education: 20-30 additional hours of study through distance learning platform assigned after completion of Unit 3 covering mental health, goal setting, and intimate partner violence.
  • Other required education offered by third parties:
    • Keys to Caregiving Self-Study Course, approximately 6 hours
    • DANCE Fundamentals (Dyadic Assessment of Natural Caregiver-Child Experiences), 24 classroom hours offered by the Prevention Research Center (PRC) at the University of Colorado. DANCE is completed after completing Keys to Caregiving, about nine months after hire.

For Supervisors (in addition to the above):

  • Unit 4: 24 hours of face-to-face education in Denver 4-6 months after completing Unit 2.
  • Ongoing consultation with a Nurse-Family Partnership Nurse Consultant

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Nurse-Family Partnership (NFP) as listed below:

The pre-implementation materials are used as part of NFP’s planning and development process. Key steps in the local planning and development process include the following:

  • Data-driven assessment of need: Interested parties can request program materials to help them determine whether implementing the program makes sense in their own com m unities. These materials pose pertinent questions and suggest statistical analyses (e.g., identifying child abuse rates, crime, unemployment, and health problems) to inform decision-making.
  • Review of existing services: Interested parties perform a thorough assessment of currently available services for low-income women and children to determine how the program could fit into that continuum.
  • Creation of task force to select program host: Based on the assessment of existing services, interested parties set up a planning task force with representatives of the various organizations (e.g., hospitals, public health departments, women's clinics, community organizations) that might host or support the program. This task force then decides which agency would be the best host for the program.
  • Feasibility assessment: The selected agency performs a feasibility assessment during which it considers its ability to staff and finance the program, including whether it can serve enough women to be viable.
  • Determination of referral sources and outreach methods: Using program materials, the agency designs a referral and outreach process to ensure that qualified women hear about the program.
  • Development of implementation plan: The agency develops an implementation plan that incorporates processes for identifying sustainable sources of funds, hiring and training staff, ensuring client identification and outreach, and managing the program with fidelity to the model.
  • Hiring: The agency hires nurses and a nursing supervisor. The Nurse-Family Partnership National Program Office offers sample job descriptions and interviewing guidance.

The materials are available upon request by contacting programdevelopment@nursefamilypartnership.org..

Formal Support for Implementation

There is formal support available for implementation of Nurse-Family Partnership (NFP) as listed below:

Ongoing training is provided for nurses and their supervisors. Nurses and their supervisors participate in a 9-month comprehensive training program to learn how to conduct the in-home visits. The training incorporates a combination of a self-study workbook, web-based training activities, and two onsite training sessions at the Nurse-Family Partnership National Service Office in Denver. Ongoing education and training occurs for both new nurse home visitors and supervisors hired to implement the program. Supervisors receive ongoing consultation to help them develop strong skills with respect to reflective supervision, along with coaching from experienced program consultants.

Fidelity Measures

There are fidelity measures for Nurse-Family Partnership (NFP) as listed below:

Before becoming a NFP Network Partner, there must be assurance by the applying agency of its intention to deliver the program with fidelity to the model tested. Such fidelity requires adherence to all 19 of the Nurse-Family Partnership Model Elements. The NFP Model Elements are available upon request by contacting Programdevelopment@nursefamilypartnership.org.

Nurses collect client and home visit data as specified by the Nurse-Family Partnership National Service Office, and all data is sent to the Nurse-Family Partnership National Service Office's national database. The Nurse-Family Partnership National Service Office reports out data to agencies to assess and guide program implementation, and agencies use these reports to monitor, identify and improve variances, and assure fidelity to the NFP model.

Implementation Guides or Manuals

There are implementation guides or manuals for Nurse-Family Partnership (NFP) as listed below:

The Nursing team at the Nurse-Family Partnership National Service Office provides both face-to-face and distance learning environments for the core education required of all Nurse-Family Partnership Nurse Home Visitors and Nurse Supervisors prior to client enrollment. This specialized nurse training helps establish therapeutic relationships between the client and nurse home visitor, which in turn preserves the clinical integrity of the Nurse-Family Partnership model. New nurses also learn the visit-to-visit guidelines, which provide a consistent content and structure for the home visits regardless of frequency and modality. With assistance from supervisors and consultation from the National Service Office, nurses develop strong communication, personal relationship building, and problem-solving skills. Teams of nurses at local Nurse-Family Partnership network partners employ elements of reflective practice into much of their team activities, including regular case conference, where they review individual client care plans, and team meetings where new material and discussion and guidance are offered to help cope with secondary trauma and stress as a team. Additionally, nurses meet regularly with supervisors to process emotions and mitigate burnout inherent in working with clients who may be at high risk for violence in their homes, or have experienced trauma in their personal histories.

Research on How to Implement the Program

Research has been conducted on how to implement Nurse-Family Partnership (NFP) as listed below:

  • Olds, D. L., Robinson, J., O'Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., Jr., Ng, R. K., Sheff, K. L., Korfmacher, J., Hiatt, S., & Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized controlled trial. Pediatrics, 110(3), 486–496. https://doi.org/10.1542/peds.110.3.486
  • Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., Isacks, K., Sheff, K., & Henderson, C. R. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560–1568. https://doi.org/10.1542/peds.2004-0961
  • Olds, D., Holmberg, J., Donelan-McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. (2014). Effects of home visits by paraprofessionals and by nurses on children: Follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics, 168(2), 114–121. https://doi.org/10.1001/jamapediatrics.2013.3817

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety and Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Nurse-Family Partnership (NFP) are summarized below:

Olds, D. L., Henderson, C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78(1), 65–78. https://pubmed.ncbi.nlm.nih.gov/2425334/

Type of Study: Randomized controlled trial
Number of Participants: 400

Population:

  • Age — 47% younger than 19 years
  • Race/Ethnicity — 89% Caucasian
  • Gender — 100% Female
  • Status — Participants were determined at intake to have at least one risk factor: mother less than 19 years old, single parent status, or low socioeconomic status.

Location/Institution: Elmira, New York

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test a program of prenatal and infancy home visitation by nurses as a method of preventing a wide range of health and developmental problems in children born to primiparas who were either teenagers, unmarried, or of low socioeconomic status. Volunteers and women recruited due to a risk factor were randomly assigned to one of conditions described below: 1) Sensory and developmental screening at 12 and 24 months only (control group); 2) Free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; 3) Nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; or 4) Nurse home visits until the child was 2 years old in addition to nurse home visitation during pregnancy, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months [now called Nurse Family Partnership (NFP)]. Measures included medical examinations and developmental testing using the Bayley and Cattell Scales at 6, 12, and 24 months, and home observation using the Caldwell and Bradley Procedure. The list of participants was also checked against verified cases of abuse and neglect and medical records were examined. Among women at highest risk, those visited by a nurse had fewer reports of child abuse and neglect; were observed to restrict and punish children less frequently; provided more appropriate play materials; and had fewer emergency room visits. In the second year, all nurse-visited women, regardless of risk status, had fewer emergency room visits and fewer physician visits for accidents and poisoning. Limitations include generalizability due to gender and ethnicity and lack of follow-up.

Length of postintervention follow-up: Not specified.

Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93(1), 89–98. https://pubmed.ncbi.nlm.nih.gov/8265329/

Type of Study: Randomized controlled trial
Number of Participants: 316

Population:

  • Age — 47% younger than 19 years
  • Race/Ethnicity — 89% Caucasian
  • Gender — 100% Female
  • Status — Participants were determined at intake to have at least one risk factor: mother less than 19 years of age, single parent status, or low socioeconomic status.

Location/Institution: Elmira, New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Olds et al. (1986). The purpose of the study was to examine, during the 3rd and 4th years of life, the health, development, rates of child maltreatment, and living conditions of children who had been enrolled in a randomized trial of nurse home visitation during pregnancy and first 2 years of their lives. Volunteers and women recruited due to a risk factor were randomly assigned to one of conditions described below: 1) Sensory and developmental screening at 12 and 24 months only (control group); 2) Free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; 3) Nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; or 4) Nurse home visits until the child was 2 years old in addition to nurse home visitation during pregnancy, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months [now called Nurse Family Partnership (NFP)]. Measures utilized include the Caldwell and Bradley Home Inventory and the Stanford Binet test of intelligence, Additionally, home visitors observed mothers’ interactions with their children, assessed exposure to hazards and presence and accessibility of poisonous substances in the home. Pediatric and hospital records, as well as Child Protection Service records were also reviewed. No treatment differences were found for child abuse, neglect, or in intellectual functioning. Children in the nurse-visited condition had fewer hazards in the home, fewer injuries and ingestions, and fewer behavioral and parental coping problems noted on medical records. Nurse visited mothers showed higher levels of punishment and restriction, but the authors suggest that their analysis shows this level was associated with the lower instance of injuries and ingestions for the treatment group. Limitations include generalizability due to gender and race and high attrition rate.

Length of postintervention follow-up: 2 years.

Olds, D. L., Eckenrode, J., Henderson, C. R., Jr., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt, L. M., & Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 278(8), 637–643. https://doi.org/10.1001/jama.1997.03550080047038

Type of Study: Randomized controlled trial
Number of Participants: 324

Population:

  • Age — 47% younger than 19 years
  • Race/Ethnicity — 89% Caucasian
  • Gender — 100% Female
  • Status — Participants were determined at intake to have at least one risk factor: mother less than 19 years of age, single parent status, or low socioeconomic status.

Location/Institution: Elmira, New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Olds et al. (1986) and Olds et al. (1994). The purpose of the study was to examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women’s life course and child abuse and neglect. Volunteers and women recruited due to a risk factor were randomly assigned to one of conditions described below: 1) Sensory and developmental screening at 12 and 24 months only (control group); 2) Free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; 3) Nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; or 4) Nurse home visits until the child was 2 years old in addition to nurse home visitation during pregnancy, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months [now called Nurse Family Partnership (NFP)]. Assessments at this follow-up included behavioral impairments due to drug or alcohol use, use of welfare, and reviews of Child Protective Services and New York State criminal justice records. Women visited by nurses were less likely to be perpetrators of child abuse and neglect, and had fewer arrests, convictions, and number of days jailed. Limitations include generalizability due to gender and ethnicity and high attrition rate.

Length of postintervention follow-up: 13 years.

Eckenrode, J., Ganzel, B., Henderson, C. R., Jr., Smith, E., Olds, D. L., Powers, J., Cole, R., Kitzman, H., & Sidora, K. (2000). Preventing child abuse and neglect with a program of nurse home visitation. Journal of the American Medical Association, 284(11), 1385–1391. https://doi.org/10.1001/jama.284.11.1385

Type of Study: Randomized controlled trial
Number of Participants: 324

Population:

  • Age — 47% younger than 19 years
  • Race/Ethnicity — 89% Caucasian
  • Gender — 100% Female
  • Status — Participants were mothers determined at intake to have at least one risk factor: mother less than 19 years of age, single parent status, or low socioeconomic status.

Location/Institution: Semirural community in New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Olds et al. (1986, 1994, 1997, and 1998). The purpose of the study was to investigate whether the presence of domestic violence limits the effects of nurse home visitation interventions in reducing substantiated reports of child abuse and neglect. Volunteers and women recruited due to a risk factor were randomly assigned to one of conditions described below: 1) Sensory and developmental screening at 12 and 24 months only (control group); 2) Free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; 3) Nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months; or 4) Nurse home visits until the child was 2 years old in addition to nurse home visitation during pregnancy, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months [now called Nurse Family Partnership (NFP)]. Mothers were interviewed at 15 years, using a life history calendar designed to help them recall major life events. They also estimated how many months they received Aid to Families with Dependent Children, Medicaid, or food stamps. Mothers reported incidents of domestic violence using the Conflict Tactics Scale and provided consent for researchers to review CPS records. Families receiving nurse visitation during pregnancy and infancy had fewer child maltreatment reports involving mother as perpetrator and study child as victim. The treatment effect decreased as level of overall domestic violence increased. Limitations include the presence of domestic violence which may limit the effectiveness of early visitation interventions, high attrition rate, and generalizability due to ethnicity and gender.

Length of postintervention follow-up: 13 years.

Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., Isacks, K., Sheff, K., & Henderson, C. R. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560–1568. https://doi.org/10.1542/peds.2004-0961

Type of Study: Randomized controlled trial
Number of Participants: 635

Population:

  • Age — Parents: Mean=19.8 years
  • Race/Ethnicity — Parents: 45% Mexican American, 35% White non-Mexican American, 15% Black, and 3% American Indian/Asian
  • Gender — Parents: 100% Female
  • Status — Participants were recruited from clinics serving low income women who had no previous live births and either qualified for Medicaid or had no private health insurance.

Location/Institution: Denver, Colorado

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effects of prenatal and infancy home visiting by paraprofessionals and by nurses when the child turned 2 years old through age 4 years. Women were assigned to one of three conditions: developmental screening and referral at 6, 12, 15, 21, and 24 months; the above screenings plus home visitation by a paraprofessional during pregnancy and the first 2 years of the child’s life; and equivalent services with home visitations conducted by a nurse [now called Nurse-Family Partnership (NFP)]. Paraprofessionals were limited to those who had a high school education and no Bachelor’s degree or coursework in a helping profession, in order to gauge the viability of using this type of worker in home visiting in comparison with nurses. Assessed at the two-year follow-up were maternal reports of subsequent pregnancies, education and work histories, marriage, cohabitation, domestic violence, mental health, substance use, and sense of mastery. Mother-child interaction and the home environment were observed. Children were assessed for language and executive functioning, and mothers reported on children’s externalizing behavior problems. Women visited by paraprofessionals were less likely to be married or live with the biological father of the child but worked more and had better mental health and sense of mastery. Children visited by paraprofessionals displayed greater sensitivity and responsiveness and had home environments supportive of early learning. Nurse-visited women had greater intervals between 1st and 2nd children, experienced less domestic violence, and enrolled their children less in formal daycare or preschool. Nurse-visited children had better home environments, better language and executive functioning skills, and better behavioral adaptation during testing. Limitations include higher study attrition among nurse-visited women and reliability on self-reported measures.

Length of postintervention follow-up: 2 years.

Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., Luckey, D. W., Henderson, C. R., Holmberg, J., Tutt, R. A., Stevenson, A. J., & Bondy, J. (2007). Effects of nurse home visiting on maternal and child functioning: Age 9 follow-up of a randomized trial. Pediatrics, 120(4), e832–e845. https://doi.org/10.1542/peds.2006-2111

Type of Study: Randomized controlled trial
Number of Participants: 743

Population:

  • Age — Parents: 64% younger than 19 years
  • Race/Ethnicity — Parents: 92% Black
  • Gender — Parents: 100% Female
  • Status — Participants were actively recruited if they had at least two of the following risk factors: unmarried, less than 12 years of education, or unemployed.

Location/Institution: Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the effect of prenatal and infancy home visits by nurses on mothers’ fertility and children’s functioning 7 years after the program ended when the child turned 2 years old. Women were randomly assigned to one of 4 conditions: free transportation to scheduled prenatal visits only; transportation plus developmental screening and referrals at 6, 12, and 24 months; the above services plus intensive prenatal home visiting services; and the above plus continuing nurse visitation through 24 months [now called Nurse Family Partnership (NFP)]. Mothers were assessed at baseline on a created variable called psychological resources, comprised of intelligence, mental health, self-efficacy, and sense of mastery. By the time the child was 9 years old, women visited by a nurse had fewer births and longer intervals between children, used welfare and food stamps for fewer months, and had longer relationships with current partners. Researchers matched participants with the National Death Index. Of the 10 children found to have died, control group children were 4.46 times more likely to have died before the 9-year follow-up and more likely to have died by preventable causes (e.g., sudden infant death syndrome). Limitations include reliability of self-reported measures, program impact on childhood mortality does not reach conventional levels of statistical significance, and generalizability due to ethnicity.

Length of postintervention follow-up: 7 years.

Sidora-Arcoleo, K., Anson, E., Lorber, M., Cole, R., Olds, D., & Kitzman, H. (2010). Differential effects of a nurse home-visiting intervention on physically aggressive behavior in children. Journal of Pediatric Nursing, 25, 35–45. https://doi.org/10.1016/j.pedn.2008.07.011

Type of Study: Randomized controlled trial
Number of Participants: 721

Population:

  • Age — Parents: Mean=18.1 years
  • Race/Ethnicity — Parents: 89–92% African American
  • Gender — Parents: 100% Female
  • Status — Participants were actively recruited if they had at least two of the following risk factors: unmarried, less than 12 years of education, or unemployed.

Location/Institution: Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the differential effects of nurse home visiting (NV) on physical aggression (PA) among children aged 2-12 years. In the original study, mothers were randomized to Nurse-Family Partnership (NFP) or one of 3 other conditions. The present study evaluated the long-term effects of the NFP program on physical aggression and verbal ability in girls and boys. Results at 12-year follow-up indicated that there were significant reductions in physical aggression observed among girls in the intervention group at 2 years old and intervention group children of high-psychological-resource mothers at 6 and 12 years old. Mediation analyses suggest that reductions in physical aggression yield increased verbal ability among girls. Limitations include reliability of self-reported measures, program impact on childhood mortality does not reach conventional levels of statistical significance, and generalizability due to ethnicity.

Length of postintervention follow-up: 4 and 10 years.

Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Jr., Cole, R., Kitzman, H., Anson, E., Sidora-Arcoleo, K., Powers, J., & Olds, D. (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19 year follow-up of a randomized trial. Archives of Pediatrics & Adolescent Medicine, 164(1), 9–16. https://doi.org/10.1001/archpediatrics.2009.240

Type of Study: Randomized controlled trial
Number of Participants: 310

Population:

  • Age — Children: 19 years
  • Race/Ethnicity — Children: 78% Caucasian and 22% Other
  • Gender — Children: 53% Female and 47% Male
  • Status — Participants were youths whose mothers participated in the Olds et al. (1986) sample.

Location/Institution: Semi-rural country in New York

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the effect of prenatal and infancy nurse home visitation [now called Nurse-Family Partnership (NFP)] on the life course development of 19-year-old youths whose mothers participated in the program. In the original study, mothers were randomized to one of four treatment conditions. Measures utilized include youth’s histories of arrests, convictions, delinquent and criminal behavior, use of substances, educational achievement, pregnancies, births, and use of welfare. Results indicate that youths whose mothers participated in either of the two treatment groups were less likely to have ever been arrested or convicted than were those in the comparison group. Girls in the nurse-visited group also had fewer lifetime arrests and convictions than did those in the comparison group. Girls in the nurse-visited group born to high-risk (unmarried and low-income) mothers had fewer children and were less likely to have received Medicaid than were high-risk girls in the comparison group. The major study limitation was the reliance on youth self-report as the only outcome measure and lack of racial diversity.

Length of postintervention follow-up: 17 years.

Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics, 168(9), 800–806. https://doi.org/10.1001/jamapediatrics.2014.472

Type of Study: Randomized controlled trial
Number of Participants: 1138

Population:

  • Age — Parents: 64.1% 18 years and younger
  • Race/Ethnicity — Parents: 92.1% African American
  • Gender — Parents: 100% Female
  • Status — Participants were women from a clinic serving low-income populations.

Location/Institution: Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
This study attempted to determine the effect of prenatal and infant/toddler nurse home visiting [now called Nurse Family Partnership (NFP)] on maternal and child mortality during a 2-decade period (1990-2011). Measures utilized include the International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases, 10th Revision (ICD-10). Results indicate during the 2-decade period following registration in this trial, women enrolled in the 2 nurse-visited groups were less likely to have died than women assigned to the control group, and by age 20 years, children whose mothers received home visits during pregnancy and through when the child turned 2 years old were less likely to have died from preventable causes compared with their counterparts in the control group. Limitations include sparseness of the data and limited sample size for a study of mortality.

Length of postintervention follow-up: 18 years.

Robling, M., Bekkers, M., Bell, K., Butler, C. C., Cannings-John, R., Channon, S., Corbacho Martin, B., Gregory, J. W., Hood, K., Kemp, A., Kenkre, J., Montgomery, A. A., Moody, G., Owen-Jones, E., Pickett, K., Richardson, G., Roberts, Z. E. S., Ronaldson, S., Sanders, J., Stamuli, E., & Torgerson, D. (2016). Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (building blocks): A pragmatic randomised controlled trial. The Lancet, 387(10014), 146–155. https://doi.org/10.1016/S0140-6736(15)00392-X

Type of Study: Randomized controlled trial
Number of Participants: 1,645

Population:

  • Age — Parents: 19 years and younger (Mean=17.9 years)
  • Race/Ethnicity — Parents: 88% White, 5–6% Mixed, 4–5% Black, 1–2% Asian, and
  • Gender — Parents: 100% Female
  • Status — Participants were women who were eligible to receive publicly funded health and social care.

Location/Institution: England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to test the effectiveness of The Family Nurse Partnership (FNP) [now called Nurse-Family Partnership (NFP)] in a population of teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. Women were randomly assigned to FNP or usual care, with randomization stratified by site and minimized by gestation, smoking, and preferred language of data collection and weighted towards minimizing the imbalance in trial groups. Measures utilized include outcome data on birth weight, emergency department attendances and admissions, and second pregnancies; as well as, self-reported measures of tobacco use and from urine samples. Results indicate no evidence of benefit from FNP for smoking cessation, birth weight, rates of second pregnancies, and emergency hospital visits for the child. Limitations include minor adaptations were made for implementation in a UK setting and it was delivered in a substantially different publicly funded and configured healthcare system than the previous studies in the U.S., which may have impacted the services received by the usual care group.

Length of postintervention follow-up: None.

Enoch, M.-A., Kitzman, H., Smith, J. A., Anson, E., Hodgkinson, C. A., Goldman, D., & Olds, D. L. (2016). A prospective cohort study of influences on externalizing behaviors across childhood: Results from a nurse home visiting randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(5), 376–382. https://doi.org/10.1016/j.jaac.2016.02.007

Type of Study: Randomized controlled trial
Number of Participants: 600

Population:

  • Age — Parents: Mean=18.1 years; Children: Not specified
  • Race/Ethnicity — Parents: 76–78% African Ancestry; Children: Not specified
  • Gender — Parents: 100% Female; Children: Not specified
  • Status — Participants were mothers and their first-born children.

Location/Institution: Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate genetic and environmental influences on behavior in a cohort of 600 children followed prenatally to 18 years whose mothers participated in a nurse home visiting program (NHV, now called Nurse-Family Partnership [NFP]). Measures utilized include the 38-item Rand Mental Health Battery, the Child Behavior Checklist (CBCL), the Pearlin Mastery Scale, and the Substance Abuse Module (SAM) of the Composite International Diagnostic Interview (CIDI). Results indicate that behaviors at younger ages strongly predicted later behaviors. Children whose mothers had high self-efficacy and had received NHV were better behaved at age 2 years. Poorer maternal mental health adversely influenced externalizing disorders (ED) up to 12 years, but at age 18 years, maternal mastery exerted a strong, positive effect. Maternal smoking was associated with worse ED at 6 and 18 years. Main and interactive effects of genetic polymorphisms varied across childhood. Limitations include there was a degree of attrition from baseline, child behavior was assessed only by mothers, and, other than smoking and alcohol/drug use, the maternal measures were obtained only during pregnancy.

Length of postintervention follow-up: 2, 6, 12, and 18 years.

Eckenrode, J., Campa, M. I., Morris, P. A., Henderson, C. R., Jr., Bolger, K. E., Kitzman, H., & Olds, D. L. (2017). The prevention of child maltreatment through the Nurse Family Partnership program: Mediating effects in a long-term follow-up study. Child Maltreatment, 22(2), 92–99. https://doi.org/10.1177/1077559516685185

Type of Study: Randomized controlled trial
Number of Participants: 400

Population:

  • Age — Parents: 47% younger than 19 years
  • Race/Ethnicity — Parents: 89% Caucasian
  • Gender — Parents: 100% Female
  • Status — Participants were determined at intake to have at least one risk factor: mother less than 19 years old, single parent status, or low socioeconomic status.

Location/Institution: Elmira, New York

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Olds et al. (1986). The purpose of the study was to examine maternal life-course mediators of the impact of the Nurse Family Partnership (NFP) program on reducing child maltreatment among participants in the Elmira trial from the first child’s birth through age 15. Measures utilized include CPS records, and as potential mediators, months on public assistance and number of subsequent children. Results indicate for women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency. Limitations include the differences observed in child maltreatment may have been caused by additional mediators that were not measured in this study; the contemporaneous nature of the measurement of child maltreatment and maternal life-course outcomes does not allow a definitive conclusion in the direction of the relation between these outcomes; the subsample employed was restricted to women reporting low to moderate levels of domestic violence, which was most of the women in the trial; and the external validity of our findings may be affected by the fact that the intervention occurred over 30 years ago.

Length of postintervention follow-up: 13 years.

Kitzman, H., Olds, D. L., Knudtson, M. D., Cole, R., Anson, E., Smith, J. A., Fishbein, D., DiClemente, R., Wingood, G., Caliendo, A. M., Hopfer, C., Miller, T., & Conti, G. (2019). Prenatal and infancy nurse home visiting and 18-year outcomes of a randomized trial. Pediatrics, 144(6), Article e20183876. https://doi.org/10.1542/peds.2018-3876

Type of Study: Randomized controlled trial
Number of Participants: 742

Population:

  • Age — Parents: 64% less than 18 years old
  • Race/Ethnicity — Parents: 92% African American
  • Gender — Parents: 100% Female
  • Status — Participants were pregnant, low-income women with no previous live births.

Location/Institution: A public system of obstetric and pediatric care in Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses a subset of data from the 1997 Memphis, Tennessee, trial. The purpose of the study was to examine whether the Nurse-Family Partnership (NFP) program would improve 18-year-old first-born youths’ cognition, academic achievement, and behavior and whether effects on cognitive related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. Participants were randomly assigned to receive either free transportation for prenatal care plus child development screening and referral (control; n=514) or prenatal and infant home nurse visit (NV) (now called Nurse-Family Partnership [NFP]) plus transportation and screening (n=228). Measures utilized include the Kaufman Brief Intelligence Test 2, the Youth Self Report (YSR), the Drug Use Screening Inventory (Adolescent Version), and the Composite International Disease Interview, Substance Abuse Module (CIDI-SAM). Results indicate that compared with control-group counterparts, NV youth born to mothers with limited psychological resources (LPR) had better receptive language, math achievement, and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions. There were no intervention effects on other behaviors. Limitations include nearly all behavioral health findings were based on self-report, the age range for completing 18-year assessments was larger than anticipated, and the number of outcomes analyzed raises challenges with multiple comparisons.

Length of postintervention follow-up: 16 years.

Olds, D. L., Kitzman, H., Anson, E., Smith, J. A., Knudtson, M. D., Miller, T., Cole, R., Hopfer, C., & Conti, G. (2019). Prenatal and infancy nurse home visiting effects on mothers: 18-year follow-up of a randomized trial. Pediatrics, 144(6), Article e20183889. https://doi.org/10.1542/peds.2018-3889

Type of Study: Randomized controlled trial
Number of Participants: 742

Population:

  • Age — Parents: 64% less than 18 years old
  • Race/Ethnicity — Parents: 92% African American
  • Gender — Parents: 100% Female
  • Status — Participants were pregnant, low-income women with no previous live births.

Location/Institution: A public system of obstetric and pediatric care in Memphis, Tennessee

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to compare the Nurse-Family Partnership (NFP) program with a control-group of women for public-benefit costs, rates of substance abuse and depression, and examine possible mediators of intervention effects. Measures utilized include the Composite International Disease Interview, Substance Abuse Module (CIDI-SAM), the Beck Depression Screening Inventory, and the Beck Anxiety Screening Inventory. Results indicate nurse-visited women (NFP) incurred less in public benefit costs; an effect more pronounced for women with higher psychological resources. There were no program effects on substance abuse or depression. Nurse-visited women were more likely to be married from when the child turned 2 years old through 18, and those with higher psychological resources had fewer cumulative years rearing subsequent children after the birth of the first child. Pregnancy planning was a significant mediator of program effects on public benefit costs. Limitations include maternal substance use and abuse being evaluated by self-report, the rate of depression may underestimate its prevalence, given low rates of major depressive disorder reported by African American survey respondents compared with non-Hispanic white respondents, as well as the way Medicaid cost was calculated assumed that all children lived with very-low-income families living in impoverished communities.

Length of postintervention follow-up: 16 years.

Lorber, M. F., Olds, D. L., & Donelan-McCall, N. (2019). The impact of a preventive intervention on persistent, cross-situational early onset externalizing problems. Prevention Science, 20, 684–694. https://doi.org/10.1007/s11121-018-0973-7

Type of Study: Randomized controlled trial
Number of Participants: 735

Population:

  • Age — Parents: Mean=19.8 years
  • Race/Ethnicity — Parents: 49% Latino, 36% European American and 16% African American
  • Gender — Parents: 100% Female
  • Status — Participants were women who were pregnant with their first child who qualified for Medicaid or did not have private insurance.

Location/Institution: Denver, Colorado

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study is to describe the results of new analyses of additional waves of assessment in the Denver trial, conducted to determine if the Nurse-Family Partnership (NFP) home visiting program prevents persistent early onset externalizing problems (EXT) exhibited at both school and home. Measures utilized include the Child Behavior Checklist (CBCL), the Teacher Report Form, the Shipley–Hartford IQ scale, the RAND mental health assessment, and the Pearlin and Schooler’s sense of mastery measure. Results indicate through latent profile analyses, the presence of persistent, cross-situational early onset EXT in approximately 6 to 7% of girls and boys. The intervention deflected girls away from these EXT and toward a pattern marked by a persistent moderate elevation of externalizing behavior that was evident at home and not at school. The intervention also moved girls away from stable low level externalizing behavior toward the moderately elevated pattern. Both of the significant effects on girls’ externalizing behavior were modest. No statistically significant effects were found for boys’ externalizing behaviors. Limitations include limited statistical power, an increasing rate of missing data over time, and reliance on maternal report of externalizing behavior before age 6.

Length of postintervention follow-up: 2, 4, 6, and 9 years.

Jack, S. M., Boyle, M., McKee, C., Ford-Gilboe, M., Wathen, C. N., Scribano, P., Davidov, D., McHaughton, D., O’Brien, R., Johnston, C., Gasbarro, M., Tanaka M., Kimber, M., Coben, J., Olds, D. L., & MacMillan, H. L. (2019). Effect of addition of an intimate partner violence intervention to a nurse home visitation program on maternal quality of life: A randomized clinical trial. JAMA, 321(16), 1576–1585. https://www.doi.org/10.1001/jama.2019.3211

Type of Study: Randomized controlled trial
Number of Participants: 492

Population:

  • Age — Parents: 16 years or older (Mean=20.3 years)
  • Race/Ethnicity — Parents: 57–69% White, 42–62% Hispanic/Latina, 16–28% Black or African American, 6–9% Declined to Self-Identify, 5–6% Multirace, 1–2% American Indian or Alaska Native, 0–1% Asian, and 0–4% Native Hawaiian or other Pacific Islander
  • Gender — Parents: 100% Female
  • Status — Participants were socially disadvantaged pregnant women participating in a 2.5-year nurse home visitation program.

Location/Institution: Eight states throughout the United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to determine the effect on maternal quality of life of a nurse home visitation program, Nurse-Family Partnership (NFP), augmented by an IPV intervention compared with the NFP program alone. Measures utilized include the WHOQOL-BREF, the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. Results indicate that among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. Limitations include it was not possible to make previous IPV exposure an eligibility criterion; only 36% of women deemed eligible for the study enrolled in the trial, and a low level of fidelity to the intervention.

Length of postintervention follow-up: None.

Additional References

Dawley, K., Loch, J., & Bindrich, I. (2007). The Nurse-Family Partnership. American Journal of Nursing, 107(11), 60–67. https://doi.org/10.1097/01.NAJ.0000298065.12102.41

Hill, P., Uris, P., & Bauer, T. (2007). The Nurse-Family Partnership: A policy priority. American Journal of Nursing, 107(11), 73–75. https://doi.org/10.1097/01.NAJ.0000298080.26456.32

Isaacs, J. B. (2007). Cost-effective investments in children. https://www.brookings.edu/wp-content/uploads/2016/06/01childrenfamilies_isaacs.pdf

Contact Information

Shannon Sainer
Title: Director of Impact and Learning
Agency/Affiliation: Nurse-Family Partnership - National Service Office
Website: www.nursefamilypartnership.org
Email:
Phone: (303) 951-3847
Toni Panetta
Title: Government Affairs Manager
Email:

Date Research Evidence Last Reviewed by CEBC: September 2021

Date Program Content Last Reviewed by Program Staff: August 2020

Date Program Originally Loaded onto CEBC: April 2008