Nurse Family Partnership (NFP)
Category
Family Support, Child & Family Health
Child's Age
Prenatal, 0-1 years, 1-2 years
Languages
English, Spanish
Brief Description
Nurse-Family Partnership (NFP) is a community health program designed to provide first-time moms with a supportive, caring relationship with their nurse through regular home visits from pregnancy to their child’s second birthday. NFP strives to improve pregnancy outcomes, child health and development, and the economic self-sufficiency of the family.
Expected Impact
Based on the North Carolina 2022 Profile and research reviewed below.
Measured via parent reports, interviews, observations, and medical records
- Reduced likelihood of child injuries, emergency room visits, and hospitalizations for child injuries
- Reduced likelihood of second pregnancies during the first 2 years postpartum
- Reduced likelihood of child abuse/neglect
- Longer intervals between first and subsequent pregnancies
- Reduced likelihood of punishing and restricting children
- Greater likelihood of providing children with appropriate play materials
- Increase in parent employment
- 61% of NFP clients in NC over the age of 18 years were employed at 24 months
- Decrease in preterm births
- 89% of NFP-enrolled babies in NC born at term (37 weeks’ gestation)
- Increase in breastfed babies at 6 months
- 85% of NFP-enrolled mothers in NC initiated breastfeeding
- Increase in immunized infants at 6 months
- 89% of NFP-enrolled babies in NC received all immunizations by 24 months
Core Components for Model Fidelity
- Home Visits: Home visits are made by registered nurses to low-income, first-time mothers. The nurses educate the women on prenatal health and prepare them for the birth process. After delivery, nurses provide parent coaching on developmental milestones and behaviors as well as positive parenting techniques. The nurses also promote economic self-sufficiency by helping mothers develop a plan for their future schooling, employment, and/or future pregnancies.
- Fidelity: Nurses and partner sites must adhere to the 19 Nurse-Family Partnership Model Elements.
Languages Materials are Available in
English, Spanish
Delivery Mode
In-person home visits.
Dosage
60-90 minute visits once a week until six weeks after delivery and then every other week until the child is 21 months of age. Then, visits occur monthly until the child’s second birthday.
The model is designed to provide a total of 64 home visits, ideally starting by the 16th week of pregnancy.
Infrastructure for Implementation
Other: Pre-implementation assessment of provider readiness includes the following:
- Assessment of need
- Review of existing services
- Creation of task force for program host selection
- Feasibility assessment
- Referral sources and outreach methods determination
- Develop an implementation plan
- Hire the nurse home visitors and supervisors
Staffing Requirements
Nurse Home Visitor - Must be a Registered Nurse who holds a bachelor's degree in nursing. Nurse home visitors serve a caseload of approximately 25 clients.
Nurse Supervisors - must have at least a bachelor's degree in nursing, although a master's degree in nursing is preferred.
An NFP program is required to have a minimum of 2 nurse home visitors and 1 supervisor before they can begin serving families.
NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) for more information, training, and certification.
Training for Model Fidelity
Training is provided virtually or at NFP’s headquarters in Denver.
Training required for nurse home visitors AND supervisors:
- Unit One: 20 hours (22 for supervisors)
- Unit Two: 27 hours over 3 ¾ days of face-to-face learning and practice in Denver
- Unit Three: 10 hours virtual learning and team-based, supervisor-led professional development
- Advanced Education: 20-30 additional virtual hours for after completion of Unit 3 on mental health, goal setting, and intimate partner violence
Additional education through the University of Colorado:
- Keys to Caregiving (6 hours)
- DANCE Fundamentals (Dyadic Assessment of Natural Caregiver-Child Experiences), 24 classroom hours at the University of Colorado through the Prevention Research Center. Taken after Keys to Caregiving and about 9 months post-hire.
Additional Supervisor Training:
- Unit 4: 24 face-to-face hours of education in Denver. Occurs 4-6 months after Unit 2 is complete
- Continuous consultation with a NFP Nurse Consultant
Contact Information
https://www.nursefamilypartnership.org/
Elly Yost: 303-327-4240, elly.yost@nursefamilypartnership.org
Michelle Stapleton: Manager, Strategic Funding; 303-327-4277, programdevelopment@nursefamilypartnership.org
Cost Estimates
There are one-time start-up expenses related to nurse education, physical supplies and other supports, with the primary driver for the ongoing NFP budget being nurse salaries. The total cost can vary based on local salaries and the size of the program. The average cost per family runs between $6,000-$9,000. Please reach out to a network development specialist to provide a budget template and guidance for developing a budget at: programdevelopment@nursefamilypartnership.org.
Purpose Service Code (PSC)
5525 – Home Visiting
Program Identifier (PID)
Nurse Family Partnership
Minimal Outputs for NCPC Reporting
FY 24-25:
- Number of parents/guardians participating†
†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.
Minimal Outcomes for NCPC Reporting
FY 24-25:
- Increase in parent use of services
Minimal Measures for NCPC Reporting
FY 24-25:
- Nurse Family Partnership Client Survey (36 weeks gestation-pre; 1 year postpartum-post)
NCPC Evidence Categorization
Evidence Based- 3 randomized control trials.
Research Summary
The following studies were included due to their topic relevance and strength of study. In 1986, Olds et al.1 conducted the first randomized controlled trial on Nurse Family Partnership. Their study found no statistically significant differences between groups when considering the abuse/neglect outcomes. However, there were trends in favor of the nurse home visitation group for lower percentages of abuse/neglect. The home visitation mothers punished their young children less and provided more appropriate play opportunities. The children of mothers receiving the intervention also went to the emergency room significantly less. In 1997, Kitzman et al.2 completed another RCT. Researchers collected data revolving around pregnancy outcomes, the children’s injury histories, and the mother’s subsequent pregnancies. Women involved in the nurse home visiting intervention experienced less hypertension. During the first two years of their children’s lives, their children were seen by health care workers for fewer injuries and were hospitalized for fewer injuries. The mothers also had fewer second pregnancies during those two years. Significant effects were not found for preterm delivery, low birth weight, immunizations, mental development, behavioral problems, and mothers’ educations or employment. In 2002, Olds et al.3 completed a randomized controlled trial in Denver, CO. Participants were placed in a control group or received care from either paraprofessionals or nurses. The nurses had many more statistically significant outcomes. In the nurse visited groups the women experienced greater reductions in cotinine levels, fewer subsequent pregnancies, greater intervals between pregnancies, and worked more frequently after their child turned 1. The children in nurse-visited homes also displayed less emotional vulnerability and those born to women with low psychological resources experienced fewer language delays at 21 months and had higher mental development scores at 24 months. Results regarding ancillary prenatal service, educational achievement, use of welfare, children’s temperament, and behavioral issues were not significant.
- ^ See Olds, et al. (1986). 400 women participated that enrolled in nurse family partnership before their 30th week of pregnancy. There received no services, free transportation for typical prenatal care, the transportation along with nurse home visitation during pregnancy, or transportation and nurse home visitation until the children were 2 years old. The data was collected through Rotter’s Locus of Control, Abuse and Neglect Registries, Caldwell Home Observation checklist and interview, Bayley Mental Development Index, Cattell Scales, and medical records.
- ^ See Kitzman, et al. (1997). 1139 African American joined the study when they were less than 29 weeks’ gestation with their first child. They were also considered to have at least 2 sociodemographic risk characteristics (including being unmarried, unemployed, and having less than 12 years of education). Data was collected using medical records, mother’s reports, and state welfare records. Other measures used include the Nursing Child Assessment Satellite Training procedure, the Home Observation for Measurement of the Environment, the Bayley scales of infant development, and the Child Behavior Checklist.
- ^ See Olds, et al. (2002). Researchers conducted an RCT in Denver, CO where 255 women were randomized to the control group, 245 to the paraprofessional group, and 235 to the nurse group. Participants were low-income women in the metropolitan area around Denver who did not have health insurance or qualified for Medicaid and had no previous births. Data was collected through interviews that focused on their socioeconomic conditions, mental health, personality, medical history, psychoactive drug use, conflicts with partners and their mothers, domestic violence, education, workforce, and welfare use. The Conflict Tactics Scale was also used. The women provided urine for analysis and completed intellectual functioning assessments. Women were interviewed at registration, 36 weeks of gestation, and 12, 15, 21, and 24 months postpartum. Mother-Infant interaction and home environment were measured using observation measures and the Home Observation for Measurement of the Environment (at 12 and 21 months). For infants, measures included the Preschool Language Scale (at 21 months), the Bayley Scales of Infant Development, and measures for emotional reactivity (at 6 months).
Researched Population
- Low-income, first-time mothers who enroll early in their pregnancy
Clearinghouse and Compendium References
California Evidence Based Clearinghouse for Child Welfare- rating of “1 Well-Supported by Research Evidence”
Home Visiting Evidence of Effectiveness- rating of “Meets HHS criteria for general population”
National Home Visiting Resource Center- rated Evidence-Based
Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., McConnocie, K. M., Sidora, K., Luckey, D. W., Shaver, D., Engelhardt, K., James, D., & Barnard, K. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial. JAMA, 27, 644-652.
Olds, D. L., Henderson Jr., C. R., Chamberlin, R. , & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65-78. https://doi-org.proxy006.nclive.org/10.1542/peds.78.1.65
Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., 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
Local Partnerships Currently Implementing
Local Partnerships in purple have adopted Nurse Family Partnership (NFP). Local Partnership contact information can be found here.