Nurse-Family Partnership

Nurse-Family Partnership (NFP) is a home visitation program that provides first time mothers with guidance and support in developing effective childrearing practices with the goal of improving long-term outcomes for mother and child. The program begins in pregnancy, when NFP nurses initiate home visitations with pregnant women who are predisposed to infant health and developmental problems (e.g. preterm delivery, low birth weight). NFP nurses educate parents on fetal and infant development, engage other family members and friends in supporting the mother during pregnancy and post-partum, and assist families in using formal health and social services.

Visitations typically begin in the second trimester, lasting 60-90 minutes every other week, and continue through the child’s second birthday. NFP nurses possess all standard medical training and certifications and are equipped with a visit-by-visit protocol for guiding first-time mothers through improving health behaviors, developing parenting skills, and creating plans for education and employment.

The Blueprints certification of Nurse-Family Partnership is based on three randomized controlled trials from implementation sites in New York, Tennessee, and Colorado. Each study involved samples of pregnant, first-time mothers facing exceptional challenges including low income, teen pregnancy, or single parenthood.

The first certified study produced several articles over a span of decades (Eckenrode et al., 2010; Olds et al., 1986a, 1986b, 1997, 1998) and began in 1978 with 400 pregnant women from the rural Appalachian region of New York State. The women, who were recruited from private obstetrics offices and a free antepartum clinic, were randomly assigned to one of three groups: a treatment group receiving home visits during pregnancy (n = 100); a second treatment group receiving home visits up to 24 months after birth (n = 116); or a comparison group (n = 184). Relative to women in the comparison group, nurse-visited women were significantly healthier – fewer hypertensive disorders and kidney infections, improved diet, reductions in cigarette use – during pregnancy and for two years after the child’s birth. Compared to children in the comparison group, children of nurse-visited mothers displayed improved emotional and cognitive development in early childhood, experienced fewer instances of child abuse and neglect through age 15 and had fewer arrests and convictions through age 19.

The second Blueprints-certified study (Olds et al., 2002, 2004) involved low-income pregnant women receiving antepartum care in Denver, Colorado. The women were predominantly Black or Hispanic and were randomly assigned to one of two treatment groups (received home visits from a nurse, n = 235, or a paraprofessional, n = 245), or a comparison group (n = 255) receiving standard care. For four years after giving birth, nurse-visited women experienced better outcomes in general and reproductive health, including smoking cessation and pregnancy intervals, than women in the comparison group or the paraprofessional-visited group. Children of nurse-visited mothers, relative to comparison group children, displayed improved emotional coping and reduced likelihood of developmental delays in early childhood through age 4.

The third Blueprints-certified evaluation (Kitzman et al. 1997; Olds et al., 2004, 2007, 2014) was a scaled-up replication of the program and recruited low-income pregnant women in Memphis, Tennessee. The women were randomly assigned to one of four groups: a high exposure treatment group (n = 228), a low exposure treatment group (n = 230), a usual care comparison group (n = 166), or a slightly enhanced usual care comparison group (n = 515) offering developmental screening and referral services. All women in the nurse-visited treatment groups received intensive home visits during pregnancy, but the low exposure group received only two post-partum visits while the high exposure group continued receiving visits for 24 months after birth. Relative to the comparison groups, nurse-visited women had better mental, physical, and reproductive health outcomes and more economically stable households for six years after birth. Over the first two years of life, children born to nurse-visited mothers had fewer injuries and hospitalizations compared to children of control group mothers. Program benefits of higher test scores and fewer behavior problems extended to age six for all children of nurse-visited women, and to age nine for a high-risk subgroup. Maternal and child mortality rates were also significantly lower for nurse-visited mothers and their children through 20 years after birth.

In terms of cost-benefit analysis, Washington State Institute for Public Policy (December 2018) reports $1.40 in measured benefits per $1 spent in implementing Nurse-Family Partnership (NFP).

References:

Eckenrode, J., Campa, M., Luckey, D. W., Henderson, C. R., Cole, R., Kitzman, H., … 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, 9-15.

Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., … Barnard, K. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. Journal of the American Medical Association, 278(8), 644-652.

Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., … Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: 15-year follow-up of a randomized trial. Journal of the American Medical Association278(8), 637-643.

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, 65-78.

Olds, D. L., Henderson, C. R., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., … Powers, J. (1998). Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. Journal of the American Medical Association, 280(14), 1238-1244.

Olds, D. L., Henderson, C. R., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77,16-28.

Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., … Bondy, J. (2007). Effects of nurse home visiting on maternal and child functioning: Age 9 follow-up of a randomized trial. Pediatrics, 120, 832-845.

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 pediatrics168(9), 800-806.

Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., … Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110, 486–496.

Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., … Henderson Jr., 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.