Nurse-Family Partnership (NFP) - Detailed Report

Clients

• Voluntary
• First time mothers
• Low income
• Enrolled early in pregnancy

Intervention context

• Within a 1:1 therapeutic relationship
• Visits are in the clients home
• Visit schedule per 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, no more than 25 families

Reflection and Clinical Supervision

• 1:1 weekly clinical supervision for each nurse with the nurse supervisor
• Case conferences are structure, 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 sent to the NFP NSO’s national database called the Clinical Information System (CIS)
• 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

Olds, D.L., Henderson, C.R., Chamberlin, R., &, Tatelbaum, R. (1985). Preventing Child Abuse and Neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65-78.

Type of Study: Randomized Controlled Trial
Number of participants: 400 mothers
Population:

Age Range: 47% younger than 19
Race/Ethnicity: 89% Caucasian. Non-Caucasian sample reported in separate paper.
Status (e.g., foster care, CW): Determined at intake to have at least one risk factor: mother < 19, single parent status, or low socioeconomic status

Location/Institution: Elmira, New York
Summary: (To include comparison groups, outcomes, measures, notable limitations): Volunteers and women recruited due to a risk factor were randomly assigned to one of 4 conditions: Nurse home visitation during the first two years of life, nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months only. Nurse home visits included education on parenting, involving friends and family, enhancing social support, and linking families to other health and human services. 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.
Length of post-intervention follow-up: 2 years after birth of child

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, 89-98.

Type of Study: Randomized Controlled Trial
Number of participants: 316 to 340, depending on assessment period
Population:

Age Range: 47% of mothers less than 19 years of age
Race/Ethnicity: 89% Caucasian. Non-Caucasian sample reported in separate paper.
Status (e.g., foster care, CW): Determined at intake to have at least one risk factor: mother < 19, single parent status, or low socioeconomic status

Location/Institution: Elmira, New York
Summary: (To include comparison groups, outcomes, measures, notable limitations): Note: This study used the same sample as Olds, et al., 1985. Volunteers and women recruited due to a risk factor were randomly assigned to one of 4 conditions: Nurse home visitation during the first two years of life, nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months only. Home assessments were made using the Caldwell and Bradley Home Inventory. Interviewers also compiled a checklist evaluating children’s exposure to hazardous substances and situations in the home. The Stanford Binet test of intelligence was administered at 36 and 48 months. Finally, pediatric and hospital records were reviewed for the 25th through the 50th month and Child Protective Service records were checked against the list of participants. 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.
Length of post-intervention follow-up: 25 to 50 months after birth of child

Olds, D.L., Eckenrode, J., Henderson, C.R., 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.

Type of Study: Randomized Controlled Trial
Number of participants: 324
Population:

Age Range: 47% of mothers less than 19 years of age at intake
Race/Ethnicity: 89% Caucasian at intake.
Status (e.g., foster care, CW): Determined at intake to have at least one risk factor: mother < 19, single parent status, or low socioeconomic status

Location/Institution: Elmira, New York
Summary: (To include comparison groups, outcomes, measures, notable limitations):Note: This study used the same sample as Olds, et al., 1985 and 1994. Volunteers and women recruited due to a risk factor were randomly assigned to one of 4 conditions: Nurse home visitation during the first two years of life, nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months only. 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.
Length of post-intervention follow-up: 15 years after birth of child

Olds, D.L., Henderson, C.R., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., Pettitt, L.M., Sidora, K., Morris, P., & Powers, J. (1998). Long-term effects of nurse home visitation on children’s criminal and antisocial behavior. Fifteen-year follow-up of a randomized trial. Journal of the American Medical Association, 280(14), 1238-1244. REANALYZED in 2006: Nurse-Family Partnership. (2006). Interview with Dr. David Olds available at http://www.nursefamilypartnership.org/resources/files/PDF/DavidOldsinterview1-24-06.pdf.

Type of Study: Randomized Controlled Trial
Number of participants: 315
Population:

Age Range: 15 years old
Race/Ethnicity: 89% born to Caucasian mothers
Status (e.g., foster care, CW): Born to mothers determined at intake to have at least one risk factor: mother < 19, single parent status, or low socioeconomic status

Location/Institution: Elmira, New York
Summary: (To include comparison groups, outcomes, measures, notable limitations):Note: This study used the same sample as Olds, et al., 1985, 1994, and 1997. Volunteers and women recruited due to a risk factor were randomly assigned to one of 4 conditions: Nurse home visitation during the first two years of life, nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months only. Assessments at this follow-up included self-reports of running away, criminal justice encounters, initiation of sexual intercourse, number of sex partners, and use of illegal substances. Records of school suspension, teachers’ reports of disruptive behavior in school, and parents’ report of arrests and problems due to substance use were also reviewed. Adolescents who received home visits had fewer arrests, fewer cigarettes smoked, and fewer days of alcohol use. Parents reported fewer behavioral problems due to substance use.
Length of post-intervention follow-up: 15 years after birth

Eckenrode, J., Ganzel, B., Henderson, C.R., 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.

Type of Study: Randomized Controlled Trial
Number of participants: 324
Population:

Age Range: 47% of mothers less than 19 years of age at intake
Race/Ethnicity: 89% Caucasian mothers at intake
Status (e.g., foster care, CW): Mothers determined at intake to have at least one risk factor: mother < 19, single parent status, or low socioeconomic status

Location/Institution: Semi-rural community in New York
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Olds, et al., 1985, 1994, 1997, and 1998. Participants were randomly assigned to 1 of 4 treatment groups: Nurse home visitation during the first two years of life, nurse home visitation during pregnancy only, free transportation to regular prenatal and perinatal visits, and sensory and developmental screening at 12 and 24 months only. 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. The authors conclude that the presence of domestic violence may limit the effectiveness of early visitation interventions.
Length of post-intervention follow-up: 15 years after birth of child

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. Journal of the American Medical Association, 278(8), 644-652.

Type of Study: Randomized controlled trial
Number of participants: 1139
Population:

Age Range: 64% less than 19 years of age
Race/Ethnicity: 92% African American
Status (e.g., foster care, CW): Actively recruited if they had two risk factors: unmarried, <12 years of education, or unemployment.

Location/Institution: Memphis, TN
Summary: (To include comparison groups, outcomes, measures, notable limitations) Women were randomly assigned to 1 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; the above plus continuing nurse visitation through 24 months. Assessments included abstraction of medical records for pregnancy-induced hypertension, preterm delivery, low birth-weight, children’s injuries, ingestions, and immunizations. Mothers reported on children’s behavioral problems and their own subsequent pregnancy, educational achievement, and employment. Use of welfare was derived from state records, and children’s mental development was tested. Children visited by nurses have fewer total health care encounters for injuries and ingestions and had fewer outpatient visits for injuries and ingestions. There was no effect on children’s mental development or behavioral problems or mother’s education or employment.
Length of post-intervention follow-up: 2 years after birth of child

Olds, D.L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D.W., Henderson, C.R., Hanks, C., Bondy, J., & Holmberg, J. (2004). Effects of nurse home visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial. Pediatrics, 114(6), 1550-1559.

Type of Study: Randomized controlled trial
Number of participants: 1139 allocated to treatment; 641 seen in this follow-up.
Population:

Age Range: 64% less than 19 years of age at intake
Race/Ethnicity: 92% African American at intake
Status (e.g., foster care, CW): Actively recruited if they had two risk factors: unmarried, <12 years of education, or unemployment.

Location/Institution: Memphis, TN
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Kitzman, et al., 1997. Women were randomly assigned to 1 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; the above plus continuing nurse visitation through 24 months. The outcomes described here refer to comparisons between the second and fourth groups only. Mothers were assessed at baseline on a created variable called psychological resources, comprised of intelligence, mental health, self-efficacy, and sense of mastery. They were interviewed at or around the child’s sixth birthday regarding life course issues, including subsequent pregnancies, substance abuse and legal or child welfare related outcomes stemming from substance abuse, educational achievement, employment history and use of aid programs such as welfare. They were also asked about marriage, cohabitation, and domestic violence. Children were assessed using the Child Behavior Checklist, Hightower Teacher-Child Rating Scale and the McArthur Story Stem Battery, which assesses aggression, perceptions of parental warmth and coherency. Women visited by a nurse had fewer and more widely spaced pregnancies, longer relationships, and fewer months using welfare or food stamps. Children visited by a nurse were more likely to have been enrolled in a formal pre-school program and had higher intellectual and behavioral functioning. No effects were found on other maternal variables measured.
Length of post-intervention follow-up: 6 years after birth of child

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, e832-e845.

Type of Study: Randomized controlled trial
Number of participants: 1139 allocated to treatment; 627 seen in this follow-up.
Population:

Age Range: 64% less than 19 years of age at intake
Race/Ethnicity: 92% African American at intake
Status (e.g., foster care, CW): Actively recruited if they had two risk factors: unmarried, <12 years of education, or unemployment.

Location/Institution: Memphis, TN
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Kitzman, et al., 1997 and Olds, et al., 2004. Women were randomly assigned to 1 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; the above plus continuing nurse visitation through 24 months. 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 as 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.)
Length of post-intervention follow-up: 9 years after birth of child

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., and Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized controlled trial. Pediatrics, 110(3), 486-496.

Type of Study: Randomized Controlled trial
Number of participants: 735
Population:

Age Range: Average 19.8 years
Race/Ethnicity: Approximately 16% African American, 35% Caucasian and 45% Hispanic.
Status (e.g., foster care, CW): Recruited from clinics serving low income women if no previous live births and either qualified for Medicaid or had no private health insurance.

Location/Institution: Denver, CO
Summary: (To include comparison groups, outcomes, measures, notable limitations) 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. Paraprofessionals were limited to those who had a high school education and no bachelors 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. The paraprofessionals were recruited from other home visitation programs. At baseline, mothers interviewed to assess socioeconomic conditions, mental health, conflict with partners and their own mothers, and experience of domestic violence. They were also screened for substance abuse. At 12, 15, 21, and 24 months, women were interviewed to assess timing of subsequent pregnancies, work history and use of welfare. Mothers were videotaped in the laboratory and at home to assess responsive interaction with their children. Children were assessed by observation on their interactions with mothers and emotional responses and also on language and cognitive development, using the Mental Development Index. No major differences were found in outcomes between the paraprofessional home visitation group and the control group. Mothers visited by a nurse had fewer and more widely spaced pregnancies, worked more, and showed more responsive interaction with their children. Children visited by a nurse showed fewer language delays and higher mental development.
Length of post-intervention follow-up: 2 years after birth of child.

Olds, D.L., Robinson, J., Pettitt, L.M., Luckey, D.W., Holmberg, J., Ng, R.K., Isacks, K., Sheff, K.L, & 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.

Type of Study: Randomized Controlled trial
Number of participants: 635
Population:

Age Range: Average 19.8 years at intake Race/Ethnicity: Approximately 16% African American, 35% Caucasian and 45% Hispanic at intake.
Status (e.g., foster care, CW): Recruited from clinics serving low income women if no previous live births and either qualified for Medicaid or had no private health insurance.

Location/Institution: Denver, CO
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study used the same sample as Olds, et al., 2002. 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. Paraprofessionals were limited to those who had a high school education and no bachelors 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. The paraprofessionals were recruited from other home visitation programs. Assessed at this 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.
Length of post-intervention follow-up: 4 years after birth of child.

Dawley, K., Loch, J., & Bindrich, I. (2007). The Nurse-Family Partnership. American Journal of Nursing, 107(11):60-67.

Hill, P., Uris, P. & Bauer, T. (2007). The Nurse-Family Partnership: A Policy Priority, American Journal of Nursing, 107(11): 73-75.

Isaacs, J.B. (2007). Cost-Effective Investments in Children. Washington D.C.: Brookings Institute January Budget Options series (Budgeting for National Priorities); http://www.brookings.edu/views/papers.200701isaacs.htm.