Nurse Family Partnership (NFP) program

Evidence Review:

Preventing child maltreatment: Evidence-informed programs

Evidence Type:

Evidence-informed programs

Client outcomes:

Child maltreatment
Improved Parenting
Child health

Location:

North America

Strength of evidence:

Supported research evidence

Direction of effect:

Positive

About the program

The Nurse Family Partnership (NFP) program is a home-based visitation program. It is designed to prevent a wide range of childhood health and developmental problems, including abuse and neglect. The program was designed by Olds et al. (1986).

The program aims to:

Improve pregnancy outcomes by helping women engage in good preventive health practices, including prenatal care, improving their diets and reducing use of cigarettes, alcohol and illegal substances.
Improve child health and development by helping parents provide responsible and competent care.
Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.

Nurse-Family Partnership works by having specially trained nurses regularly visit young, first-time mums to-be starting early in the pregnancy, and continuing through to the child’s second birthday.

Pregnant women benefit by getting the care and support they need to have a healthy pregnancy. At the same time, new mothers develop a close relationship with a nurse who becomes a trusted resource they can rely on for advice on everything from safely caring for their child to taking steps to provide a stable, secure future for them both. Through the partnership, the nurse provides new mothers with the confidence and the tools they need to assure a healthy start for their infants.

See also Nurse-Family Partnership Program Summary in the Reducing Child Harm and Maltreatment Evidence Review.

Who does it work for?

The NFP program is designed for socially disadvantaged young mothers with a first-time pregnancy.

The NFP program has only been evaluated in the USA (Olds et al. 1986, Olds et al. 1998, Eckenrode et al. 2000, Eckenrode et al. 2017).

Four randomised control trials were conducted.

The original trial was with 400 people (216 people in the two intervention groups, and 184 people in the control group). 47% of the participants were less than 19 years old. Participant ethnicity was not reported. Participants were mostly from low income families. (Olds et al. 1986)

The second trial was with 1,139 people (458 people in the two intervention groups, and 681 people in the two control groups). Participants were mostly African-American, from low income families, and aged 18 or younger (Olds et al. 1998).

Two more follow up studies were conducted on the original trial participants.

The first follow up had 324 people (intervention and control group split is not recorded), and was evaluated 14 years after the first trial (Eckenrode et al. 2000). The second follow up had 251 people (intervention and control group split is not recorded), and was evaluated 31 years after the first trial (Eckenrode et al. 2017).

There is an Australian version of the NFP aimed at Aboriginal and/or Torres Strait Islanders. However, it has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

Child abuse reports (substantiated):
- There are significantly fewer child maltreatment reports for families receiving NFP compared with those not receiving the program (Eckenrode et al. 2000).
- In the first 15 years of life, first born children of women with low-moderate risk of domestic violence who also received the NFP program, have 4.5 times fewer substantiated maltreatment reports (Eckenrode et al. 2017).
Child hospitalisations:
- children have fewer health care encounters and are hospitalised for fewer days due to injuries and ingestions if their families have received the NFP program (Olds et al. 1998).
- in infants first and second years of life, babies of mothers receiving the NFP program present with fewer accidents and poisonings in the emergency room (Olds et al. 1998).
General parenting behaviours:
- groups most at risk of child abuse and neglect (the poor, unmarried teenagers) have lower rates of punishing and restricting their children when they receive the NFP program (Olds et al. 1986).
- families who receive the NFP program have homes more conducive to child development than families who do not receive the program (Olds et al. 1998).
Parenting attitudes: women have fewer beliefs about child-rearing associated with child abuse and neglect, such as a lack of empathy, belief in physical punishment, and unrealistic expectations of infants, when they have received the NFP program (Olds et al. 1998).

No effects:

Harsh parenting: the program has no significant effect on parental rates of conflict with and scolding their infants (Olds et al. 1986).

Negative outcomes:

No negative effects were found.

How effective is it?

Overall, the NFP program has positive effects on client outcomes.

How strong is the evidence?

Supported research evidence:

At least two high-quality randomised controlled trial (RCT) studies report statistically significant positive effects for at least one outcome, AND
Fewer RCT studies of similar size and quality show no observed effects than show statistically significant positive effects for the same outcome(s), AND
No RCT studies show statistically significant adverse effects.

How is it implemented?

The NFP program a home visitation program, during pregnancy up until a child is two years old. The visitation frequency is based on the needs of the mothers and families. Nurses use the home visits to carry out three major activities:

parent education regarding fetal and infant development
involving family members and friends in childcare and support of the mother
linking family members with other health and human services

A central aspect of the nurses’ approach is to emphasise the strengths of women and their families.

Nurses use a detailed curriculum to guide their educational activities but tailor the content of their visits to the individual needs of each family. Specific objectives include improving parents’ understanding of:

the infant’s temperament, especially crying behaviour and its meanings
the infant’s socioemotional and cognitive needs, including their need for responsive care giving and for progressively more complex motor, social, and intellectual experiences.
the infant’s physical health care needs, such as dietary requirements, bathing how to take the baby’s temperature and manage common health problems, and the need for routine health care and immunisations.

Both during pregnancy and early child rearing, nurses encourage the women’s close friends and relatives to participate in home visits, to help with household responsibilities, to aid in the care of the child/mother, and to reinforce the advice of the nurses in their absence.

The nurses also connect families with community health and human service agencies. Parents are urged to keep childcare appointments and to call the physician’s office when a health problem occurred, so the office staff can help them make decisions about whether office or emergency room visits are necessary.

The nurses send two regular reports of their observations regarding medical, social, and emotional conditions to the private physicians who provided the babies’ paediatric care. When visiting families’ homes, the nurses also clarified and reinforced the physicians’ recommendations.

When necessary, parents were referred to other services such as vocational training programs, Planned Parenthood, mental health counselling, legal aid, and the nutritional supplementation program for women, infants, and children.

How much does it cost?

Not reported

What else should I consider?

The two follow up studies provide evidence on the long-term efficacy of the NFP program. They demonstrate that children have fewer maltreatment reports over their first 15 years of life if their mothers have participated in the program. The first follow up (see Eckenrode et al. 2000) was published 14 years after the original RCT by Olds et al. (1986). The second follow up (see Eckenrode et al. 2017) was published 31 years after the original RCT.

An Australian version of the program is aimed at Aboriginal and/or Torres Strait Islander populations. See their website at: https://www.anfpp.com.au

Where does the evidence come from?

Two original RCTs and two follow ups to the earliest RCT:

One original conducted in the USA, involving 400 participants (Olds et al. 1986).
One original conducted in the USA, involving 1,139 participants (Olds et al. 1998).
One follow up conducted in the USA, involving 324 participants – follow up from Olds et al. (1986) (Eckenrode et al. 2000).
Second follow up conducted in the USA, involving 251 participants – follow up from Olds et al. (1986) (Eckenrode et al. 2017).