Australian Nurse-Family Partnership

About the program

The Australian Nurse-Family Partnership Program is a culturally safe adaptation of the Nurse-Family Partnership program for Aboriginal families. It has been implemented in central Australia where it was delivered by an Aboriginal community-controlled health organisation. It involves a program of nurse home visiting for mothers. The nurses promote three aspects of maternal functioning: health-related behaviours during pregnancy and the early years of the child’s life, the care parents provide to their children, and maternal life-course development (such as family planning, educational achievement, and participation in the workforce).  The goals of the program are to improve pregnancy outcomes, to promote children’s health and development, and to strengthen families’ economic self-sufficiency.

The main adaptation was to include Aboriginal community workers as part of the home visiting team. The program also had an open referral pathway, and was not restricted to first-time mothers.

Who does it work for?

The program is designed for families experiencing vulnerability, for example, young mothers, single mothers, and families of low socioeconomic status. The original program was developed by David Olds some forty years ago, based on his work in a semi-rural USA community with high rates of child abuse and neglect. Several RCTs have shown that the original program is effective with young mothers unmarried mothers, African American mothers, and mothers  from low socioeconomic backgrounds (Eckenrode et al. 2017, 2000, Olds et al. 1994, 1999).

The ANFPP has been evaluated (Segal et al. 2018). A study was conducted in Central Australia with a sample of 854 mothers. There were 291 mothers in the intervention group and 563 in the control group. The mean age of control group mothers was 25.6 years, and the mean age of intervention group mothers was 23.1 years. 100% of the children were Aboriginal. Participants from the most disadvantaged quintile of the whole population made up 35.2% of the control group, and 32.5% of the intervention group. Mothers in employment comprised 19.7% of the control group and 20% of the intervention group. In the control group, 15.8% had had more than one house move per year, and this figure was 20.6% in the intervention group. The program was implemented by a large Aboriginal community-controlled health organisation in Central Australia. Aboriginal home visitors were included in the team. The study sample were pregnant women who met the following inclusion criteria: location in the town of Alice Springs between 10 and 22 weeks gestation, the expectant mother (or father) was Aboriginal, and the mother had not previously participated in the ANFPP.

What outcomes does it contribute to?

Positive outcomes:

Child abuse and neglect, Child abuse reports: Substantiated:

The ANFPP had a positive effect on child abuse, neglect and maltreatment reports. For children of mothers under 20 years of age, and for children of first-time mothers, the rates of a child protection report made to the statutory child protection department, or an investigation or substantiation of such a report, were all substantially and statistically significantly lower in the ANFPP group than in the control group. This was especially the case for young mothers or first-time mothers (Segal et al. 2018). There was no significant result in this outcome for other demographics.

Out-of-home placement: The mean annualised adjusted rate of days in out-of-home was lower for children in the ANFPP intervention group than those in the control group. This was statistically significant for children of mothers under 20 years of age, and for first time mothers. There was no significant result in this outcome for other demographics (Segal et al. 2018).

No effect:

None.

Negative outcomes:

None.

Is the program effective?

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

In the evaluation included in this review, the ANFPP was delivered through home visiting by community workers. Aboriginal community workers were included as part of the home visiting team. No information was given on the number or duration of home visits, nor over what period they occurred. The content of the home visit was not specified. 

How much does it cost?

Information not available.

Where does the evidence come from?

One QED non-randomised design study conducted in Australia with a sample of 854 mothers, including 563 in the control group, and 291 who received the intervention (Segal et al. 2018).

Further resources

• https://www.anfpp.com.au
• Segal, L., Nguyen, H., Gent, D., Hampton, C., and Boffa, J. (2018). ‘Child protection outcomes of the Australian Nurse Family Partnership Program for Aboriginal infants and their mothers in Central Australia’, PloS One, 13, e0208764.