A home visitation program by registered nurses to first-time, low-income mothers, beginning during pregnancy and continuing through to the child’s second birthday.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
The Nurse-Family Partnerships (NFP) program provides home visits by specially trained registered nurses to first-time, low-income mothers, beginning during pregnancy and continuing through to the child’s second birthday. Throughout the partnership, the nurse provides new mothers with the confidence and tools they need to assure a healthy start for their babies and plan a life of stability and opportunities for success for both the mother and child. The goal of NFP is to improve pregnancy outcomes by helping women engage in good preventive health practices to improve child health and development and the economic self-sufficiency of the family to plan future pregnancies, continuing education and employment.
Aims
- Improve pregnancy outcomes by promoting health-related behaviours
- Improve prenatal care
- Improve child health, safety and development
- Promote competent caregiving
- Promote pregnancy planning, educational achievement and employment
- Enhance parent life-course development
- Enhance families’ material support
- Promote links to needed health and social services
- Promote supportive relationships between family and friends.
Impact
Evidence suggests that NFP was effective for improving parent/caregiver's wellbeing but evidence for other outcomes was mixed. There was no effect found for improving welfare in terms of parents' self-reported help with child care. A negative effect was found for use of health services.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Yes | Yes |
| System | Health service use | Not found | Not found | Yes |
| System | Justice system | Yes | Yes | Yes |
| System | Welfare/poverty | Not found | Yes | Not found |
| Child | Education | Yes | Yes | Yes |
| Child | Mental health/behaviour | Yes | Yes | Yes |
| Child | Reproductive outcomes | Yes | Yes | Yes |
| Child | Substance abuse | Yes | Yes | Yes |
| Child | Wellbeing | Yes | Yes | Not found |
| Family | Employment | Yes | Yes | Yes |
| Family | Functioning | Yes | Yes | Yes |
| Family | Welfare/poverty | Yes | Yes | Not found |
| Parent/caregiver | Education | Yes | Yes | Not found |
| Parent/caregiver | Mental health/functioning | Yes | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Yes | Not found |
| Parent/caregiver | Reproductive outcomes | Yes | Yes | Not found |
| Parent/caregiver | Substance abuse | Yes | Yes | Yes |
| Parent/caregiver | Wellbeing | Yes | Not found | Not found |
| Cost | Cost effectiveness | Yes | Yes | Yes |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
NFP has an evidence rating of Well-Supported+.
This means that NFP has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 25 research outputs from 6 primary studies - 5 RCTs and one QE. NFP has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 24 |
| Quasi-experiment | 1 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of the evidence from the included studies. When interpreting the results, it is important to take into consideration the broad evidence base of 6 primary RCTs supporting this evidence.
The studies were conducted internationally and do not include Aboriginal children and families. NFP is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The studies were conducted in the United States, United Kingdom and Netherlands.
Sample
- Participants were women who were less than 25 weeks pregnant, unmarried and from low socio-economic backgrounds.
- The studies included participants identifying as African-American and White.
Implementation
Delivery model, mode and setting
- NFP is delivered in-person, and is typically conducted in the birth family home or at community-based agency or provider organisations. Visits are scheduled as per the program’s guidelines and client’s needs.
Target cohort
- Low-income, first-time mothers and parents/caregivers of children aged up to 5
- Children aged up to 5.
Program delivery
- Registered nurses provide intensive prenatal and postnatal home visitation to low-income, first-time mothers.
- 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
- Nurse supervisors conduct joint home visits with each nurse 3 times per year. Nurses begin 60- to 90-minute visits with pregnant mothers at about 16 weeks gestation.
- Nurses carry manageable caseloads, defined as no more than 25 families.
- Nurses use their professional nursing judgment to increase or decrease the frequency and length of visits based on the client's needs.
- The program is voluntary.
Duration and intensity
- Registered nurses visit weekly for the first month after enrolment and then fortnightly until the baby is born.
- After the baby is born, visits are conducted weekly for the first 6 weeks and then fortnightly through to the child's first birthday. Visits continue on a fortnightly basis until the baby is 20 months old. The last 4 visits occur monthly until the child is 2 years old.
- The duration of the whole program is 30 months.
Manuals and guides
- There is a manual and pre-implementation materials to deliver NFP.
- There are fidelity measures and program monitoring to ensure NFP Implementing Agencies deliver the program with fidelity and adherence to the NFP Model Elements.
- 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, Efforts to Outcomes (ETO).
- NFP NSO reports data to agencies to assess and guide program implementation. Agencies use these reports to monitor fidelity to the NFP model.
Additional information
- The Nurse-Family Partnerships website has more information about the program and the model elements.
- The Australian Nurse Family Partnerships program website provides more information about the program’s provision in Australia.
Staffing
- Nurse home visitors are registered nurses with a bachelor's degree in nursing as a minimum qualification.
- Nurse supervisors should have a bachelor's degree in nursing as a minimum qualification. A master's degree in nursing preferred.
- The recommended staffing is one FTE Nurse Supervisor per 4 FTE nurse home visitors and 0.5 FTE clerical/data entry support for each nurse team of 4 serving 100 families.
Training
- Nurse home visitors and supervisors need to complete all NFP core education which includes:
- Unit 1: 40 hours of orientation self-study.
- Unit 2: 25 hours over 3.75 days in Denver of face-to-face education and experiential practice.
- Unit 3: Approximately 10 hours of additional distance education and a series of team-based, supervisor-led, topical professional development modules. Orientation self-study includes distance-learning strategies.
- Supervisors are required to undergo additional training days and ongoing consultation with a nurse consultant.
- Clinical supervision includes:
- One to one weekly clinical supervision for each nurse with the nurse supervisor
- Case conferences at least twice per month.
To our knowledge, NFP is available in Australia.
NFP was adapted for use in Australia in 2008 to empower and inform first time Indigenous mothers or mothers whose partner was Aboriginal or Torres Strait Islander to support them to reach their personal goals and grow strong, healthy families. Implementation began in 2009 and has sine been operating in 4 states and 2 territories across Australia, including Queensland, New South Wales, Australian Capital Territory, Victoria, South Australia and Northern Territory.
The Australian Nurse-Family Partnership Program (ANFPP) is funded by the Australian government as part of the Closing the Gap Strategy and managed by the Commonwealth Department of Health.
Cost
We were unable to locate any information on the cost of NFP.
References
Studies identified and included in the review
- Eckenrode J, Ganzel B, Henderson CR Jr, Smith E, Olds DL, Powers J, Cole R, Kitzman H & Sidora K (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. Journal of the American Medical Association, 284(11):1385-1391.
- Eckenrode J, Campa M, Luckey DW, Henderson Jr CR, Cole R, Kitzman H, Anson E, Sidora-Arcoleo K, Powers J & 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(1):9-15.
- Euser S, Alink LR, Stoltenborgh M, Bakermans-Kranenburg MJ and van IJzendoorn MH (2015). A gloomy picture: A meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health, 15: 1068.
- Geeraert L, Van den Noortgate W, Grietens H & Onghena P (2004). The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: A meta-analysis. Child Maltreatment, 9(3):277‑291.
- Kitzman H, Olds DL, Henderson CR Jr, Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, 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. Journal of the American Medical Association, 278(8):644-652.
- Kitzman HJ, Olds DL, Cole RE, Hanks CA, Anson EA, Arcoleo KJ, Luckey DW, Knudtson MD, Henderson CR, Holmberg JR (2010). Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years. Archives of pediatrics & adolescent medicine. 164(5):412-8.
- Mejdoubi J, Van Den Heijkant SCCM, Van Leerdam FJM, Heymans MW, Crijnen A & Hirasing RA (2015). The effect of VoorZorg, the Dutch Nurse-Family Partnership, on child maltreatment and development: A randomized controlled trial. PLoS ONE, 10(4):e0120182.
- Olds DL, Henderson CR Jr, Chamberlin R & Tatelbaum R (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78(1):65-78.
- Olds DL, Henderson Jr CR, Tatelbaum R & Chamberlin R (1988). Improving the life-course development of socially disadvantaged mothers: A randomized trial of nurse home visitation. American Journal of Public Health, 78(11):1436‑1445.
- Olds DL, Henderson CR Jr, Phelps C, Kitzman H & Hanks C (1993). Effect of prenatal and infancy nurse home visitation on government spending. Medical Care, 31(2):155-174.
- Olds DL, Henderson Jr CR & 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(1):89-98.
- Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM & 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.
- Olds DL, Henderson CR Jr., Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L. Sidora K, Morris P and 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. Jama, 280(14), pp.1238-1244.
- Olds DL, Kitzman H, Cole R, Robinson J, Sidora K, Luckey DW, Henderson CR, Hanks C, Bondy J & Holmberg J (2004a). 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.
- Olds DL, Kitzman H, Hanks C, Cole R, Anson E, Sidora-Arcoleo K, Luckey DW, Henderson Jr CR, Holmberg J, Tutt RA, Stevenson AJ & Bondy J (2007). Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics, 120(4):e832-e845.
- Olds DL, Kitzman HJ, Cole RE, Hanks CA, Arcoleo KJ, Anson EA, Luckey DW, Knudtson MD, Henderson Jr CR, Bondy J & Stevenson AJ (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics and Adolescent Medicine, 164(5):419-424.
- Robling M, Bekkers MJ, Bell K, Butler CC, Cannings-John R, Channon S, Martin BC, Gregory JW, Hood K, Kemp A, Kenkre J, Montgomery AA, Moody G, Owen-Jones E, Pickett K, Richardson G, Roberts ZES, Ronaldson S, Sanders J, Stamuli E & Torgerson D (2016). Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): A pragmatic randomised controlled trial. The Lancet, 387(10014):146-155.
- Rubin DM, O'Reilly ALR, Luan X, Dai D, Localio AR & Christian CW (2011). Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program. Archives of Pediatrics and Adolescent Medicine, 165(3):198-204.
- Sidora-Arcoleo K, Anson E, Lorber M, Cole R, Olds D & Kitzman H (2010). Differential effects of a nurse home-visiting intervention on physically aggressive behavior in children. Journal of Pediatric Nursing, 25:35-45.
- Zielinski DS, Eckenrode J & Olds DL (2009). Nurse home visitation and the prevention of child maltreatment: impact on the timing of official reports. Development & Psychopathology, 21(2):441-453.
Studies identified but not counted towards the evidence rating due to study quality
- Kitzman H, Olds DL, Knudtson MD, Cole R, Anson E, Smith JA, Fishbein D, DiClemente R, Wingood G, Caliendo AM, Hopfer C, Miller T & Conti G (2019). Prenatal and infancy nurse home visiting and 18-year outcomes of a randomized trial. Pediatrics, 144(6):e20183876.
- Mejdoubi J, van den Heijkant SCCM, van Leerdam FJM, Heymans MW, Hirasing RA & Crijnen AAM (2013). Effect of nurse home visits vs usual care on reducing intimate partner violence in young high-risk pregnant women: A randomized controlled trial. PLoS ONE, 8(10):e78185.
- Mejdoubi J, van den Heijkant SC, van Leerdam FJ, Crone M, Crijnen A & HiraSing RA (2014). Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: A randomized controlled trial. Midwifery, 30(6):688-695.
- Olds DL, Robinson J, O’Brien R, Luckey DW, Pettitt LM, Henderson CR, Ng RK, Sheff KL, Korfmacher J, Hiatt S, Talmi A. (2002).Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics, 110: 486-496.
- Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K & Henderson CR (2004b). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114:1560‑1568.
- Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA & 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. Journal of the American Medical Association Pediatrics, 168(9):800-806.
- Olds DL, Kitzman H, Anson E, Smith JA, Knudtson MD, Miller T, Cole R, Hopfer C & Conti G (2019). Prenatal and infancy nurse home visiting effects on mothers: 18-year follow-up of a randomized trial. Pediatrics, 144(6): e20183889.