Nurse-Family Partnership

About the Program

The Nurse-Family Partnership (NFP) is a program of home visiting for first-time mothers. The program was designed to address risk factors for child maltreatment. The goals of the program are to improve pregnancy outcomes, to promote children’s health and development, and to strengthen families’ economic self-sufficiency.

During home visits, 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). 

See also Nurse-Family Partnership Program Summary in the Preventing Child Maltreatment Evidence Review.

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. Eckenrode et al. (2017, 2000) and Olds et al. (1994) report on the original RCT with a final sample of 324 mothers and their infants. Of these mothers, 61% were from low socioeconomic backgrounds, 47% were under 19 years old at registration, 11% were African American, and 62% were unmarried. Olds et al. (1999) reports on this RCT, and an additional RCT with two study groups, with final samples of 324 and 671 mothers and their infants, where 92% of mothers were African American, 85% had incomes at or below the poverty line, and 98% were unmarried.

The program has been adapted for Aboriginal communities in Central Australia. The adapted program, termed Australian Nurse-Family Partnership, has been evaluated (Segal et al. 2018). 

What outcomes does it contribute to?

Positive outcomes:

Hazards in the home, Child visits to hospital ER, and Child injuries and ingestion: Olds et al. (1994, 1999) found a positive effect on child safety as measured by hazards observed in the home, and child injury in hospital records. Children in the intervention group had fewer health care encounters in which injuries and ingestions were detected than did children in the comparison group (0.43 versus 0.56, p = .05) (Olds et al. 1999)

Child abuse and neglect: The NFP program had a positive effect on abuse and neglect perpetrated by mothers. Although one study found that there was no significant difference in allegations of child abuse and neglect made to child welfare (Olds et al. 1994), a later study found that there were significantly fewer child maltreatment reports involving the mother as perpetrator for families receiving home visitations during pregnancy and infancy than for the control group (Olds et al. 1999). This effect was observed up to 15 years later (Eckenrode et. al. 2017, 2000).

No effect:

Domestic violence: A follow-up study of the Olds et al. (1994) sample 15 years later found no significant effect of the NFP program on levels of domestic violence (Eckenrode et al. 2000).

Negative outcomes:

Harsh punishment/discipline: Olds et al. (1994) reports that at the 46-month assessment, mothers who participated in the NFP program were more involved with and observed to punish their children more severely than mothers in the control group. This effect was particularly strong for low income, older, unmarried women who joined the workforce more rapidly. This negative outcome was not necessarily associated with adverse effects. Among families in the control group, higher levels of punishment were associated with more injuries and ingestions, but among families in the intervention group, higher levels of punishment were associated with fewer injuries and ingestions. Olds (1994) states that the effects should be interpreted in the context of the program influence on the life course development of at-risk women. Intervention group mothers were more likely to participate in the work force and to delay subsequent pregnancies than control group mothers, and it is reasonable that they would expect at least comparable levels of eventual participation in the work force by their children. It is suggested that the higher rates of involvement and punishment and improved safety of nurse-visited households are reflections of the intervention group mothers’ greater belief that their children must be disciplined and protected for them to succeed in school, work, and mainstream society. For these reasons, the review has treated this client outcome as inconclusive and excluded it from the program rating.

Is the program effective?

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

How strong is the evidence?

Supported research evidence:

• At least two high-quality RCT/QED 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?

Weekly visits begin while the mother is pregnant and continue once every week during pregnancy and until the baby is 6 weeks old, then less frequently until the child is two years old. Visits are made by a qualified nurse. Sometimes mothers are offered transport to prenatal check-ups and child health and development check-ups at health clinics. 

How much does it cost?

Information not available.

What else should I consider?

There is a large, long-term body of evidence demonstrating positive effects of the Nurse-Family Partnership program on prenatal health behaviours, parental care of the child, child abuse and neglect, child health and development, maternal life-course, and criminal involvement of the mothers and children. The program has been shown to work best and have the largest impact for low income and higher risk groups.

The program has also been adapted for Aboriginal families in Central Australia as the Australian Nurse-Family Partnership Program.

Where does the evidence come from?

• One RCT conducted in the USA with a final sample of 324 mothers and their infants (Olds et al. 1994)
• One RCT conducted in the USA with 2 study groups, comprised of 324 and 671 mother and infant dyads (Olds et al. 1999)
• One RCT conducted in the USA with a final sample of 400 mothers and their infants (Eckenrode et al. 2017, Eckenrode et al. 2000)

Further resources

• https://www.nursefamilypartnership.org
• Eckenrode, J., et al. (2017). “The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study.” Child maltreatment 22(2): 92-99.
• Eckenrode, J., et al. (2000). “Preventing child abuse and neglect with a program of nurse home visitation: the limiting effects of domestic violence.” JAMA: Journal of the American Medical Association 284(11): 1385-1391.
• Olds, D. L., et al. (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, D. L., et al. (1999). “Prenatal and infancy home visitation by nurses: recent findings.” Future of Children 9(1): 44-65.