NFPx is a change to two of the Nurse Family Partnership (NFP) ‘model elements’ through the expansion of eligibility for NFP to individuals with previous live births (multiparous people or ‘multips’) and those who are referred to NFP after 28 weeks gestation but before the birth of the child (late registrants). Our team initially studied this expansion through a formative study that was conducted in partnership with 31 sites implementing NFP around the U.S. Based on what we learned from the formative study, the National Service Office for NFP and Child First developed additional education and support for sites serving multips and late registrants, and we designed three additional studies to evaluate NFPx. As part of this work we developed an NFPx Evaluation Guide that can be accessed here:  

• Our goal is to conduct analyses using health data obtained through electronic medical records (EMR) from existing Nurse-Family Partnership (NFP) partner sites to determine whether the NFP program effects seen in primiparous women also hold true for multiparous women. We hypothesize that program effects seen in primiparous women will also be observed in multiparous women.

• Our specific aims for this study are to estimate NFP effectiveness for key outcomes among multiparous women and to generate risk categories to determine enrollment, engagement, and retention in the NFP across different risk profiles. The findings of this study will have major implications for the Nurse-Family Partnership program and its potential expansion to serving multiparous women in the United States and elsewhere, in addition to implications for public policy, as did the original NFP trials for first-time mothers.

• Using propensity scoring matching, we matched risks and background between a control group from other multiparous families in the health system that did not enroll in NFP services versus multiparous families enrolled in the NFP.  This control group was compared with the NFP group using a variety of regression techniques depending on the outcome.  This will create a site-specific estimate that will then be aggregated together with other site-specific estimates using meta-analysis techniques. Outcome measures explored in this study include: 1) presence of pregnancy induced hypertension, 2) preterm delivery, 3) low birth weight, 4) NICU admission and length of stay, 5) use of recommended postpartum care visit 6) use of recommended child preventative care visits, 6) child emergency room visits and hospitalization for injuries.  

• PI: Greg Tung, Mandy Allison  

• Other staff: Venice Williams, Mike Knudtson, Carol Franco-Rowe, Bridget Mosley (ACCORDS), Jake Thomas (ACCORDS)  
  

• The purpose of this study is to:  1) describe characteristics of people referred to NFP after 28 weeks of pregnancy (i.e. ‘late’) reasons for late referral, rates of NFP enrollment for people referred late, and reasons for not enrolling; 2) determine how clients enrolled in NFP late may differ from those enrolled ‘on time’ (i.e. prior to 28 weeks of pregnancy); and 3) explore the use of existing state-level data to measure impact of NFP on multips and late registrants. First, we used data routinely collected by the NFP teams as part of NFP implementation; data from the prenatal risk screens, birth certificates, and centralized intake and referral; and interviews of NFP nurses and supervisors and NFP clients enrolled late to conduct a descriptive study.  Currently, we are using statistical tests to determine how those referred and enrolled late compare to those referred and enrolled on time.  Next, once enough multips and late registrants have received NFP in Florida, we will conduct analyses to measure impact of NFP on multips and late registrants.

• PI: Mandy Allison, Venice Williams  

• Other staff: Greg Tung, Mike Knudtson, Carol Franco-Rowe, Wendy Mazzuca, Connie Lopez, James Kaferly, and NSO partners 
  

• Our goals are to 1) determine the impact of NFP for multiparous people for pregnancy outcomes, 2) determine the impact of NFP on the index child (the child from the pregnancy when the client was enrolled in NFP) for health and development outcomes, and 3) provide preliminary data about the effect of home-visiting on siblings of the index child. We are recruiting multiparous pregnant people to participate in the study at the time of enrollment in NFP (NFP group) or when they are referred to other community resources, including other home-visiting programs, but NFP (comparison group).   Research assistants will collect data directly from all of the study participants and will not know which group (NFP or comparison) the participants belong to.  We will also use data from birth certificates.  We will use statistical methods to measure impact by comparing the NFP group to the comparison group.  

• PI: Mandy Allison

• Other staff: Greg Tung, Mike Knudtson, Wendy Mazzuca, Natalie Murphy 
  

• This study consists of a 29-year follow-up of participants (N=742) in a randomized clinical trial of the Nurse-Family Partnership (NFP), a program of prenatal and infant/toddler home-visiting by nurses for low-income women with no previous live births, focusing on emergent chronic disease in mothers and first-born offspring. Findings from earlier follow-ups have led to our general hypothesis that, over the life-course, the intervention will lead to reductions in the emergence of cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes (T2D), and premature mortality among both mothers and their first-born offspring. Our specific aims are: 
  • Aim 1: Estimate NV-C differences in markers of chronic disease and mortality. The NV group is hypothesized to have: H1: lower measures of obesity; H2: lower risks for macrovascular disease reflected in measures of functional arterial stiffness; H3: fewer markers of chronic kidney disease (CKD); H4: better metabolic outcomes; H5: lower levels of immune/inflammatory markers; and H6: lower mortality rates.
  • Aim 2: Examine modifiers of the intervention on outcomes in H1-5. H7: Given results through age 18, NV effects on H1-5 outcomes will be greater for mothers of females and female offspring.
  • Aim 3: Explore mediators of NV on selected outcomes: H8: NV effects on maternal outcomes will be mediated, in part, by earlier NV beneficial effects on prenatal health behaviors, PIH, preterm delivery in first and subsequent births, closely spaced subsequent pregnancies, maternal sense of mastery, stable family structure, family economic resources, and hypertension at 12 and 18 years postpartum.  H9: NV effects on offspring outcomes will be mediated, in part, by NV beneficial effects on prenatal health behaviors, PIH, preterm delivery, breastfeeding, qualities of parental care, lower screen-time, stable family structure, family economic resources, and obesity at ages 12 and 18. 

•  PI: David Olds

• Other staff: Mike Knudtson, Wendy Gehring, Anna Lindberg

• PUPPETalk (PUppets to Play, Praise, Educate, and Talk) is a simple, low-cost intervention that uses finger puppets to support positive, language-rich caregiver-infant interactions promoting early relational health. Findings from two pilot studies have been encouraging, suggesting that families receiving the puppet intervention as early as 2 months of age had better outcomes related to maternal postpartum depression, the cognitive home environment, and early language development during the first year of life as well as improved social-emotional developmental trajectories to age three years. While further research is underway to better understand its impact, PUPPETalk is currently being implemented in several community-based programs. 

• PI: Gretchen Domek

• Other staff: Mariarosa Gasbarro

• Contact: puppetalk@cuanschutz.edu

• Funded by the Robert Wood Johnson Foundation, the purpose of this research to understand how collaboration and integration between Nurse-Family Partnership (NFP) and other community services affects patient outcomes in the US. We had three primary aims in this study:  
  • Aim 1. Assess the degree of collaboration by NFP implementation site between NFP and cross-sector providers including healthcare systems and social services using a panel survey methodology. Collaboration is measured as relational coordination and structural integration between NFP and 10 provider types: women’s care, pediatrics, mental health, substance use treatment, Child Welfare, Special Supplemental Nutrition program for Women, Infants, Children (WIC), housing services, parenting programs, other home visiting programs, and early intervention. 
  • Aim 2. Estimate the effect of site-level collaboration on program outcomes. Using mixed models, we examined the relationships between collaboration measures (relational coordination and structural integration) with 10 provider types and program outcomes, including: 1) program implementation: client retention and referrals to services, 2) maternal behavior:  prenatal tobacco cessation, breastfeeding practices, educational attainment, employment status, use of services, and 3 ) infant health: low birthweight, preterm birth, up-to-date immunizations, and hospitalizations and injuries.  
  • Aim 3. Identify and disseminate best practices of successful collaboration with health systems and social services. We identified five highly collaborative NFP sites across the United States using a positive deviance approach and conducted in-depth qualitative case studies informed by key informant interviews with NFP staff, NFP clients, and community providers, as well as documents and site visit observations. Using learnings from the five case studies, we developed a best practice guide for collaboration with healthcare and social service providers.

   

• PI: Venice Williams

• Other staff: Mandy Allison, Greg Tung, Mike Knudtson, Carol Franco-Rowe, Connie Lopez, and NSO partners 
  

Understanding the mechanisms by which organizational context and community commitment affect client and nurse retention in the Nurse-Family Partnership (NFP) program, among other features of program implementation, is critical to defining how NFP is replicated over the next decade. Our goal is to understand how organizational context may affect client and nurse retention, an important indicator of program success and ultimately impact on maternal and child outcomes.

• This study has three primary aims: 
  
  • Aim 1: Examine variation in program implementation by organizational factors. Our team is examining variation in program implementation measures including client enrollment, engagement, and retention by different agency type classifications (e.g., programs implemented by healthcare, government, community-based organizations, education systems). We are also examining nurse retention based on agency type classification, agency culture, and organizational policies and practices.  
  • Aim 2: Identify potential mechanisms of action that explain effects of organizational factors on client and nurse retention:  Our team is conducting in-depth qualitative case studies of high and low performing local network partners to explore potential mechanisms of action that explain the variation on program implementation measures based on agency type. This approach helps us to understand the ‘WHY’ and ‘HOW’ between the effects, or lack of them. 
  • Aim 3: Data Collection for Quality Improvement and Program Implementation Evaluation: Based on the learnings from Aims 1 and 2, our team is collaborating with partners at the National Service Office to generate recommendations for forms changes required for quality improvement and process evaluation purposes as it relates to measuring organizational structures and community commitment. 

• PI: Venice Williams

• Other staff: David Olds, Mandy Allison, Greg Tung, Mike Knudtson, Carol Franco-Rowe, Connie Lopez, Sandra Garcia-Hernandez, Amanda Skenador, and NSO partners 
  

• The purpose of this study is to test the effectiveness of an augmentation of home-visiting to promote maternal and child cardiovascular health. This project involves 7 different clinical sites around the country, a coordinating center, and four home-visiting models (NFP, Parents as Teachers, Healthy Families America, and Family Check-Up. Here is a link to the main ENRICH website: https://www.hvenrich.org/

• PI:  Mandy Allison , Kate Sauder
  

• The Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE) was developed by the PRC to support health care professionals working with parents of young children to provide care that promotes healthy growth and development.  DANCE is a valid, reliable, strengths-based, and clinically useful assessment that is currently being used in prevention programs in the United States, England, Scotland, Northern Ireland, British Columbia, and Australia. Benefits of DANCE include: 
  • DANCE provides users with a strengths-based tool to objectively assess the interaction between a caregiver and child during a naturalistic observation such as a home or clinic visit.
  • Users apply the information from DANCE assessments to choose targeted activities, with guidance from the DANCE STEPS (Strategies to Enhance Parenting Skills), that address the unique strengths and challenges of each client.
  • DANCE creates a common language that enables health care professionals to effectively communicate their observations to their peers, supervisors, and other professionals working to support families.
• Staff: Nancy Donelan-McCall, Francesca Pinto, and Madonna Schafer. 
  

• Our team is interested in the ways that Nurse-Family Partnership (NFP) can best support pregnant and parenting people with a substance use disorder (SUD), including opioid use disorder (OUD). For the past five years, our team has worked on the following efforts: 
  • Characterizing the NFP client population affected by substance use, 
  • Identifying gaps in NFP data collection used to better characterize the NFP client population affected by substance use,
  • Learn about the specific needs of the clients experiencing SUD/OUD through qualitative inquiry, and 
  • Support NFP nurses serving SUD/OUD affected clients through additional training and education. 
  As part of our efforts to support this client population, we have submitted a grant proposal to the National Institute on Drug Abuse to develop, pilot, and test an innovation to the NFP model that augments current NFP nursing practice to address the needs of families affected by substance use. 

• PI: Venice Williams
• Co-investigators: Mandy Allison, Susan Jack
  

• Preventing child maltreatment is a public health and national priority due to the long-term consequences of maltreatment.  Evidence-based home visitation programs (HVP) are a central strategy to prevent child maltreatment in young children. HVP are uniquely positioned to study child welfare outcomes including, and distal to, verified maltreatment reports. Yet, few HVP evaluations include distal child welfare outcomes such as placement in and type of foster care and parental reunification.

• Nurse Family Partnership (NFP) clinical trials are among the strongest HVP evidentiary base available supporting maltreatment prevention.  Few studies have examined if NFPs’ protective effects against maltreatment persist with implementation from the research setting to community practice. Currently, limited data exists about the effect of NFP in community practice to prevent verified maltreatment or to promote family preservation. NFP strengthens safe, nurturing relationships for the dyad through higher co-parent engagement in childcare, healthy relationships with partners and family members and identification of alternate caregivers among friends and family. Yet, the impact of NFP in community practice on maltreatment prevention and family preservation is limited for two reasons. First, two prior evaluations of NFP in community practice and a follow up of an original NFP clinical trial found no significant program effects on protection from maltreatment or placement in foster care but both lacked corroborative child welfare data. Second, despite foundations of and evidence from NFP suggesting the model may promote family preservation, no studies have examined either kinship placement or parental reunification among nurse-served children who experience verified maltreatment and enter foster care

• A proposed research project, “Nurse Family Partnership through Community Practice: Impact on Child Welfare Outcomes”, seeks to address these gaps by evaluating the impact of NFP in community practice on child maltreatment and family preservation outcomes among children born in several states. We are pursuing data sharing agreements with States’ Departments of Health (DOH) and Child Welfare (DCW) for individual-level, administrative health and child welfare datasets. Through a mixed methods approach, we will compare state-specific and overall maltreatment, placement and reunification outcomes between children of NFP-served and matched comparison dyads using integrated data then conduct qualitative individual/focus group interviews to understand perspectives regarding family preservation qualities of NFP among child welfare providers involved in placement and permanency decisions.

• PI: James Kaferly

• Other staff: Natalie Murphy
  

• The NFP program is currently being implemented and evaluated in eight countries, including the United States. Each country has made some adaptations for the specific context and population being served whilst maintaining fidelity to the program model and each is at a different phase of program testing and expansion.

• PI: N/A

• Other staff: David Olds, Anna Lindberg, Gail Radford-Trotter, Deirdre Webb

• Link to international website: https://nfpinternational.org/