Principal Investigators: David Olds, Harriet Kitzman

The Nurse-Family Partnership (NFP) is based on over 37 years of rigorous research from randomized controlled trials conducted in the United States, the Netherlands, England, and British Columbia, Canada. There are three program goals: 1) to improve pregnancy outcomes; 2) to improve child health and development; and 3) to improve families’ economic self-sufficiency. This research shows that first-time mothers working with a NFP nurse can transform their lives and the lives of their children. NFP was developed and originally tested through three randomized control trials: Elmira, New York beginning in 1977, Memphis, Tennessee beginning in 1987, and Denver, Colorado beginning in 1994.

Trial of Nurse-Family Partnership in Elmira, NY

The Elmira study was a randomized control trial with 300 participants in Elmira New York, with mostly white, low-income, unmarried women, with an average age of 19. Pregnant women enrolled were randomly assigned to 1) a control group receiving developmental screening and referral for their child at ages 1 and 2, as well as transportation to prenatal appointments, and 2) an experimental group receiving the Nurse-Family Partnership intervention.

Trial of Nurse-Family Partnership in Memphis, TN

The Memphis study was a randomized control trial with 742 participants in Memphis, Tennessee, with mostly Black, low-income, unmarried women, with an average age of 18. Pregnant women enrolled were randomly assigned to 1) a control group receiving developmental screening and referral for their child at ages 1 and 2, as well as transportation to prenatal appointments, and 2) an experimental group receiving the Nurse-Family Partnership intervention.

Trial of Nurse-Family Partnership in Denver, CO

The Denver study was a randomized control trial with 490 participants in Denver, Colorado, with a majority of Mexican-American participants (46%, 36% White, and 15% Black), low-income, unmarried women, with an average age of 20. Pregnant women enrolled were randomly assigned to 1) a control group receiving developmental screening and referral for their child at ages 1 and 2, as well as transportation to prenatal appointments, and 2) an experimental group receiving the Nurse-Family Partnership intervention.

Learn more about all three trials and the evidence supporting NFP here: https://www.nursefamilypartnership.org/about/proven-results/.

• Despite NFP’s positive outcomes, attrition by Black mothers remains a concern. To understand factors that influenced client retention by Black mothers and to provide insights for program improvement, we conducted 21 semi-structured qualitative interviews with former Black NFP clients from four NFP sites in the US. Findings highlighted the importance of the nurse-client relationship, access to reliable health information, and racial concordance in the nurse-client relationship in retention of Black clients.

• PI: Mandy Allison, Brooke Dorsey-Holliman 
  

Project Duration: July 2013-June 2015

Funder: Colorado Department of Human Service “Keeping Kids Safe and Families Healthy 2.0”

Principal Investigator: David Olds

Team Members Invest in Kids: Christina Ostrom NFP National Service Office: Jen McDonald, Georgette McMichael, Cheryl Williams, Joan Barrett, Joan Loch, Carolyn Johnston, Sharon Sprinkle, Julie Jagim and Jeanne Anderson University of Colorado: David Olds, Greg Tung, Venice Ng, Roman Ayele, Mason Hohstadt, Suzuho Shamasaki, and Elly Yost, Erin Wright, Sarah Carlson

This project aimed to accomplish three goals: 1) to deepen collaboration between local teams of NFP nurses and child welfare workers; 2) to increase NFP nurses’ skills in preventing and reducing harm associated with child maltreatment; and 3) to increase enrollment in NFP in Colorado.

This project was motivated by the Colorado Department of Human Service’s (CDHS) commitment to building and/or enhancing relationships between prevention programs like NFP and child welfare. As CDHS and local counties adopted a family engagement model, it was important to connect with and utilize partners to support families. This grant supported the development of important education for NFP nurses in Colorado including the Strengths and Risks Framework and the NFP Intimate Partner Violence Intervention. We hosted 16 local gatherings to bring together child welfare caseworkers and nurses in 26 counties to facilitate increased collaboration to support families. Nurses learned more about child welfare, the implementation of differential response, and how to identify signs of abuse versus risks as well as how to make a thorough report. Caseworkers learned about the length and type of services delivered by NFP as well as how and who to refer.

We also conducted a multiple case study to assess the level of organizational collaboration NFP and Child Protective Services (CPS) in Colorado, as well as facilitators and barriers to effective collaboration between these agencies. The multiple case study was primarily informed by key informant interviews with NFP nurses and nurse supervisors; CPS caseworkers, supervisors, and senior-level workers; and other community partners familiar with NFP or CPS and/or involved in child maltreatment prevention. The findings indicated that organizational collaboration between NFP and CPS varied tremendously within and among sites and the majority of NFP and CPS staff perceived a need to strengthen local organizational collaboration. Organizational collaboration has led to successes in effectively serving high-risk clients.

The multiple case study influenced the development of the first and second years of education, helped guide and refine the regional meetings, and were the basis for policy and programmatic recommendations to CDHS and the NFP National Service Office to facilitate stronger organizational collaboration between NFP and CPS.

Relevant Publications and Products:

Characteristics of effective collaboration: A study of Nurse-Family Partnership and child welfare -https://www.sciencedirect.com/science/article/pii/S0145213419302054

Risk assessment practices among home visiting nurses and child protection caseworkers in Colorado, United States: A qualitative investigation - https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12773

Multiple Case Study executive summary 

Full Multiple Case Study

Recommendations report

Model of Collaboration fact sheet

As part of a multi-disciplinary and international team, led by Dr. David Olds, Dr. Harriet MacMillan and Dr. Jeffrey Coben, Dr. Susan Jack led the formative development of a nursing intervention to guide nurse home visitors in their practice of asking about and responding to intimate partner violence among their clients enrolled in Nurse-Family Partnership. This nursing intervention consists of five components: 1) a comprehensive program of nurse education; 2) guidelines for reflective supervision; 3) a checklist to support NFP sites to implement the intervention, 4) implementation coaching; and a clinical pathway to guide decision making across the nursing process, with accompanying client facilitators and nurse instructions. This intervention was evaluated through a cluster, randomized controlled trial in the US, which included an embedded process evaluation. The intervention was subsequently adapted, informed by “lessons learned” from the US, and integrated into the Canadian NFP program, and evaluated as part of the British Columbia Healthy Connections Project. Principles and components of this intervention have also been shared, adapted and piloted with other international NFP teams.

PI: Susan Jack 

Publications:

Scribano, P.V., Stevens, J., Kaizar, E. et al. The Effects of Intimate Partner Violence Before, During, and After Pregnancy in Nurse Visited First Time Mothers. Matern Child Health J 17, 307–318 (2013). https://doi.org/10.1007/s10995-012-0986-y

Jack, S.M., Ford-Gilboe, M., Wathen, C.N. et al. Development of a nurse home visitation intervention for intimate partner violence. BMC Health Serv Res 12, 1952 (2012). https://doi.org/10.1186/1472-6963-12-50

Jack, S.M., Ford-Gilboe M., Davidov D., MacMillan H.L. Identification and assessment of intimate partner violence in nurse home visitation. Journal of Clinical Nursing 26, 15-16 (2017). https://doi.org/10.1111/jocn.13392

Davidov, D. M., Nadorff, M. R., Jack, S. M., & Coben, J. H. (2012). Nurse Home Visitors’ Perceptions of Mandatory Reporting of Intimate Partner Violence to Law Enforcement Agencies. Journal of Interpersonal Violence, 27(12), 2484-2502. https://doi.org/10.1177/0886260511433511

Davidov, D. M., Jack, S.M. Nurse home visitors' perceived awareness of mandatory reporting requirements: pregnant women's and children's exposure to intimate partner violence. Journal of Advanced Nursing, 70(8), 1770-1779 https://doi.org/10.1111/jan.12334

Jack SM, Boyle M, McKee C, et al. Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial. JAMA. 2019;321(16):1576–1585. doi:10.1001/jama.2019.3211

Jack, S.M., Davidov, D. M., Stone, C. et al. Factors influencing the implementation of an intimate partner violence intervention in nurse home visiting: A qualitative descriptive study. Journal of Advanced Nursing, 79(4) 1367-1384 (2023). https://doi.org/10.1111/jan.15353

Jack, S.M., Kimber M., Davidov D. et al. Nurse-Family Partnership nurses’ attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation. Journal of Advanced Nursing, 77(9) 3894-3910 (2021). https://doi.org/10.1111/jan.14979

The NFP Mental Health Intervention (MHI) is a multi-component enhancement to NFP practice created under the leadership of Dr. Linda Beeber to respond to nurses’ requests for additional support to address client depression and anxiety. The MHI consists of augmented nursing education and clinical resources and was implemented into standard NFP practice and education using: 1) web-based, asynchronous education modules (focused on: identifying risk factors, assessment and recognition of depression and anxiety, intervention planning using evidence-based strategies, crisis management, and mental health promotion); 2) clinical resources (client-centered program materials to help assess and manage symptoms, develop care plans, and refer for mental health services); and 3) team-meeting integration modules (resources to facilitate reflective team discussion of web-based modules to deepen learning and clinical integration). In addition to the MHI modules and clinical resources, expert mental health consultation was offered to teams randomized to participate in multi-team consultation calls. Evaluation of MHI implementation to examine the impact of MHI on NFP client and nurse outcomes took place from January 2018-February 2020, and found that clients without elevated mental health screening scores or diagnoses at program enrollment showed a significant decrease in depressive symptoms, while clients who enrolled with and without significant mental health needs displayed decreased anxiety severity and increased referral to mental health services. This evaluation also observed increased: enrollment of clients with existing mental health needs, completion of well-child visits, and use of infant safe sleep practices among teams participating in mental health consultation calls. Although the MHI evaluation period was cut short due to COVID-19, the observed findings suggest the benefit and potential in integrating mental health care as part of NFP to reach populations in need and lower barriers and stigma associated with mental health care.