• 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. 
  

• 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

• 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 

• 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
  

Project Duration: August 2021-August 2024 Funder: Nurse-Family Partnership National Service Office

Principal Investigator: Venice Williams

Co-Investigators: Greg Tung, Mandy Allison, David Olds Team Members, University of Colorado: Michael Knudtson, Carol Franco-Rowe, Connie Lopez, Amanda Skenadore, Sandra Garcia-Hernandez, Jacob Thomas

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. 

• 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/
  

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 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 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.

• 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 WTG Foundation Reducing Inequalities Grant Program to develop and pilot an innovation to the NFP model to support NFP nurses to address the needs of families affected by substance use disorder.

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

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 

Memphis, TN 1987 is a replicated trial with large sample of primarily very low-income African American families in Memphis, Tennessee. 1138 registered during pregnancy and 742 followed by design postnatally. Effects of the trial include: postnatally, significant reduction in number of days hospitalized for injuries/accidental ingestions among children, especially those with mothers with the lowest psychological resources; increased rates of graduation with offers in nurse-visited sample for study children. 

• Related Publications: 
  
  • Kitzman H, Olds DL, Sidora K, et al. Enduring Effects of Nurse Home Visitation on Maternal Life Course: A 3-Year Follow-up of a Randomized Trial. JAMA. 2000;283(15):1983. doi:10.1001/jama.283.15.1983 
  • Olds DL, Kitzman H, Cole R, et al. Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-Up Results of a Randomized Trial. Pediatrics. 2004;114(6):1550-1559. doi:10.1542/peds.2004-0962 
  • Olds DL, Kitzman H, Hanks C, et al. Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial. Pediatrics. 2007;120(4):e832-e845. doi:10.1542/peds.2006-2111 
  • Kitzman HJ, Olds DL, Cole RE, et al. Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Children: Follow-up of a Randomized Trial Among Children at Age 12 Years. Arch Pediatr Adolesc Med. 2010;164(5). doi:10.1001/archpediatrics.2010.76 
    
  • Olds DL, Kitzman HJ, Cole RE, et al. 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. Arch Pediatr Adolesc Med. 2010;164(5). doi:10.1001/archpediatrics.2010.49 
    
  • Kitzman H, Olds DL, Knudtson MD, et al. Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial. Pediatrics. 2019;144(6):e20183876. doi:10.1542/peds.2018-3876 
    
  • Olds DL, Kitzman H, Anson E, et al. Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial. Pediatrics. 2019;144(6):e20183889. doi:10.1542/peds.2018-3889 
    
  • Conti G, Smith J, Anson E, et al. Early Home Visits and Health Outcomes in Low-Income Mothers and Offspring: 18-Year Follow-Up of a Randomized Clinical Trial. JAMA Network Open. 2024;7(1):e2351752. doi:10.1001/jamanetworkopen.2023.51752 
    
  • Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. 2014;168(9):800. doi:10.1001/jamapediatrics.2014.472 
    

   

Denver, CO 1994 is a replicated trial with largely low-income Latinx population (n=735) in Denver, Colorado, and focused on treatment effects between program delivery by a nurse versus paraprofessionals. Overall, nurses produced effects that were significantly better than their comparison group counterparts, results with paraprofessionals fell in between control and nurse-home visited group. 

• Related Publications: 
  • Olds DL, Robinson J, O’Brien R, Luckey LM et al. Home Visiting by Paraprofessionals and by Nurses: A Randomized, Controlled Trial. Pediatrics. 2002;110;486-496. DOI: 10.1542/peds.110.3.486 
    
  • Olds DL, Robinson J, Pettitt L, et al. Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics. 2004;114(6):1560-1568. doi:10.1542/peds.2004-0961   
  • Olds DL, Holmberg JR, Donelan-McCall N, Luckey DW, Knudtson MD, Robinson J. Effects of home visits by paraprofessionals and by nurses on children. JAMA Pediatrics. 2014;168(2):114-121. doi:10.1001/jamapediatrics.2013.3817

 

The P³ program was carefully developed to address critical public health issues for socially disadvantaged parents and their children. P³ is an innovative, group-based program grounded in the methods and curriculum of the Nurse Family Partnership (NFP), an evidence-based maternal child health program. P³ utilizes a psycho-educational group-based format to promote positive behavior change and enhance social support. P³ has a strong theoretical framework and employs rigorous testing to ensure effective approaches are utilized to decrease health disparities in the highest risk populations.  

Cross-sector collaboration is the alignment of service delivery and/or financing systems across sectors of public health, medical care and social services. Collaboration involves multiple systems, organizations, and service providers collectively focusing their expertise and resources on addressing complex community issues through shared goals.

In Nurse-Family Partnership (NFP), home visitors link families to needed health and social support services. Strengthening home visitors’ collaborative practices with community service providers across sectors may support building systems of care to more efficiently and effectively address issues of childhood poverty. Home visitors’ ability to address maternal and child health risks can be improved through better integrating approaches and systems across public health, medical care, and social services. This integration of services and systems would ensure that families receive needed services and continuity of care through implementation of wraparound approaches to service planning and delivery with family involvement and care coordination.

Our prior work has included mixed methods approaches to understand how collaboration and integration between NFP and other community services affect program implementation and family outcomes (See Systems for Action[AL1] ). Our next research project seeks to deepen our understanding of NFP collaboration with Part C Early Intervention (EI, a federally-funded program that promotes early identification and intervention for developmental delays among young children) to address health disparities among families facing adversities. Through a mixed methods approach, we will describe characteristics of families eligible for NFP, EI or both programs; measure collaboration between NFP and EI providers and its association with child and family outcomes; and identify factors that promote or hinder collaboration to address families’ needs.

Multiple Principal Investigators: Venice Williams and Beth McManus

Co-Investigators: Mandy Allison, Greg Tung, Meredith Matone, James Guevara

Team Members: Natalie Murphy

Project Duration: May 2020-April 2023 Funder: Robert Wood Johnson Foundation Systems for Action

Principal Investigator: Venice Williams

Co-Investigators: Greg Tung, Mandy Allison Team Members, University of Colorado: Michael Knudtson, Carol Franco-Rowe, Connie Lopez, Amanda Skenadore

Advisory Board: David Olds (NFP Founder), Chris Arestides (NFP National Service Office, Health Care Integration), Jade Woodard (Illuminate Colorado, Child Welfare)

The purpose of this research was to understand how collaboration and integration between Nurse-Family Partnership (NFP) and other community services affect family outcomes. 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.

Relevant Publications and Products: Williams et al. 2021 National survey of nurse home visitor collaboration with health care and social services 

Williams et al. 2023a Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program 

Williams et al. 2023b Changes in cross‐sector collaboration between nurse home visitors and community providers in the United States: A panel survey analysis 

Williams et al. 2024 Structural and relational factors for successful cross-sector collaboration in home visiting: a multiple case study

Best Practice Guide for Collaboration

Case Study 1. S4A Case Study Brief - Rural Health Dept Western FINAL

Case Study 2. S4A Case Study Brief - Urban Health System Mid-Atlantic FINAL

Case Study 3. S4A Case Study Brief - Urban Health System SouthCentral FINAL

Case Study 4.S4A Case Study Brief - Urban LHD Southeastern FINAL

Case Study 5. S4A Case Study Brief - CBO Northeastern FINAL

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