Social Programs That Work

Nurse-Family Partnership

Updated: Jan 03, 2020
Evidence Rating:
Top Tier

Highlights

  • Program:

    A nurse home visitation program for first-time mothers – mostly low-income and unmarried – during their pregnancy and children’s infancy.

  • Evaluation Methods:

    Five well-conducted randomized controlled trials (RCTs), each carried out in a different population and setting (three in the United States, one in the Netherlands, and one in the United Kingdom).

  • Key Findings:

    Pattern of sizable, sustained effects on important child and maternal outcomes in four of the five studies. Effects replicated across two or more studies include: (i) reductions in child abuse/neglect and injuries (20-50%); (ii) reduction in mothers’ subsequent births (10-20%) during their late teens and early twenties; and (iii) improvement in cognitive/educational outcomes for children of mothers with low mental health/self-confidence/intelligence (e.g., 6 percentile point increase in grade 1-6 reading/math achievement).

The Nurse-Family Partnership (NFP) program provides nurse home visits to pregnant women with no previous live births, most of whom are (i) low-income, (ii) unmarried, and (iii) teenagers. The nurses visit the women one to two times per month during their pregnancy and the first two years of their children’s lives. The nurses teach (i) positive health related behaviors, (ii) competent care of children, and (iii) maternal personal development (family planning, educational achievement, and participation in the workforce). The program costs approximately $15,000 per woman over the three years of visits (in 2019 dollars).

Click here for Nurse-Family Partnership’s website.

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

Study 1 – (Elmira, NY):

Eckenrode, John, Mary Campa, Dennis Luckey, Charles Henderson Jr., Robert Cole, Harriet Kitzman, Elizabeth Anson, Kimberly Sidora-Arcoleo, Jane Powers, and David Olds. “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 Pediatric and Adolescent Medicine, vol. 164, no. 1, January 2010, pp. 9-15.

Zielinsky, David S., John Eckenrode, and David Olds. “Nurse Home Visitation and the Prevention of Child Maltreatment: Impact on the Timing of Official Reports.”  Development and Psychopathology, vol. 21, 2009, pp. 441-453.

Luckey, Dennis W., David L. Olds, Weiming Zhang, Charles Henderson, Michael Knudtson John Eckenrode, Harriet Kitzman, Robert Cole, and Lisa Pettitt. “Revised Analysis of 15-Year Outcomes in the Elmira Trial of the Nurse-Family Partnership.” Prevention Research Center for Family and Child Health, University of Colorado Department of Pediatrics, 2008.

Olds, David L., Charles R. Henderson Jr, Robert Cole, John Eckenrode, Harriet Kitzman, Dennis Luckey, Lisa Pettitt, Kimberly Sidora, Pamela Morris, and Jane Powers. “Long-term Effects of Nurse Home Visitation on Children’s Criminal and Antisocial Behavior: 15-Year Follow-up of a Randomized Controlled Trial.” Journal of the American Medical Association, vol. 280, no. 14, October 14, 1998, pp. 1238-1244.

Olds, David L., John Eckenrode, Charles R. Henderson Jr, Harriet Kitzman, Jane Powers, Robert Cole, Kimberly Sidora, Pamela Morris, Lisa M. Pettitt, and Dennis Luckey. “Long-term Effects of Home Visitation on Maternal Life Course and Child Abuse and Neglect: 15-Year Follow-up of a Randomized Trial.” Journal of the American Medical Association, vol. 278, no. 8, August 27, 1997, pp. 637-643.

Olds, David L., Charles R. Henderson, Jr., and Robert Tatelbaum. “Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy,” Pediatrics, vol. 93, no. 2, February 1994, pp. 228-233.

Olds, David L., Charles R. Henderson, Jr., and Harriet Kitzman. “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, vol. 93, no. 1, January 1994, pp. 89-98.

Olds, David L., Charles R. Henderson, Jr., Robert Tatelbaum, and Robert Chamberlin. “Improving the Life-Course Development of Socially Disadvantaged Mothers: A Randomized Trial of Nurse Home Visitation,” American Journal of Public Health, vol. 88, no. 11, 1988, pp. 1436-1444.

Olds, David L., Charles R. Henderson, Jr., Robert Chamberlin, and Robert Tatelbaum. “Preventing Child Abuse and Neglect: A Randomized Trial of Nurse Home Visitation,” Pediatrics, vol. 78, no. 1, July 1986, pp. 65-78.

Olds, David L., Charles R. Henderson, Jr., Robert Tatelbaum, and Robert Chamberlin. “Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation,” Pediatrics, vol. 77, no. 1, January 1986, pp. 16-27.

Study 2 – (Memphis, TN):

Kitzman, Harriet, et. al. “Prenatal and/or Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial. Pediatrics, vol. 144, no. 6, December 2019, e20183876.

Olds, David L., et. al. “Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial.” Pediatrics, vol. 144, no 6, December 2019, e20183889.

Kitzman, Harriet J., David L. Olds, Robert E. Cole, Carole A. Hanks, Elizabeth A. Anson, Kimberly J. Arcoleo, Dennis W. Luckey, Michael D. Knudtson, Charles R. Henderson Jr., and John R. Holmberg. “Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Children.” Archives of Pediatrics and Adolescent Medicine, vol. 164, no. 5, May 2010, pp. 412-418.

Olds, David L., Harriet J. Kitzman, Robert E. Cole, Carole A. Hanks, Kimberly J. Arcoleo, Elizabeth A. Anson, Dennis W. Luckey, Michael D. Knudtson, Charles R. Henderson Jr., Jessica Bondy, and Amanda J. Stevenson. “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, vol. 164, no. 5, May 2010, pp. 419-424.

Olds, David L., Harriet Kitzman, Carole Hanks, Robert Cole, Elizabeth Anson, Kimberly Sidora-Arcoleo, Dennis W. Luckey, Charles R. Henderson Jr, John Holmberg, Robin A. Tutt, Amanda J. Stevenson and Jessica Bondy. “Effects of Nurse Home Visiting on Maternal and Child Functioning: Age-9 Follow-up of a Randomized Trial.” Pediatrics, vol. 120, October 2007, pp. e832-e845.

Olds, David L., Harriet Kitzman, Robert Cole, JoAnn Robinson, Kimberly Sidora, Dennis W. Luckey, Charles R. Henderson Jr, Carole Hanks, Jessica Bondy and John Holmberg. “Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-Up Results of a Randomized Trial,” Pediatrics, vol. 114, no 6, December 2004, pp. 1550-1559.

Kitzman, Harriet, David L. Olds, Kimberly Sidora, Charles R. Henderson Jr, Carole Hanks, Robert Cole, Dennis W. Luckey, Jessica Bondy, Kimberly Cole, and Judith Glazner. “Enduring Effects of Nurse Home Visitation on Maternal Life Course.” Journal of the American Medical Association, vol. 283, no. 15, April 19, 2000, pp. 1983-1989.

Kitzman, Harriet, David L. Olds, Charles R. Henderson Jr, Carole Hanks, Robert Cole, Robert Tatelbaum, Ken M. McConnochie, Kimberly Sidora, Dennis W. Luckey, D Shaver, Kay Engelhardt, D James and K. Bernard. “Effect of Prenatal and Infancy Home Visitation by Nurses on Pregnancy Outcomes, Childhood Injuries, and Repeated Childbearing.” Journal of the American Medical Association, vol. 278, no. 8, August 27, 1997, pp. 644-652.

Study 3 – (Denver, CO):

Olds, David L., JoAnn Robinson, Lisa Pettitt, Dennis W. Luckey, John Holmberg, Rossanna K. Ng, Kathy Isacks, Karen Sheff and Charles R. Henderson Jr. “Effects of Home Visits by Paraprofessionals and by Nurses: Age 4 Follow-Up Results of a Randomized Trial.” Pediatrics, vol. 114, no. 6, December 2004, pp 1560-1568.

Olds, David L., JoAnn Robinson, Ruth O’brien, Dennis W. Luckey, Lisa M. Pettitt, Charles R. Henderson Jr, Rossanna K Ng, Karen L Sheff, Jon Korfmacher, Susan Hiatt, and Ayelet Talmi. “Home Visiting By Paraprofessionals and By Nurses: A Randomized, Controlled Trial.” Pediatrics, vol. 110, no. 3, September 2002, pp. 486-496.

Olds, David L., John R. Holmberg, Nancy Donelan-McCall, Dennis W. Luckey, Michael D. Knudtson, JoAnn Robinson. “Effects of Home Visits by Paraprofessionals and by Nurses on Children: Follow-up of a Randomized Trial at Ages 6 and 9 Years.” JAMA Pediatrics, in press, December 2, 2013.

Study 4 – (The Netherlands):

Jamila Mejdoubi, Silvia C. C. M. van den Heijkant, Frank J. M. van Leerdam, Martijn W. Heymans, Alfons Crijnen, and Remy A. Hirasing, “The Effect of VoorZorg, the Dutch Nurse-Family Partnership, on Child Maltreatment and Development: A Randomized Controlled Trial,” PLOS One, April 1, 2015.

Jamila Mejdoubi, Silvia van den Heijkant, Elle Struijf, Frank van Leerdam, Remy HiraSing, and Alfons Crijnen, “Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care,” BMC Public Health, 11: 823, 2011.

Study 5­ – (The United Kingdom):

Robling, Michael, et. al. (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.

Other Studies:

Nagle, Geoffrey A. and Neil W. Boris, “Nurse Home Visiting Impact on Prenatal Maternal Depression and Partner Violence: Preliminary Results,” Tulane University Health Sciences Center – Tulane School of Medicine, 2008.

Nguyen, Jody D., Michael L. Carson, Kathleen M. Parris, and Patricia Place. “A Comparison Pilot Study of Public Health Field Nursing Home Visitation Program Interventions for Pregnant Hispanic Adolescents.” Public Health Nursing, vol. 20, no. 5, September/October 2003, pp. 412-418.

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