Nurse-Family Partnership (NFP)®

Model Effectiveness
Evidence Based Model
MIECHV Eligible

302

Manuscripts

Released in 1979 through 2023

32

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
Prenatal
0-6 months
07-11 months
12-23 months
Favorable results from well-defined research
Child development and school readiness
Child health
Family economic self-sufficiency
Maternal health
Positive parenting practices
Reductions in child maltreatment
Reductions in juvenile delinquency, family violence, and crime

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The Nurse-Family Partnership (NFP) is designed for first-time, low-income mothers and their children. It includes one-on-one home visits by a trained public health nurse to participating clients.

Where to find out more

Effectiveness

This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

Nurse-Family Partnership (NFP)®

302

Manuscripts

Released in 1979 through 2023

53

Manuscripts

Eligible for review

32

Manuscripts

Impact studies rated high or moderate quality

NFP with Paraprofessional Home Visitors

5

Manuscripts

Released in 1979 through 2023

5

Manuscripts

Eligible for review

4

Manuscripts

Impact studies rated high or moderate quality

Note: When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Nurse-Family Partnership (NFP)®
Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child development and school readiness View 17 Manuscripts 39
(25) 		206
(58) 		2
Child health View 16 Manuscripts 5 58 5
Family economic self-sufficiency View 17 Manuscripts 12 152
(8) 		11
(2)
Linkages and referrals Not measured - - -
Maternal health View 16 Manuscripts 26 105 6
Positive parenting practices View 7 Manuscripts 8 32 0
Reductions in child maltreatment View 10 Manuscripts 7 24 0
Reductions in juvenile delinquency, family violence, and crime View 10 Manuscripts 15
(7) 		79
(14) 		0
NFP with Paraprofessional Home Visitors
Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child development and school readiness View 4 Manuscripts 4
(3) 		67
(32) 		0
Child health View 1 Manuscript 1 1 0
Family economic self-sufficiency View 2 Manuscripts 1 9 0
Linkages and referrals Not measured - - -
Maternal health View 2 Manuscripts 3 11 0
Positive parenting practices View 2 Manuscripts 1 3 0
Reductions in child maltreatment Not measured - - -
Reductions in juvenile delinquency, family violence, and crime View 1 Manuscript 0 2 0

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics:

Race/Ethnicity

Black or African American
51.38%
Hispanic or Latino
16.23%
White
24.54%
Some other race
0.23%
Two or more races
0.60%
Unknown
7.03%

Maternal Education

Less than a high school diploma
29.26%
High school diploma or GED
26.90%
Some college or Associate's degree
18.81%
Bachelor's degree or higher
4.14%
Unknown
20.89%

Well-designed impact studies about this model were conducted in the following locations:

  • South
  • Tennessee
  • West
  • Colorado
  • Northeast
  • New York
  • California
  • South Carolina
  • Massachusetts
  • New Jersey
  • Pennsylvania
  • Midwest
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Michigan
  • Wisconsin
  • Georgia
  • North Carolina
  • Nevada
  • Washington

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

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Support Availability

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Service Delivery

Model services, adaptions and enhancements, model intensity and length.

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Requirements

Staffing and organizational requirements.

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Overview

Theoretical approach

Nurse-Family Partnership® (NFP) is a home visiting model shaped by attachment theory, human ecology theory, and social-cognitive or self-efficacy theory. The model is client-centered and driven by goals the client identifies. NFP nurse home visitors (referred to as NFP nurses) combine input from parents, nursing experience, nursing practice, and model-specific resources with principles of motivational interviewing to serve first-time parents with low incomes. The model promotes the parent’s health during pregnancy, care of the child, and personal growth and development.

Intended population

NFP is designed for pregnant people with low incomes and their children and focuses on first-time parents. Clients may invite family members and/or friends to participate in home visits.

NFP requires clients to enroll in the program early in their pregnancy and to receive their first home visit no later than the end of the 28th week of pregnancy. Services are delivered until the child’s second birthday.

Targeted outcomes

NFP is designed to (1) improve prenatal and maternal health and birth outcomes, (2) improve child health and development, and (3) improve families’ economic self-sufficiency and maternal life course development.

Highlights

Populations Intended
Families with a history of child abuse or neglect, or interactions with child welfare services
Families with low-income
Families with pregnant people under age 21
Services intended at ages
Prenatal
0-6 months
07-11 months
12-23 months

Support Availability

Implementation support availability

NFP is supported by the National Service Office (NSO) for NFP and Child First, a national nonprofit organization based in Denver, Colorado. The NSO helps states and communities implement and sustain NFP.

NSO managers of nursing practice provide implementing agencies (referred to as network partners) and nursing supervisors with regular, ongoing coaching and consultation on model fidelity, organizational capacity and culture, nursing practice, nursing management, establishing and retaining caseloads, using data to improve practice, developing and maintaining community linkages, program sustainability, and participating in research.

In addition, the NSO provides technical support in 10 areas: 

  1. Orientation to the model and its implementation and evaluation requirements 
  2. Community planning 
  3. Selection of network partners or entities 
  4. Staff recruitment, retention, education, coaching, and consulting development 
  5. Implementing the model 
  6. Continuous quality improvement 
  7. Research 
  8. Evaluation 
  9. Contracts 
  10. Marketing and communication

Highlights

Locations where model has been implemented
Within the U.S.
Internationally, outside the U.S.

Service Delivery

Model services

The NFP model includes one-on-one home visits with a registered nurse educated in the NFP model. The NFP nurse visits the client in their permanent or temporary home, as defined by the client, or in a location of the client’s choice.

NFP nurses provide the intervention through the nursing process, clinical assessment, and individualized goal setting with the client. NFP nurses use visit-to-visit guidelines to support clients’ goals and meet each family’s needs.

Model intensity and length

NFP nurses partner with their clients to determine the content and frequency of visits. They assess clients at every visit using the NFP Strengths and Risks Framework. Visit frequency is flexible and the NFP nurses adapt content based on each client’s needs, strengths, risks, and preferences. Home visits typically last 60 to 75 minutes.

The NFP program begins as early as possible in pregnancy but not later than the end of the 28th week. Clients complete the program on their child’s second birthday.

Adaptations and enhancements

With input from tribal communities, NFP has modified its outreach materials for tribal communities to reflect tribal members. All tribal communities review the materials to assure cultural relevance, and the NSO will work with tribes to adapt the materials based on the needs of their communities. In addition, NFP nurses participate in a community of practice with an internal consultant with expertise working with tribal communities.

Model developer Dr. David Olds at the Prevention Research Center at the University of Colorado oversees adaptations to the model in collaboration with the NSO. Two adaptations are available. Network partners may request to (1) enroll clients after the 28th week of pregnancy or (2) serve clients who have had a previous live birth. Dr. Olds and the Prevention Research Center also manage requests for enhancements to the model.

Highlights

Language that the program is available in
Spanish
Other language
Maximum program duration
More than one year up to three years
Visit frequency
Visit frequency varies
Delivery Method Supported
Supports hybrid in-person and virtual service delivery

Requirements

Staffing requirements

Network partners must employ four types of staff: (1) NFP nurses who conduct home visits with families, (2) nursing supervisors who supervise the NFP nurses, (3) an administrative assistant who manages data entry and other administrative tasks, and (4) a site administrator who oversees implementation of the model and sustainability of the program.

The NSO requires that NFP nurses and nursing supervisors be registered professional nurses with a minimum of a bachelor’s degree in nursing. The NSO prefers that supervisors have a master’s degree in nursing.

Nursing supervisors provide NFP nurses with clinical and reflective supervision and facilitate professional development essential to the NFP nurse’s role. Supervisory activities include one-on-one clinical and reflective supervision, case conferences, team meetings, and field supervision. Clinical supervision involves discussing topics such as client care and how to translate the theories behind NFP into practice. During reflective supervision, the supervisor and NFP nurse discuss the NFP nurse’s work with clients, the impact of the work on the NFP nurse, and strategies to strengthen the NFP nurse’s relationships with their clients.

NSO managers of nursing practice meet with nurse supervisors regularly by teleconference, by videoconference, and in person. They support operational efficiency, clinical practice, quality improvement, and implementation fidelity by analyzing data, setting goals, and monitoring progress collaboratively.

The NSO requires NFP nurses and nursing supervisors complete three core education sessions, in virtual and in-person training formats. The sessions take place over about nine months. Nursing supervisors must also complete four introductory education sessions designed for supervisors, including two in-person sessions. Please contact the NSO for additional information about preservice training requirements.

Supervisors are provided with topical education modules to use during team meetings based on the training needs of their nursing teams. In addition, the NSO managers of nursing practice help supervisors create professional development plans for each NFP nurse and incorporate the expertise of other professionals in their communities to meet the unique learning needs of each team. Network partners and nurse supervisors also have access to reports of performance data to support quality improvement by making data analysis and program performance monitoring more accessible and user-friendly. Please contact the NSO for additional information about the ongoing professional development requirements.

Organizational requirements

The NSO does not specify the type of agency that can implement the model. However, it does require that network partners be organizations known in the community for providing prevention services to families with low incomes. All agencies that want to implement NFP must submit an implementation plan demonstrating that the organization is prepared to implement the model with fidelity.

The NSO requires network partners to adhere to 19 fidelity standards. Please contact the NSO for additional information about these standards.

Highlights

Minimum education requirement
Bachelor’s degree

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.