Nurse-Family Partnership (NFP)^®

Nurse-Family Partnership (NFP) is designed for pregnant people with low-incomes and their children and focuses on first-time parents. Participating clients receive one-on-one home visits from a registered professional nurse. The visits begin early in the client’s pregnancy (with program enrollment no later than the 28th week of pregnancy) and conclude when the client’s child turns 2 years old. NFP is designed to improve (1) prenatal and maternal health and birth outcomes, (2) child health and development, and (3) families’ economic self-sufficiency and maternal life course development. 

This report also includes a review of an alternate implementation of NFP in which paraprofessionals, rather than nurses, conducted the home visits. The paraprofessionals received the same length of training as the nurses and carried the same caseloads but had a higher ratio of supervisors to home visitors.

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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.

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

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.

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.

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.

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.

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.

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.

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.

Nurse-Family Partnership
National Service Office
1900 Grant Street, Suite 400
Denver, CO 80203

Phone: (866) 864-5226
Email: info@nursefamilypartnership.org
Website: http://www.nursefamilypartnership.org