BACKGROUND: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials. OBJECTIVE: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension. METHODS: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them. RESULTS: We describe a framework used to address these issues and illustrate its use in improving nurses’ skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers’ care of their children, addressing parents’ mental health problems, classifying families’ risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation. CONCLUSIONS: The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP.

Two hundred and forty five women were identified in recruiting and enrolling 103 study participants involving 1,232 contact-attempts. Self-referral had the highest ratio of referrals to enrollees (55.6%), while this ratio was the lowest for community outreach (33.3%). Retention activities succeeded in maintaining over 90% of the sample. Ninety-two percent of English-speaking participants completed the study versus 79% of Spanish-speaking participants. The time expenditure per enrollee was 10.4 hours for recruitment and 1.2 hours for retention, with an estimated cost per enrollee of $324.03 for recruitment and $39.14 for retention. More retention activities were required to maintain women in the comparison group than in the intervention group.

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IntroductionAlthough safe and effective contraceptive methods are readily available, unintended pregnancy remains a serious public health problem, causing adverse health effects for thousands of women, children and families across the United States (Sheeder, Scott and Stevens-Simon, 2004, Stevens-Simon, Beach andKlerman, 2001). Unintended pregnancies account for about half of all births to U.S. women. An estimated 48% of women age 15-44 have at least one unplanned pregnancy sometime in their lives (Henshaw, 1998, Brown andEisenberg, 1995). Women who are younger, not married, poor and non-white have higher rates of unintended pregnancy (Henshaw, 1998).For sexually active individuals, unintended pregnancy is inextricably linked with contraceptive use and can be attributed to failure to use any contraceptive method, ineffective use of a method or method failure. The results of a recently conducted national survey revealed that over a year, approximately 40% of reproductive-aged women used no contraceptive method for at least one month and an average of 6 to 12 months. Less than 10% of the participants were pregnant or seeking pregnancy. Therefore, 30% of the participants were at risk for unintended conception during these hiatuses in contraceptive use . Three factors, difficulty obtaining contraceptive supplies and care, infrequent sexual intercourse and periodic abstinence, and ambivalence about the desirability of remaining non-pregnant accounted for 80% of the gaps in contraceptive use observed in the study . In addition, women at risk for unintended pregnancy who had less than a college education or were on Medicaid had higher likelihoods of experiencing gaps of at least one month in contraceptive use ).Correspondence to: Alan L. Melnick, MD, MPH, Dept. of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code: FM, Portland, OR 97239, Telephone: 503-494-0756, Fax: 503-494-2746, e-mail: melnicka@ohsu.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIncreasing effective contraceptive use could reduce the incidence of unintended pregnancies, and if provided after delivery, could reduce short-interval unintended pregnancy (Sable, Libbus and Chiu, 2000). Unfortunately, many women who are at high risk for unintended pregnancy and could receive services from publicly funded family planning programs may not be able to use them for several reasons. These include the cost of services, structural barriers such as childcare and transportation probl...

On December 31, 2018, Clark County Public Health (CCPH) in Washington was notified of a suspected case of measles in an unvaccinated child, aged 10 years, who had recently arrived from Ukraine. The patient was evaluated at an urgent care clinic for fever, cough, and a maculopapular rash. CCPH launched a case investigation, conducted contact tracing, and facilitated specimen collection and shipment to the Washington State Department of Health Public Health Laboratories. On January 3, 2019, measles virus was detected in the patient's urine and nasopharyngeal specimens by reverse transcription-polymerase chain reaction (RT-PCR). By January 16, among 12 patients with suspected measles reported to CCPH during January 11-14, all had laboratory-confirmed measles by RT-PCR. In response to these confirmed cases and additional suspected cases, CCPH's Incident Management Team was activated on January 15. Approximately 200 persons participated in the multiagency response, which included CCPH,