Improving the Nurse–Family Partnership in Community Practice

Abstract

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.

Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996–2013, USA

“…Unlike many operational programs, NFP replication is highly regimented and closely monitored (NFP National Service Office, 2011; Olds et al, 2013; Olds et al, 2002). Use of the NFP model and name is limited to implementing agencies that contract with the NSO, participate in centralized training and extensive reporting (including longitudinal data by client), pay fees to the NSO to administer the data system and monitor quality, and comply with 18 quality elements including standards governing maximum case loads of nurses and supervisors, time spent on NFP’s six domains, and nurse qualifications.…”

Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up

“…Program developers and managers have performed quasi-experimental and randomized controlled studies aimed at optimizing dosage (Olds et al, 2013). Those studies led to recent program changes that increased nurse-family collaboration in deciding on visit frequency, content, and location, which the studies suggested will reduce attrition and improve outcomes (Olds et al, 2013).…”

“…Those studies led to recent program changes that increased nurse-family collaboration in deciding on visit frequency, content, and location, which the studies suggested will reduce attrition and improve outcomes (Olds et al, 2013). In reducing attrition, however, they may raise costs per client.…”

Results of the First Steps study: a randomised controlled trial and economic evaluation of the Group Family Nurse Partnership (gFNP) programme compared with usual care in improving outcomes for high-risk mothers and their children and preventing abuse

“…The gFNP programme is a complex intervention made up of many components that have been designed, through education, nurse contact and peer support, to change parent behaviour. 64,65 According to Medical Research Council (MRC) guidelines, 64,65 and in line with a framework proposed for developing and evaluating NFP innovations, 66 the stages for effectively evaluating and implementing complex interventions are (1) programme development; (2) piloting for feasibility; (3) evaluation of clinical effectiveness and cost-effectiveness, ideally with a RCT; and (4) translation into mainstream practice.…”