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Nurse–Family Partnership

Ages 0-99

Rating: Level 1


Nurse–Family Partnership (NFP) provides first-time, low-income mothers of any age with home visitation services from public health nurses. NFP nurses work intensively with these mothers to improve maternal, prenatal, early childhood health, and well-being with the expectation that this intervention will help achieve long-term improvements in the lives of at-risk families. The intervention process is effective because it concentrates on developing therapeutic relationships with the family and is designed to improve five broad domains of family functioning:

  • Parental roles
  • Family and friend support
  • Health (physical and mental)
  • Home and neighborhood environment
  • Major life events (e.g., pregnancy planning, education, employment)

Beginning with expectant mothers, the program addresses substance abuse and other behaviors that contribute to family poverty, subsequent pregnancies, poor maternal and infant outcomes, suboptimal childcare, and a lack of opportunities for the children. Although the primary client is the first-time mother, ultimately her baby and all the members of her support system (e.g., friends, parents, boyfriend, child’s father) get involved in the program.


A major evaluation of NFP was conducted through three large scientifically controlled studies (Elmira, N.Y.; Memphis, Tenn.; Denver, Colo.). Researchers evaluated an efficacy trial of the NFP in Elmira, recruiting first-time pregnant women who were either under 19, single, or of low socioeconomic status. Using a pretest–posttest experimental design, researchers randomly assigned 100 women to have a nurse visit them at home throughout their pregnancy. Another 116 women had a nurse visit them from pregnancy until the child turned 2. And 184 were assigned to receive less formal services such as free transportation for prenatal and well-child care visits until the child turned 2. The families were followed for 15 years.

A replication trial in Memphis also used an experimental design wherein the researchers randomly assigned women into treatment and comparison groups. Two hundred and thirty woman received nurse home-visitation through their pregnancy. Another 228 women received nurse home-visitation from pregnancy through the child’s 2nd birthday. And 681 women served as the comparison group, receiving free round-trip transportation for scheduled prenatal visits; some of these also received referral services for the children after they were born. The children’s progress toward the program’s goals were assessed though adolescence.

The most recent evaluation occurred in Denver, where researchers also used an experimental pretest–posttest design. One of the comparison groups consisted of 255 women who received developmental screening and referral services for their children through age 2. The other comparison group consisted of 245 women who received paraprofessional home visitation services during pregnancy through the child’s 2nd birthday, in addition to the screening and referral services. The treatment group consisted of 235 women who received screening and referral services as well as nurse home-visitation from pregnancy through the child’s 2nd birthday. The families were followed for approximately 4 years.

The studies were designed to determine whether the provision of prenatal and infancy nurse home visits improve maternal, child, and family health and well-being as children mature.


NFP produced consistent benefits for low-income mothers and their children, in contrast to the comparison groups, in all three studies:

  • Mother’s prenatal health (especially in relation to their use of cigarettes) improved.
  • The number of preterm deliveries decreased.
  • There were fewer injuries to children.
  • Mothers made better use of the social welfare system.

Moreover, a 15-year follow-up study of the Elmira sample found that the program

  • Reduced child abuse and neglect
  • Reduced maternal behavioral problems attributable to substance use
  • Reduced arrests among the mothers
  • Resulted in 54 percent fewer arrests and 69 percent fewer convictions among the 15-year-old adolescents
  • Resulted in 58 percent fewer sexual partners among the 15-year-olds
  • Reduced cigarette smoking by the 15-year-olds

Risk Factors


  • Anti-social behavior and alienation/Delinquent beliefs/General delinquency involvement/Drug dealing
  • Cognitive and neurological deficits/Low intelligence quotient/Hyperactivity
  • Early onset of aggression and/or violence
  • Early sexual involvement
  • Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use
  • Life stressors
  • Mental disorder/Mental health problem/Conduct disorder
  • Teen parenthood
  • Victimization and exposure to violence


  • Broken home
  • Child victimization and maltreatment
  • Family history of the problem behavior/Parent criminality
  • Family management problems/Poor parental supervision and/or monitoring
  • Family violence
  • Having a young mother
  • Maternal depression
  • Parental use of physical punishment/Harsh and/or erratic discipline practices
  • Pattern of high family conflict
  • Poor family attachment/Bonding


  • Economic deprivation/Poverty/Residence in a disadvantaged neighborhood

Protective Factors


  • Healthy / Conventional beliefs and clear standards
  • High expectations
  • Perception of social support from adults and peers
  • Positive / Resilient temperament
  • Positive expectations / Optimism for the future
  • Self-efficacy
  • Social competencies and problem-solving skills


  • Effective parenting
  • Good relationships with parents / Bonding or attachment to family
  • Having a stable family
  • High expectations
  • Opportunities for prosocial family involvement
  • Rewards for prosocial family involvement


  • Presence and involvement of caring, supportive adults
  • Prosocial opportunities for participation / Availability of neighborhood resources


  • OJJDP: Blueprints
  • SAMHSA: Model Programs
  • NIJ: What Works
  • OJJDP/CSAP: Strengthen Families
  • HHS: Surgeon General


Olds, David L., Charles R. Henderson Jr., Harriet Kitzman, John Eckenrode, Robert Cole, and Robert C. Tatelbaum. 1998. “The Promise of Home Visitation: Results of Two Randomized Trials.” Journal of Community Psychology 26(1):5–21.

Olds, David L., Harriet Kitzman, Robert Cole, and JoAnn Robinson 1997. “Theoretical Foundations of a Program of Home Visitation for Pregnant Women and Parents of Young Children.” Journal of Community Psychology 25(1):9–26.

Olds, David L., JoAnn Robinson, Ruth O’Brien, Dennis W. Luckey, Lisa M. Pettitt, Charles R. Henderson Jr., Rosanna K. Ng, Karen L. Sheff, Jon Korfmacher, Susan Hiatt, and Ayelet Talmi. 2002. “Home Visiting by Paraprofessionals and by Nurses: A Randomized, Controlled Trial.” Pediatrics 110(3):486–96.

Olds, David L., JoAnn Robinson, Lisa M. Pettitt, Dennis W. Luckey, John Holmberg, Rosanna K. Ng, Kathy Isacks, Karen L. Sheff, and Charles R. Henderson Jr. 2004. “Effects of Home Visits by Paraprofessional and by Nurses: Age 4 Follow-Up Results of a Randomized Trial.” Pediatrics 114(6):1560–68.


Nurse–Family Partnership
National Office
1900 Grant Street, Suite 400
Denver, CO 80203
Phone: (866) 864-5226
Fax: (303) 327-4260
Web site:

Technical Assistance Provider

The Nurse–Family Partnership National Office
Nurse–Family Partnership National Office
1900 Grant Street, Suite 400
Denver, CO 80203
Phone: (866) 864-5226
Fax: (303) 327-4260
Web site: