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Governor's Office of Gang and Youth Violence Policy

Nurse Family Partnership

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Category Type Target Age Group Setting Outcomes Source of Rating
Proven Programs Delinquency & Recidivism
  • Early Childhood
  • Parents
  • In-Home
38.2% reduction in recidivism for mothers
15.7% reduction in recidivism for children
  • Blueprints for Violence Prevention (Blueprints)

    The Blueprints for Violence Prevention list has been developed by a research team headed by Delbert Elliott, Ph.D. at the Center for the Study and Prevention of Violence at the University of Colorado. For Blueprints to certify a brand name program as “model,” the program must demonstrate its effects on problem behaviors with a rigorous experimental design, show that its effects persist after youth leave the program and be successfully replicated at least once. In order for a brand name program to be certified as “promising,” the program must demonstrate effects using a rigorous experimental design. The Blueprints Web site (www.colorado.edu/cspv/blueprints/) lists 11 “model” programs and 19 “promising” programs.


    Selection Criteria:
    Lasting positive effects in well designed evaluations & emphasis on replication.

    Applicability:  Excellent for crime, violence, delinquency & substance abuse.

    Reliability:  Excellent

    Currency:  Up to Date

    Advantages:  Easy to use. Plentiful peer and tech support. Predictability of outcomes.

    Limitations:  Covers only a small number of brand name programs.

    Blueprints
  • Coalition for Evidence-Based Policy (Top Tier)

    The Coalition for Evidence-Based Policy was created to assess social interventions for scientifically demonstrated effectiveness in the areas of early childhood development, education, youth development, crime and violence prevention, substance abuse, mental health, employment and welfare, and international development. In association with the coalition, the “Top Tier” designation is being developed under the guidance of a distinguished advisory group, for programs and strategies “that have been shown, in well-designed randomized controlled trials, to produce sizeable, sustained effects on important…outcomes[.]” As of the date of this publication, the Top Tier list has only three brand name programs that address crime, substance abuse or antisocial behavior: Nurse-Family Partnership, LifeSkills Training and Multidimensional Treatment Foster Care. The Coalition’s Web site is www.coalition4evidence.org/wordpress/ and the associated Web site for Top Tier is www.toptierevidence.org/wordpress/.


    Selection Criteria:
      Uses very rigorous criteria specified by federal government.

    Applicability:  All social policy areas.

    Reliability:  Excellent

    Currency:  Just getting started.

    Advantages:  Most rigorous evidence.

    Limitations:  Small number of programs.

    Top Tier
  • Washington State Institute for Public Policy (WSIPP)

    The Washington State Institute for Public Policy (WSIPP) uses the meta-analysis methodology to conduct evaluations of evidence-based practices, but also considers the cost of such programs and strategies to taxpayers and crime victims and weighs these costs against possible benefits (i.e., costs avoided through reduced crime). Programs and strategies are not ranked, but effect on recidivism is measured and the number of evaluations is reported. Recidivism, cost to tax payers and crime victims, and benefits are estimated using data specific to Washington State.

    For the purposes of this paper, all cost and benefit information refers to the analysis conducted by WSIPP for the State of Washington. Accordingly, the information should be considered an estimate for the potential cost and dollar benefits for California. The data used for this project can be found in the article by Elizabeth K. Drake, Steve Aos and Marna G. Miller, titled “Evidence-Based Public Policy Options to Reduce Crime and Criminal Justice Costs: Implications in Washington State” (2009), and can be downloaded from their Web site, www.wsipp.wa.gov.


    Selection Criteria:  Meta-analysis & cost-benefit analysis.

    Applicability:  Meta-analysis & cost-benefit analysis.

    Reliability:  Excellent

    Currency:  Analyses are revised every few years.

    Advantages:  Predictability of outcomes; ability to compare cost effectiveness.

    Limitations:  Costs & benefits are based on WA data.

    WSIPP

Description:

Nurse-Family Partnership is a model nurse home visitation program for evidence-based public health policy. With more than 30 years of evidence of effectiveness, Nurse-Family Partnership services have shown to help break the cycle of poverty, strengthen communities, and improve lives.

Every year, approximately 600,000 children are born to low-income, first-time mothers in the U.S. who are at the greatest risk of suffering health, education and economic disparities. By offering support to this vulnerable population, Nurse-Family Partnership empowers pregnant women and their families to improve their health and education, and economic self-sufficiency.

Across the nation, cities and states are realizing the value of evidence-based public policy through programs that are verified to improve outcomes for families and communities, such as Nurse-Family Partnership. Its proven effectiveness makes Nurse-Family Partnership a model of evidence-based public policy that delivers a substantial return on investment. Along with unsurpassed health, educational and economic outcomes, Nurse-Family Partnership services have shown decreases in the number of families enrolled in Medicaid and food stamps programs, as well as improvements in pregnancy outcomes, health status, school achievement, parental employment and family stability.

Target Population

Low-income, at-risk pregnant women bearing their first child.

For more Information or to find Technical Assistance, visit:

Nurse-Family Partnership
www.nursefamilypartnership.org

 

References and/or Published Evaluations

A cornerstone of Nurse-Family Partnership is the extensive research on the model conducted over the last three decades. Randomized, controlled trials were conducted with three diverse populations beginning in Elmira, New York, in 1977; in Memphis, Tennessee, in 1988; and in Denver, Colorado, in 1994. All three trials targeted first-time, low-income mothers. Follow-up research continues today, studying the long-term outcomes for mothers and children in these three trials.

The level of proven effectiveness demonstrated is unsurpassed in evidence-based home visitation programs. The program effects that have the strongest evidentiary foundations are those that have been found in at least two of the three trials and are listed below.

Consistent program effects:

  • Improved prenatal health
  • Fewer childhood injuries
  • Fewer subsequent pregnancies
  • Increased intervals between births
  • Increased maternal employment
  • Improved school readiness

About the Research
A randomized, controlled trial is the most rigorous research method for measuring the effectiveness of an intervention. This type of trial is required by the U.S. Food and Drug Administration (FDA) for new drugs or medical devices to determine their effectiveness and safety before they are made available to the public. Because of their cost and complexity, these kinds of trials are not often used to evaluate complex health and human services.

In addition, important data from all home visits are continuously collected from Nurse-Family Partnership Implementing Agencies through the Nurse-Family Partnership National Service Office's web-based data collection system. These data are analyzed and returned to local Nurse-Family Partnership Implementing Agencies to provide them with information on their progress toward meeting Nurse-Family Partnership's implementation benchmarks in improving maternal and child health.

References
“Social Programs That Work." Coalition for Evidence-Based Policy.

MacMillan H, Wathen L, Barlow NC, Fergusson J, Leventhal DM, Taussig JM, Heather N. Interventions to prevent child maltreatment and associated impairment. Lancet 2008; 1-17.

Aos S, Lieb R, Mayfield J, Miller M, Pennucci A. Benefits and costs of prevention and early intervention programs for youth. Washington State Institute for Public Policy 2004; 1-20.

Karoly LA, Kilburn MR, Cannon JS. Early childhood interventions: Proven results, future promise. RAND Corporation 2005.

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Additional Information

Provided by www.nursefamilypartnership.org, October 2010

  • Has this program been replicated at other sites? If so, how many and where are they?
    Click here to view the NFP State Profile for California, which lists the counties in which NFP has been replicated. (Tracy – link to PDF, I will provide)
  • Is there a formal curriculum or program guidelines in place? What is the approximate cost for these materials?
  • What kind of training and technical assistance is available for this program?
    The Nurse-Family Partnership National Service Office works with communities interested in implementing the Nurse-Family Partnership model to ensure the program is right for their needs and that broad-based community support can be established and sustained. When community need and commitment come together, the Nurse-Family Partnership is ready for launch through an implementing agency.

    Nurse-Family Partnership Implementing Agencies contract with the National Service Office to provide services at a community level. These agencies are administered by a range of non-profit and for-profit entities, including state and county health departments, community-based health centers, nursing associations, and hospitals, generally through maternal and child health services.

    Implementing agencies vary in size and location. Some serve hundreds of families in parts of an urban area, while others serve a hundred families in one or two rural counties. The standard implementation of Nurse-Family Partnership is 8 nurse home visitors, each serving a maximum of 25 families – total 200 families – supported by a full-time nurse supervisor. The minimum start-up program must be able to serve 100 families. NFP Program Developers work with all communities to assess program capacity and determine an appropriate team size.

    The first step to becoming a Nurse-Family Partnership Implementing Agency is to contact the National Service Office Regional Program Developer in your area, who will work closely with you and your community and/or state to determine feasibility. Specific factors considered during this phase of the process include:

           - Need for services – what similar programs exist in your service area for the target population
           - Annual number of low-income, first-time births in your community
           - Plan for sound financing of the programExperience of the agency with innovative programs
           - Presence of, or potential for, broad-based community support
           - Ability to coordinate with existing health and human services programs
           - Ability to establish a highly effective referral procedure to ensure an adequate number of voluntary enrollments in the program
           - Ability to recruit and retain qualified registered nurses

    If the initial phase of the process establishes feasibility, the process continues with the completion of a formal implementation plan. This process provides an avenue for dialogue between the maternal and child health services agency and National Service Office staff relative to the requirements of the program. View the Nurse-Family Partnership Implementation Logic Model and the Theory of Change Logic Model.

    Most importantly, the agency must provide a stable and supporting environment for nursing staff; maintain fidelity to the Nurse-Family Partnership Model Elements; and have a sustainable, long-term funding strategy. Once formal contracts are signed, agencies become official Nurse-Family Partnership Implementing Agencies.
  • Once the program has been implemented, can an organization obtain assistance with fidelity monitoring or quality assurance?
    The Nurse-Family Partnership Model Elements are supported by evidence of effectiveness based on research, expert opinion, field lessons, and/or theoretical rationales. When the program is implemented in accordance with these model elements, implementing agencies can have a high level of confidence that results will be comparable to those measured in research.
  • Can an organization obtain assistance with data collection or measurement of outcomes?
    Nurse home visitors and nurse supervisors collect data as specified by the Nurse-Family Partnership National Service Office and use Nurse-Family Partnership reports to guide their practice, assess and guide program implementation, inform clinical supervision, enhance program quality, and demonstrate program fidelity.
  • Is a risk assessment tool typically used to identify referrals for this program? If so, which one?
    NFP operates according to strict model elements (see above), which include specific intake criteria.

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