Improving on Success: Why the Nurse-Family Partnership Model is a Work in Progress
David Olds, PhD, is founder of the Nurse-Family Partnership, a Robert Wood Johnson Foundation 40th Anniversary Force Multiplier that provides maternal and early childhood health programs for at-risk, first-time mothers. He is a professor of pediatrics at the University of Colorado School of Medicine, where he directs the Prevention Research Center for Family and Child Health.
When I finished my undergraduate degree in Baltimore in 1970, I went to work at an inner-city day care center, hoping that I might help poor preschoolers get off to a great start and have a better chance of succeeding in school and becoming productive, healthy citizens. But I soon realized that for many children in my classroom, it was already too little, too late. One little boy had been exposed to alcohol during pregnancy and was pretty profoundly developmentally compromised—he couldn’t communicate with words. Other children were being abused or neglected, so it was clear to me that parents’ prenatal health and parenting behaviors were part of the solution for low-income children.
I would have been out of touch, however, to think that all that was needed was for parents to do a better job of caring for their children. Our center was in a poor, inner-city neighborhood, where poverty, crime and a lack of adequate housing were undeniable influences for families. It was clear that parents wanted the best for their children, but their own personal histories and the social and material stressors weighing on them often made it really hard for them to protect themselves and their children. And this was happening in countless communities across the country.
After leaving that day care center and finishing graduate school, my colleagues and I developed what’s today known as the Nurse-Family Partnership® program in Elmira, New York in 1977. I developed this program in the context of a randomized, controlled trial because I didn’t want to just promote a program because our team happened to develop it; I wanted to know whether it would really help vulnerable children and families. I felt a responsibility to know, in the most disciplined fashion possible, whether or not it was effective. The findings from the Elmira trial were extremely promising, but before offering it for public investment, we decided to replicate the Elmira trial in two additional scientifically controlled trials with different populations living in different contexts throughout the US.
Today, we have an extensively tested model operating in 40 states in 432 counties nationwide. Early on in the national replication process, we created a nonprofit to manage the program’s national expansion and ensure that it was replicated with fidelity to the model we’d tested in our original trials. We recognized, however, that the program would have to be adapted to families’ individual needs in order to be meaningful to them, to elicit their engagement, and to bring about the changes needed to support maternal and child health.
Today, the Nurse-Family Partnership (NFP) serves more than 22,000 families a year in the United States. Nurses make home visits to young, low-income mothers, providing guidance and support for first-time parents before and after their babies are born. NFP improves the health of babies, as well as the health and financial well-being of mothers. They are better parents and more prepared for the challenges of raising children, have fewer subsequent pregnancies, longer intervals between births, increased employment and improved school readiness.
We think of the program itself as a work in progress, though.
For instance, we know that our nurses don’t have the resources they need to address intimate partner violence in homes. Violence is all too frequently occurring, and is dangerous and stressful for both parents and children. With that in mind, a team led by Harriet MacMillan, MD, MSc, FRCPC, and Susan Jack, BScN, PhD, are now testing an approach in randomized, controlled trials to help NFP nurses address intimate partner violence more effectively.
We strive to ensure that NFP has both clinical and scientific integrity. It has to reliably engage populations, and bring about adaptive behavioral change in key aspects of maternal and child health. We tap into parents’ instinct to protect their children, and support it in a clinically sophisticated way that motivates parents to do well by their children. At the same time, we try our best not to overstate NFP benefits; we face head on when things aren’t going as well as we’d like, and we develop and test new innovations in the NFP model to improve its impact.
At the Prevention Research Center for Family and Child Health (PRC) at the University of Colorado, we continue to follow the participants from our original trial to measure the long-term effects of NFP on health and behavioral functioning. As illustrated by the work on intimate partner violence, PRC organizes programs of research to improve the basic model and its replication. And the NFP continues to grow both in the US and abroad. We’ve partnered, for example, with governments in England, Scotland, Ireland, Canada, the Netherlands and Australia to adapt and test the program in those settings.
As we expand NFP to more and more populations, we are constantly focused on improving the basic model and our efforts to replicate it with quality.