1. What is the Nurse Family Partnership program 1? The Nurse Family Partnership (NFP) is an evidenced based, structured, intensive and sustained nurse home visitation program that improves the health, well being and self sufficiency of low-income, first time mothers and their children. The NFP is offered to first time, low income mothers. Program enrolment is voluntary, and occurs ideally by the 16 th week but no later than the 28th week of pregnancy. The program includes regular home visits by registered nurses from the prenatal period through until children are two years old. Program delivery is based on a standardized curriculum, training and resources. The program goals are to: improve pregnancy outcomes and parenting skills; improve child health and development; and improve economic self sufficiency of the family. 2. Why was the Nurse Family Partnership program chosen for implementation in British Columbia? The NFP program was chosen as the intensive home visiting model for BC because of the strength of the evidence. The NFP program is the only nurse home visiting program with a wide and varied range of strong, scientifically demonstrated positive outcomes for both mother and child sustained for more than 15 years following the program. The NFP program has been implemented in 32 states in the United States, as well as in the United Kingdom, and Australia. The NFP program is identified within four public health model core program papers as an evidence-based program improving maternal and child health outcomes: Reproductive Health and Prevention of Disabilities; Healthy Infant and Child Development; Mental Health Promotion and Prevention of Mental Disorders; and, Prevention of Violence, Abuse and Neglect. In addition, the Nurse Family Partnership is profiled as a key prevention action within the recently released ten year plan to address mental health and substance use in BC, Healthy Minds, Healthy People, and it supports the priorities articulated within the cross-government strategic framework Strong Safe and Supported: a Commitment to BC s Children and Youth. 3. What is the evidence supporting the Nurse Family Partnership The NFP program has been rigorously tested in three long-term randomized control trials in three different sites in the United States servicing population of diverse racial and ethnic backgrounds. Data was gathered over a broad range of outcomes and followed participants for many years. Long term client outcomes were evaluated 15 years after program completion in Elmira, nine years in Memphis, and four years in Denver. 1 (Source NFP Overview www.nursefamilypartnership.org)
Specific program outcomes for participating families include: Improved prenatal health and maternal health outcomes; Fewer subsequent pregnancies and increased spacing between births; 56% reduction in emergency room visits for accidents and poisonings; 48% reduction in child abuse and neglect; 67% reduction in behavioural and emotional problems for children at age six; 28% reduction mental health problems (depression and anxiety) at age 12; 59% reduction in arrests for children at age 15; 72% fewer convictions of mothers at child age 15; 67% reduction in use of cigarettes, alcohol, or marijuana at age 12; 83% increase in employment for mothers at child age four; 20% reduction in reliance on social assistance for participating families; 50% reduction in language delays for children at age 21 months; and Improved school readiness. Additional trials are underway within the United Kingdom, Germany, Australia and the Netherlands. 4. How does the Nurse Family Partnership program support better health and well being for women? The NFP program works with women to identify their life goals and aspirations. It supports them to achieve economic self-sufficiency and empowers them to make positive life changes. 5. Who would be eligible for Nurse Family Partnership The NFP program will be offered to low income, first time mothers who are under 25 years of age. 6. Why are only first time and young mothers eligible for the Nurse Family Partnership Results from trials have demonstrated the greatest potential for positive impact with first time young mothers. Young, first time mothers have been shown to be more receptive to learning about parenting and modifying behaviours to support healthy pregnancy, parenting and life skills. The NFP program targets the highest-risk population, for whom intervention has been proven to provide the strongest and most significant health and well being results and economic benefits. 7. Will services be available for women who are not eligible for the Nurse Family Partnership BC has a variety of regional and provincial maternal and child health programs and services. The continuum of prenatal and postpartum services is delivered by public health staff, primary care providers, Ministry of Children and Family Development (MCFD) services, federal services and community agencies. Women and families with episodic or transient perinatal or child health issues or who would benefit from additional community support will receive the broader range of services and programs.
8. How does Nurse Family Partnership fit within the continuum of services for pregnant and parenting women? NFP is part of the continuum of care for pregnant and parenting women. The NFP is intended to serve the most vulnerable women, who would benefit the most from intensive follow up services. Clients who do not wish to participate in the NFP may opt to receive the broader range of services and programs. Women and families enrolled in the NFP are actively linked with and encouraged to participate in other community programs and services. These linkages support ongoing community connectedness following graduation from the NFP program, and contribute to long-term physical, mental and social health and well being. 9. How does the Nurse Family Partnership fit with other home visiting programs? Will there be an impact to these programs? There are a variety of home visiting programs delivered by other service agencies. It may be expected that other home visiting programs delivered through MCFD or community agencies may see fewer young, first time mothers as these women will be offered the NFP program. This may free up additional space for women or families that do not meet NFP program eligibility. For example, second time parents who need additional support may have more access to other programs. 10. Who will be providing the service? Health authority public health nurses will be providing the NFP program. The program will also rely on a variety of partners across sectors that will refer clients into the program, work with the family and the nurse to address client needs, and support client referrals from the program. 11. Why is a public health nurse the required professional to deliver the Nurse Family Partnership The NFP program is centred on a therapeutic relationship established between the primary visitor and the mother. The Denver trial compared outcomes from NFP program model as delivered by trained, registered nurses with those delivered by well-trained, supported and supervised paraprofessionals. The trial found substantially stronger positive outcomes among nurse-visited women. Public health nurses are widely perceived as trusted, credible and competent professionals. A public health nurse s educational background, sound judgement skills and focus on a strength-based preventative approach, are the optimal qualities for delivering the NFP. 12. What training will be provided to public health nurses delivering the NFP Nurses who will deliver the NFP program will receive additional training. This includes multi-stage/component training in the NFP program model, theories and curriculum. NFP Nurses will also receive NCAST training (Keys for Caregiving and NCAST Parent-Child Interaction Feeding Scales and Teaching Scales) as well as, Partners in Parenting Education Training (PIPE). Once NFP Nurses have received NFP curriculum training they will be able to deliver the NFP program to clients.
13. What are the timelines for the Nurse Family Partnership NFP program planning and supporting activities needed to implement the NFP program are currently in progress. BC NFP guidelines, documentation processes and requirements for staff training, client eligibility criteria, program evaluation requirements and phased implementation dates are being established. 14. Will adjustments be made to the NFP program or the NFP curriculum? The NFP curriculum is being carefully reviewed to ensure that relevant content details are aligned with current BC and Canadian public health policy and practice. The NFP curriculum will not be changed unless alignment is needed. For example, the NFP dental health content will reflect BC dental health practice, infant crying will be reviewed for consistency with Period of PURPLE Crying information, and breastfeeding, nutrition and immunization information will also reflect BC guidelines and policy. 15. How will linguistic and cultural diversities be accommodated by the Nurse Family Partnership The NFP program will be largely delivered in the English language. However, we recognize that there may be young, first-time mothers in BC that do not speak any English. The NFP curriculum is by nature interactive and relationship based. Wherever possible, development of NFP nursing teams will consider regional needs and endeavour to meet the needs of potential clients with little-to-no English. Although some basic client skills in reading and writing are desirable, the NFP curriculum can accommodate clients with very low levels of literacy, or an inability to read and write English. Similar to the approach in other public health programs, the NFP Nurse will deliver the NFP program in a culturally sensitive manner. Careful consideration and planning will need to be undertaken to address the needs of Aboriginal clients, and other cultural adaptations and any translation requirements. Supporting materials about the NFP translated into common second languages within BC may be developed for extended family members of clients. 16. Will BC be evaluating the Nurse Family Partnership The Ministry of Health, MCFD, in collaboration with health authorities and Simon Fraser University Children s Health Policy Centre will be conducting a scientific evaluation of the NFP program to ensure that the programs expected outcomes are demonstrated in BC. This is essential to producing valid, actionable evidence about what does and does not work and is designed to provide conclusive evidence of effectiveness. The evaluation will measure the effectiveness of the NFP program within the BC context and determine specific individual, family and population outcomes that can be unquestionably attributed to the program. BC will follow a process that has been used within other NFP program evaluation sites.
In other jurisdictions, women were screened for eligibility for the NFP program. Half of women who were eligible for NFP program were assigned to the NFP program and the other half received existing maternal child health services and follow up. Women and their children, received follow up to track outcomes over time. Evaluation findings will be used to further adapt the NFP program as needed for the specific context of BC and provide a solid evidence base for this new public health initiative. 17. What are the implications for the Nurse Family Partnership program in rural and remote locations? The population density and geography of BC present some unique challenges in the context of the program implementation, evaluation and ongoing program delivery. BC will begin NFP implementation in all health authorities in areas with higher numbers of eligible births. Work is underway to determine if other international sites have successfully introduced the NFP in rural and remote locations. This information and evaluation findings will be considered when planning a phased approach to NFP program implementation. 18. What are the Nurse Family Partnership Model Elements? The NFP program is subject to copyright and includes 18 model elements. These elements are essential for achieving positive long-term health outcomes for children and their mothers. The NFP model elements include home visiting schedules and guidelines, client to nurse ratios, nurse to nurse supervisor ratios, training requirements, and adherence to curriculum. Please refer to the NFP 18 Model Elements handout. 19. Who is funding Nurse Family Partnership The NFP program will be funded through existing health authority global budgets.