International Program


The Nurse-Family Partnership (NFP) International Program

The NFP program is currently being implemented and evaluated in eight countries, including the United States. Each country has made some adaptations for the specific context and population being served whilst maintaining fidelity to the program model and each is at a different phase of program testing and expansion.

Where is the program currently in place? 

The various countries in which the program is in place are:

Country

United States

England

Australia

Canada

Scotland

Northern Ireland

Norway

Bulgaria

Year program initiated

1997

2007

2008

2008

2009

2010

2015

2015

Details of NFP program development within each country

Australia

In Australia, the Commonwealth Department of Health (the Department) funds the implementation of the NFP model through the Australian Nurse-Family Partnership Program (ANFPP). The ANFPP is specifically adapted for women pregnant with an Aboriginal and/or Torres Strait Islander baby. Program materials have been adapted to the Aboriginal and Torres Strait Islander health context to ensure that they are appropriate to local community needs and culturally safe.

A number of adaptations to the NFP Core Model Elements have been made for the ANFPP. These include:

  • The inclusion of multiparous mothers on a case-by-case basis
  • The inclusion of a Family Partnership Worker (FPW) role

The FPW role is an essential adaptation to the ANFPP, and as an identified position, must be staffed within implementing sites by and Aboriginal or Torres Strait Islander person. The FPW is responsible for ensuring culturally safe and culturally responsive home visits to participating mothers and their infants and provides advice on cultural issues while working in collaboration with nurse home visiting staff.

From initial implementation in three sites in 2009, the ANFPP is now implemented in thirteen sites across four states and two territories. These sites vary from large cities and urban centres, to regional towns, to remote Aboriginal communities accessible only via plane.

While the ANFPP has not yet been rigorously evaluated, program data suggests that it is contributing to a number of positive outcomes for mothers and children including: low rates of low birthweight babies, high rates of breastfeeding, very low prevalence of child injuries and/or illness requiring medical attention, and very high rates of fully immunised children. A long-term, outcomes-based evaluation, designed in conjunction with implementing sites, commenced 2021.

Further information can be found at www.anfpp.com.au or via ANFPP@health.gov.au.



Bulgaria

The NFP program was introduced in Bulgaria by the Trust for Social Achievement (TSA), with financial support from the America for Bulgaria Foundation. TSA is the license holder and the implementing agency.

In 2016 the program was first rolled out in the capital city of Sofia, in partnership with the Second Municipal Hospital for Obstetrics and Gynecology Sheynovo, which is acting as the local delivery unit. Three years later, in partnership with St. George University Hospital, the program was expanded to Bulgaria's second largest city – Plovdiv.

In those two sites the NFP is serving first-time mothers under 22 years of age who live in the largest Roma neighborhoods and their surroundings. Bulgaria’s Roma face significant health challenges that impact later educational outcomes and achievement. Social norms, poverty, and isolation prevent young mothers from seeking prenatal, peripartum, and postnatal services in formal health settings.

Health mediators from the same communities support family nurses in their field work and help identifying eligible pregnant women. So far, the teams have delivered the service to more than 200 vulnerable women through over 7000 home visits.

The Open Society Institute-Sofia is responsible for the formative evaluation of the program. Two local NGOs - the Health and Social Development Foundation in Sofia and the National Alliance for Volunteer Action in Plovdiv, support the NFP teams with psychological supervision and social work consultations.

The NFP Program in Bulgaria is managed by a Project Manager and supported by a Clinical Leader, a Data Analyst, and a Project Coordinator.  

Further information about the program may be found at: http://socialachievement.org/en/
 
Or by contacting:

Ivanka Puleva – Project Manager, IPuleva@tsa-bulgaria.org
Sarah Perrine – CEO TSA, SPerrine@tsa-bulgaria.org
Iskra Stoykova – Program Officer First Foundations, IStoykova@tsa-bulgaria.org



Canada

The NFP program was first introduced in Canada in the City of Hamilton, Ontario in 2008 where a successful feasibility and acceptability study was led by investigators at McMaster University. Ontario was also home to the successful NFP Canadian Nurse Education (CaNE) project from 2015-2018. Since January 2019, NFP has continued in five Ontario regions under one program license, currently held by the Middlesex-London Health Unit.

In 2012, the British Columbia (BC) government began implementing NFP in most health authorities across the province and funded the BC Healthy Connections Project (BCHCP) to assess how well NFP works in BC. This randomized control trial (RCT)[1] is also the first scientific evaluation of NFP in Canada. Reports on outcome indicators are being published between 2020 and 2023. The RCT also has two adjunctive studies: a nursing process evaluation, and a biological evaluation of NFP’s potential impact on biomarkers of stress in a sub-sample of RCT participants (Healthy Foundations Study). In Canada, NFP is currently not yet being offered outside of BC and ON as NFP is completing phase three of international replication and adaptation of NFP. British Columbia and Ontario work closely together on initiatives and meet regularly through their NFP Collaborative in Canada. 

More BCHCP information and list of publications can be found at: childrenhealthpolicy.ca

Further information regarding the program in Canada can be found by contacting:

Karen Ramsay Cline (BC) karen.ramsaycline@gov.bc.ca and Lindsay Croswell (ON) lindsay.croswell@mlhu.on.ca

[1] Catherine NLA, Gonzalez A, Boyle M, Sheehan D, Jack, SM, Hougham K, McCandless L, MacMillan H, Waddell C. for the BC Healthy Connections Project Scientific Team. (2016). Improving children’s health and development in British Columbia through nurse home visiting: A randomized controlled trial protocol. BMC Health Services Research, 16, 349 – 362. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1594-0

England

NFP (known as Family Nurse Partnership or FNP) was introduced into England in ten sites in 2007 and expanded rapidly following a positive formative evaluation and strong governmental and policy support. The program is now in place in more than 100 geographical areas of England and in 2015/16 served approximately 16,000 families. It is offered to young first time mothers aged up to 24 (but predominantly under 20 years). The program is provided by the National Health Service , supported centrally by the FNP National Unit, with the license held by a Government body, Public Health England. 

Following the RCT published in 2015 a number of refinements and new developments are now being introduced into the program model and evaluated. 

Further information regarding the program in England can be found at: http://fnp.nhs.uk

Or by contacting: FNPNationalUnit@phe.gov.uk


Northern Ireland

The program is also known as Family-Nurse Partnership (FNP) in Northern Ireland and serves first time mothers of less than 19 years. There are 5 FNP teams, one in each NHS Trust. The license is held by Northern Ireland’s Public Health Agency, which also provides the implementation support and 
funds the local service.

Due to the country’s small size, leaders of the program in Nothern Ireland collaborate closely with colleagues in England and Scotland, but have developed some unique program adaptations for the context of Nothern Ireland.

Further information about the program in Nothern Ireland can be found at: http://www.publichealthagency.org/directorate-public-health/health-and-social-wellbeing-improvement/family-nurse-partnership

Or by contacting: Deirdre.Webb@hscni.net


Norway

The program has been introduced into Norway by the Norwegian Directorate for Children, Youth and Family Affairs and this Government department is the license holder working with the Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP) as the implementing agency.  

Phase one adaptation work commenced in 2015 and the program moved into phase three at the beginning of 2021 as the Norwegian Government decided to expand the number of sites and to conduct an effect evaluation of the program. The latter is important in order to identify how and to what extent the program adds value to the fairly strong universal services in Norway for pre-natal and post-natal follow up of first time mothers, the child and their family. The effect evaluation research will be running from 2022 till 2027.

The sites participating in phase 3 include varied geographical regions and it is anticipated that this will provide useful information about how to implement the program in different geographical contexts. In the Norwegian context, so far, the program is considered to be particularly important for its support of sensitive, responsive caregiving and the potential to avoid child neglect and transfer of child custody to government institutions.

The real -time formative evaluation study conducted during phase 2 (2016-2020) found that “...there is a need for and high acceptance of a high-intensity programme such as NFP in Norway. The programme offers close and structured guidance for vulnerable families who need extra support in a challenging life phase. No corresponding service exists in local authority services in Norway for this target population.” Further information about this study can be found here.

For further information about the program in Norway please contact:



Tine Gammelgaard Aaserud (Clinical Lead) tga@r-bup.no
Kristin Lund (Senior Advisor Implementation) 
kristin.lund@r-bup.no

Benedicte Petersen (Policy Lead) 
benedicte.petersen@bufdir.no


Scotland

Scotland introduced the program (known as Family Nurse Partnership or FNP) in 2009 and following a positive formative evaluation have expanded to now have at least one FNP team in every viable National Health Service organizational area. They are the first country to expand the program comprehensively so that every first time pregnant young woman (19 and under) in Scotland is now offered the program.

The license for the program is held by the Scottish Government , who also support implementation and program quality improvements by local NHS Health Boards. Nurse and supervisor education is provided by NHS Education Scotland (NES).

Further information about the program in Scotland can be found at: https://beta.gov.scot/policies/maternal-and-child-health/family-nurse-partnership/

Or by contacting the Nurse Family Partnership central team: Family_Nurse_Partnership@gov.scot

United States

The program was first developed in the US, with 3 RCTs taking place between 1977 and 1995. The first replication sites for the program were established in 1996 and the program has served over 340,000 families since with over 2,335 nurses delivering NFP in 40 states, the US Virgin Islands and six Tribal Nations.

The National Service Office (NSO) in Denver contracts with and provides implementation and quality monitoring support to States, agencies and Tribal Nations that deliver the Nurse-Family Partnership (NFP) program. These include a variety of organizations (private, public and non-profit) such as state/county public health departments, community-based health centers, nursing associations and hospitals. 

More information regarding the NFP in the US can be found at: http://www.nursefamilypartnership.org


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