The Nurse-Family Partnership (NFP) International Program
The NFP program is currently being implemented or evaluated in nine 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.
The various countries in which the program is in place are:
Details of NFP program development within each country
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 midwives an appropriate qualification for nurse home visitors and nurse supervisors; and
• 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, will commence in late 2020.
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:
NFP in Canada is a policy-practice-research partnership embedded within public health. The NFP program was first introduced in the city of Hamilton, Ontario in 2008 where a feasibility and acceptability study was undertaken, led by investigators at McMaster University. Since the positive conclusion to the study in 2011, the NFP team has continued as a component of City of Hamilton Public Health Services holding its own program license until 2018. Ontario was also home to the successful NFP Canadian Nurse Education (CaNE) project from 2015-2018, a, pilot to develop, implement and evaluate a Canadian model of education for public health nurses and supervisors implementing NFP, with the Middlesex-London Health Unit, City of Toronto (Public Health Division), Niagara Region Public Health and the Regional Municipality of York, Public Health Branch. Since January 2019, NFP has continued in all five Ontario regions under one program license, currently held by the Middlesex-London Health Unit. The Canadian model of education that was successfully evaluated through the pilot has now been replicated with several additional cohorts in Ontario.
Building on the success of the Hamilton Public Health-McMaster pilot project, in 2011, the British Columbia (BC) government funded the BC Healthy Connections Project (BCHCP) to assess how well NFP works in BC. This trial is also the first scientific evaluation of NFP in Canada. The BCHCP involves a randomized controlled trial following 739 mothers, who were coping with socioeconomic disadvantage in early pregnancy, and their 737 children. The BCHCP is evaluating NFP’s effectiveness at reducing prenatal substance use, improving child development and mental health and reducing child maltreatment by age two years, and improving mothers’ life circumstances. Other outcome indicators include assessing the program’s impact on: socioeconomic status, parenting abilities, maternal mental health including substance use, intimate partner violence, and receipt of child and family health and social services. Prenatal findings from the trial show that NFP reduced cannabis use for all participants and cigarette use (for smokers). Reports on all outcome indicators will follow in 2021–2022. The BCHCP team plans to secure new funding to follow the children into adolescence — to explore replication of positive findings from NFP trials in the United States, such as improved child academics and mental health as well as conducting long-term cost-effectiveness analyses.
The BC trial is led by investigators at the Children’s Health Policy Centre, Simon Fraser University, with investigators from McMaster, the University of BC, the University of Victoria and the Public Health Agency of Canada. The BC Ministry of Health is sponsoring the trial, with support from the BC Ministries of Children and Family Development and Mental Health and Addictions — in collaboration with Fraser, Interior, Island and Vancouver Coastal Health Authorities. 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).The BCHCP closed trial enrollment in 2016; completed in-person and telephone data collection in late 2019; and are collecting administrative data on child injuries from the BC Ministry of Health until 2021. The trial is embedded within BC’s public health system to ensure that findings inform policy and practice.
NFP is also now available as an enhanced program embedded in public health services in 68 urban and rural communities including some First Nations communities (provided by over 47+ public health nurses and 7 Supervisors). To sustain the advanced education program for nurses, BC tailored and revised the education program beginning with International and National consultation in 2015 and has since provided the clinical education to 11 cohorts of BC NFP public health nurses as of November 2020. As a result of COVID-19, BC (collaborating with Ontario) pivoted to providing the nursing education virtually (rather than in-person) in the fall of 2020 and received positive reviews from both nurses and educators.
In Canada, NFP is not being offered outside of BC and the two Ontario projects, while awaiting the BCHCP results. This is to ensure that the program is effective in the Canadian context, prior to widespread implementation. The NFP Canadian Collaborative group, comprised of practitioners, researchers, and policy makers, share and collaborate on collective NFP work in Ontario and British Columbia. This group follows the recommended implementation aspects provided by Dr. David Olds and the International NFP team.
For further information on NFP in Canada can be found at:
- Implementation of NFP: Lindsay Croswell, Ontario NFP Nursing Practice Lead, Middlesex-London Health Unit; email@example.com; 519-719-3329
- NFP Research and Evaluation: Dr. Susan Jack, Associate Professor, School of Nursing, McMaster University;firstname.lastname@example.org; 905-525-9140 x 26383
- Implementation of NFP: Karen Ramsay Cline, Senior Provincial Manager, BC Ministry of Health: email@example.com Phone: 250-952-2632 https://www.healthyfamiliesbc.ca/nurse-family-partnership
- NFP Research (RCT on NFP’s Effectiveness in Canada): Dr. Nicole Catherine, University Research Associate; Scientific Director, BC Healthy Connections Project; Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University; Nicole_catherine@sfu.ca
- For BCHCP Information and List of Publication: childrenhealthpolicy.ca
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
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-partnershipOr by contacting: Deirdre.Webb@hscni.net
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 is being tested by two NFP teams in Oslo municipality (Gamle Oslo and Søndre Nordstrand townships) and Stavanger/Sandnes/Time municipalities, who will serve 150 clients. A research study was commissioned to evaluate the population most likely to benefit from the program within the Norwegian context and this has informed the development of program eligibility criteria. An extensive evaluative study is being undertaken for the initial testing of the program.
Further information about the program in Norway can be found at: http://www.r-bup.no/no/vi-tilbyr/metoder-og-tiltak/nurse-family-partnership-programmet-nfp
Or by contacting:
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 in Scotland will be offered the program from 2018.
Or by contacting: Carolyn Wilson at Carolyn.Wilson@gov.scot
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 now serves over 31,000 clients with over 1640 nurses delivering NFP in 43 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
Or by contacting: firstname.lastname@example.org
Role of the Prevention Research Center for Family and Child Health (PRC) at the University of Colorado
- Approves the license required for implementation of the program within a society
- Long-term follow-up of participants from the Memphis trial and continued analysis of data from the three original NFP randomized controlled trials
- Conducting research aimed at improving the NFP program model
- Establish systems and processes needed to support high quality implementation of the NFP internationally
- Provides international expert support and guidance for NFP implementing societies
- Annual review of NFP implementation and fidelity with licensed partner societies for quality monitoring and assurance