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. The program is first being rolled out in Bulgaria’s capital city of Sofia, in partnership with the Second Municipal Hospital for Obstetrics and Gynecology Sheynovo, which is acting as the local delivery unit. Open Society Institute – Sofia is responsible for conducting the Feasibility and Acceptability Study of NFP in Bulgaria.
The NFP in Bulgaria started Phase Two – Pilot testing in the summer of 2016 and is serving first-time mothers under 20 years of age who are living in Sofia’s 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 these young mothers from seeking prenatal, peripartum, and postnatal services in formal health settings. Health mediators and family nurses are supporting the NFP promotion of the program to the community and helping to identify eligible pregnant women. Preparations for a second NFP site in another region commenced in 2018.
Further information about the program may be found at: http://socialachievement.org/en/
Or by contacting:
Maria Evgenieva – Clinical Lead – MEvgenieva@tsa-bulgaria.org
Sarah Perrine – CEO TSA – SPerrine@tsa-bulgaria.org
Iskra Stoykova – Program Officer Early Childhood Development – IStoykova@tsa-bulgaria.org
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. The Hamilton NFP program is funded by the Ontario Ministry of Children and Youth Services and through philanthropy. Ontario is also home to the NFP Canadian Nurse Education (CaNE) project, a new initiative to develop, pilot, 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), and the Regional Municipality of York, Public Health Branch. NFP implementation within the CaNE project in these sites is funded by the Ontario Ministry of Children and Youth Services, the Ontario Ministry of Health and Long-Term Care, and the Province of Ontario’s Local Poverty Reduction Fund.
Building on the success of the Hamilton Public Health-McMaster pilot project, in 2011, the BC government funded the BC Healthy Connections Project (BCHCP) to ensure that young pregnant and parenting women who are coping with socioeconomic disadvantage receive the evidence-based supports that they and their families need across BC. In 2011/12, 52 NFP Nurses and Supervisors were hired across the five Regional Health Authorities and they began enrolling clients into the program upon completion of advanced clinical nursing education. In 2013, BC embarked on the first Canadian large-scale randomized controlled trial (RCT) — evaluating NFP’s effectiveness at improving child development and mental health, reducing child maltreatment, and improving mothers’ life circumstances in a sample of over 700 families. Led by investigators at Simon Fraser University, McMaster, University of BC, and the University of Victoria, the RCT is being conducted in close collaboration with policy and practice partners in the BC Ministries of Health and Children and Family Development and in BC’s 5 Regional 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). Final RCT results will be available in 2021.
Enrolment into the BCHCP study closed in December 2016 and NFP is now available as an enhanced program embedded in public health services in 52 urban and rural communities including some First Nations communities (provided by over 70+ public health nurses and 9 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 6 cohorts of Canadian nurses as of February 2018.
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: Donna Jepsen, Provincial NFP Coordinator, BC Ministry of Health: email@example.com; Phone 604-775-0336 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 778.782.7775 / Nicole_catherine@sfu.ca
General Enquiries: Please email firstname.lastname@example.org and your enquiry will be redirected to the most appropriate NFP contact in Canada/Internationally.
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: email@example.com
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