International Program

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.

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

Australia is delivering the program (ANFPP) only to women pregnant with an Aboriginal or Torres Strait Islander baby. Consequently, a great deal of collaborative work with indigenous communities has been undertaken to ensure that the necessary adaptations are being made for this specific cultural context. To date, these adaptations have included: 1) delivering the ANFPP to multiparous women; and 2) the development of an indigenous worker role (Family Partnership Worker[FPW]) who introduces the program to the client, family and community and reinforces cultural safety.


There are currently 13 sites:

Queensland 

Wuchopperen Health Service – Cairns

Institute for Indigenous Health - Brisbane North, Caboolture, Pine Rivers (Strathpine)

Institute for Indigenous Health - Brisbane South, Redland, Logan (Goodna)

Northern Territory          

Central Australian Aboriginal Congress – Alice Springs, Amoonguna, Santa Teresa, Titjikala, Hermannsburg Top End Health Service - Thamarrurr inc Wadeye, Maningrida and Outstations, Gunbalanya, Wurrumiyanga Danila Dilba Biluru Butji Binnilutlum Health Service Aboriginal Corporation - Palmerston, Darwin Wurli-Wurlinjang Health Service - Katherine

New South Wales            

Wellington Aboriginal Corporation Health Service – Wellington, Dubbo, Gilganrda, Narromine Wellington Aboriginal Corporation Health Service - Blacktown Local Government Area Durri Aboriginal Corporation Medical Service - Kempsey

South Australia 

Nunkuwarrin Yunti - Playford, Port Adelaide, Enfield (Adelaide Metro)

Victoria

Rumbalara Aboriginal Co-Operative - Campaspe, Shepparton, Moira.

Canberra            

Winnunga Nimmityjah - Canberra North, Canberra South
 
Further information about the program in Australia can be found at: http://www.anfpp.com.au
 
Or by contacting: info@anfpp.com.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.  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

Canada

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: 

Ontario:

  • Implementation of NFP: Dianne Busser, Nursing Supervisor NFP Program, City of Hamilton Public Health Services; dianne.busser@hamilton.ca; 905-546-2424 x3655
  • NFP Research and Evaluation: Dr. Susan Jack, Associate Professor, School of Nursing, McMaster University;jacksm@mcmaster.ca; 905-525-9140 x 26383

British Columbia:

General Enquiries: Please email nfpcan@mcmaster.ca and your enquiry will be redirected to the most appropriate NFP contact in Canada/Internationally.

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: enquiries@fnp.nhs.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 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:

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 in Scotland will be offered the program from 2018.

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: Carolyn Wilson at Carolyn.Wilson@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 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: eleanor.yost@ucdenver.edu

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