NFP Model

Overview

The Nurse-Family Partnership (NFP) is a nurse home visiting program that is based on over 37 years of rigorous research from randomized controlled trials conducted in the United States, the Netherlands, and England. There are three program goals: 1) to improve pregnancy outcomes; 2) to improve child health and development; and 3) to improve families’ economic self-sufficiency. This research shows that first-time mothers working with a NFP nurse can transform their lives and the lives of their children. That NFP Conceptual Model summarizes how program influences on maternal & child health and development are thought to reinforce one another over time.

NFP is a licensed evidence-based program that includes a set of core model elements; Visit-to-Visit guidelines; Client-centred principles; underlying theories, and specifications for NFP nurse competencies, education and data collection. Specially educated NFP nurses visit clients in their home starting early in the pregnancy and continuing until the child’s second birthday. NFP nurses utilize a strength-based approach directed toward optimizing the client and family’s self-efficacy. The program is designed to activate and develop parents’ natural instincts to protect their children.  Through the establishment of a therapeutic relationship with the client, NFP nurses: 1) provide empathic support and life coaching; 2) provide health education and anticipatory guidance to promote positive health, and caregiving practices 3) guide clients with system navigation; and 4) undertake continuous assessment of child development and parenting and adjust visit content and approaches accordingly. During home visits the NFP nurse provides structured support and guidance across the six program domains: personal health, environmental health, life course development, maternal role, family & friends, and health & human services.

NFP is committed to ensuring that nurses are able to sustain high quality practice for the benefit of the families served in the program. As a consequence, implementing organizations are expected to commit to a number of supporting systems and processes, including the participation in reflective supervision on a weekly basis, case conferences and team meetings. NFP is also committed to continuous refinement of the program through ongoing research internationally and the development of innovations and program enhancements such the STAR Framework. We now have over 10 years of experience of implementing the NFP in nine countries, serving more than 40,000 vulnerable children and families. This has given us valuable learning about how to implement the NFP program with quality and fidelity in different international contexts using a process of adaptation, testing and evaluation.  

The NFP Core Model Elements (CMEs) are supported by evidence of effectiveness based on research, expert opinion, field lessons, and/or theoretical rationales. When NFP is implemented with fidelity to these CMEs, implementing agencies/countries can have a high level of confidence that results will be comparable to those measured in research. The CMEs were revised in 2017 through an extensive review process.

  1. Client participates voluntarily in the Nurse-Family Partnership (NFP) program.
  2. Client is a first-time mother.
  3. Client meets socioeconomic disadvantage criteria at intake.
  4. Client is enrolled in the program early in her pregnancy and receives her first home visit by no later than the end of the 28th week of pregnancy.
  5. Each client is assigned an identified NFP nurse who establishes a therapeutic relationship through individual NFP home visits.
  6. Client is visited face-to-face in the home, or occasionally in another setting (mutually determined by the NFP nurse and client), when this is not possible.
  7. Client is visited throughout her pregnancy and the first two years of her child's life in accordance with the current standard NFP visit schedule or an alternative visit schedule agreed upon between the client and NFP nurse.
  8. NFP nurses and supervisors are registered nurses or registered nurse-midwives with a minimum of a Baccalaureate/bachelor's degree.
  9. NFP nurses and supervisors develop core NFP competencies by completing the required educational curricula and participating in on-going learning activities.
  10. NFP nurses, using professional knowledge, judgment, and skill, utilize the Visit-to-Visit Guidelines; individualizing them to the strengths & risks of each family, and apportioning time appropriately across the six program domains.
  11. NFP nurses and supervisors apply the theoretical framework that underpins the program (self-efficacy, human ecology, and attachment theories) to guide their clinical work and achievement of the three NFP goals.
  12. Each NFP team has an assigned NFP Supervisor who leads and manages the team and provides nurses with regular clinical and reflective supervision.
  13. NFP teams, implementing agencies, and national units collect and utilize data to: guide program implementation, inform continuous quality improvement, demonstrate program fidelity, assess indicative client outcomes, and guide clinical practice/reflective supervision.
  14. High quality NFP implementation is developed and sustained through national and local organized support.

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