from science to practice

© Copyright 2011 Nurse-Family Partnership. All rights reserved.

NURSE FAMILY PARTNERSHIP INTERNATIONAL

From Science to

Practice

II International Symposium on

Early Childhood

Development

Sao Paulo 2012 In collaboration with the Prevention

Research Centre for Child and

Family Health, University of Colorado

"There is a magic window during pregnancy…it’s a time when the desire to be a good mother and raise a healthy, happy child creates motivation to overcome incredible obstacles including poverty, instability or abuse with the help of a well-trained nurse."

David Olds, PhD, Founder,

Nurse-Family Partnership


NURSE FAMILY PARTNERSHIP

•Program with power

–Nurses visit families from early pregnancy through child age two

–Makes sense to parents

–Solid empirical & theoretical underpinnings

–Focuses on parental behavior and context

•Rigorously tested


FAMILIES SERVED

•Low income

pregnant women

–Usually teenagers

•First-time parents

NURSE FAMILY PARTNERSHIP

In collaboration with the Prevention



Cover this gray area with one of the 8 provided filmstrip photo JPG files.


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Program Goals

• Improve pregnancy

outcomes

• Improve child

health and

development

• Improve parents’

economic self-

sufficiency

• First-time, at-risk

mothers

• Registered nurses

• Intensive services

(intensity, depth and

duration)

• Focus on behavior

• Program fidelity

• Knowledge,

judgment and skills

• High level of trust,

low stigma

• Credibility and

perceived authority

• Nursing theory and

practice at core of

original model

Overview

Key Program

Components Why Nurses?


Research Centre for Child and Family Health,

University of Colorado


Home Visit Overview

6 Overview

Personal Health

Health Maintenance Practices

Nutrition and Exercise Substance Use

Mental Health Functioning

Environmental Health

Home

Work, School, and

Neighborhood

Life Course Development

Family Planning Education and Livelihood

Maternal Role

Mothering Role

Physical Care Behavioral and Emotional

Care

Family and Friends

Personal network Relationships

Assistance with Childcare

Health and Human Services

Service Utilization




Child

Neurodevelopmental

Impairment

Emotional/Behavior

Dysregulation

Cognitive

Impairment

Program

Prenatal

Health-Related

Behaviors

Dysfunctional

Caregiving

Maternal

Life Course

Closely Spaced

Unplanned Pregnancy

Welfare Dependence

Substance Abuse

Negative

Peers

Antisocial

Behavior

Substance

Abuse

Child/Adolescent

Functioning


Programme Capitalizes On

•Neurogenetic systems that

promote

–Survival

•Food, Water, Shelter

•Social Bonding

•Attachment

–Protection of Offspring


Research Centre for Child and Family

Health, University of Colorado


On-going trials of the Programme

1977

Elmira, NY

Participants: 400

Population: Low-income

whites

Studied: Semi-rural area

9

1988

Memphis, TN

Participants: 1,139

Population: Low-income blacks

Studied: Urban area

1994

Denver, CO

Participants: 735

Population: Large portion of Hispanics

Studied: Nurse and paraprofessionals

Research





CONSISTENT RESULTS ACROSS TRIALS

Improvements in women’s prenatal health

Reductions in children’s injuries

Fewer subsequent pregnancies

Greater intervals between births

Increases in fathers’ involvement

Increases in employment

Reductions in welfare and food stamps

Improvements in school readiness (low resource mothers)

Effects greatest for most susceptible





Washington State Institute for Public

Policy Economic Analysis

Nurse Family Partnership produced

large return on investment:

–Implementation costs $9, 118

–Benefits $26, 298

–Return on investment $17, 180

*Benefits and Costs of Prevention and Early Intervention Programs for Youth, S. Aos, et al.. Washington State Institute for Public Policy:

Olympia, WA, 2004.



12 Research



13 Research



14 Research



15 Monetary Benefits to Society

Monetary Savings


Implementation of NFP in England

• Led by Government as part of

wider child and family policy

• Started with 10 teams in 2006/7,

today there are 80 teams with

over 400 nurses serving 9,500

families

• National implementation unit

• Service funded from local NHS budgets

• License and consultancy from

University of Colorado (Prof David

Olds)

• Formative evaluation and

research trial

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Achievements

• High levels of engagement and retention (87%)

• Can deliver the NFP with fidelity

• High level of demand from organisations

• Clients who can have an alternative story of

themselves and different futures for the babies

• Clients and dads who can be authoritative, loving

parents

• Nurses who love their jobs

• A service model that others are learning from

• Promising early evaluation and RCT underway

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The Challenges

• What it takes to make a difference

• Adapting to different context from US

• Improving quality as FNP becomes permanent and

grows

• Building capacity for replication of evidence based

programmes nationally and locally

•Sustainable funding

•Building local ownership

•Relationship of evidence based programmes to

mainstream services

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Pattern of Denver Program

Effects

Maternal

and

Child

Functioning

Comparison Para Nurse

100

0

-100

-200

-300

-400

Change in Cotinine From

Intake to End of Pregnancy

Control

-36.6 Para

-73.8

Nurse

-235.6*

*Pc-n < .05

Change

In

Cotinine

Pediatrics, 2002;110: 486-496.


•Rigorous evidence (cost benefits, who benefits and how)

•Core model elements for replication of research

•Programme guidelines

•Systems for continual quality assurance and improvement (information)

•Government sponsorship and committed communities

•High quality training and technical assistance

From Science to Practice: what helps


From Science into Practice: Personal reflections

• The quality of NFP and its resonance with policy

makers, funders, nurses and families

• Focus on practice with families

• The role of the national leadership team

• Building a ‘research mind set’ from the beginning

• Prepare for sustainability from the beginning

• Test on a big enough scale

• Work in progress – on-going research programme

• Thinking about the workforce

• Impact on the whole system

• Being part of an international community

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For More Information

[email protected]

www.nursefamilypartnership.org




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http://www.nursefamilypartnership.org/index.cfm?fuseaction=home

from science to practice

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family health

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emotional care family

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welltrained nurse

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