Nurse-Family Partnership (NFP)

The Nurse-Family Partnership (NFP) is a voluntary home visiting program that supports low income, first-time mothers and their babies. Specially trained registered nurses provide support, advice, and education on diverse topics regarding child and maternal health, development, and care. Visits to families begin during pregnancy and continue until a child’s second birthday (NFP). 

Expected Beneficial Outcomes (Rated)

  • Improved well-being

  • Improved family functioning

  • Improved child development

  • Reduced risky health behaviors

  • Reduced child maltreatment

Other Potential Beneficial Outcomes

  • Improved economic security

  • Increased breastfeeding

  • Reduced rapid repeat pregnancies

  • Reduced hospital utilization

  • Reduced mortality

  • Improved social emotional skills

  • Increased academic achievement

  • Reduced delinquent behavior

Evidence of Effectiveness

There is strong evidence that Nurse-Family Partnership (NFP) improves child health and development, as well as maternal well-being, providing ongoing benefits to mothers and their children in a cost-effective manner (US DHHS-HomVEE NFP, Blueprints, Miller 2015d*, Brookings-Isaacs 2007, Eckenrode 2010, OJJDP Model Programs, US DOJ-Olds 2011, RAND-Karoly 2005, RAND-Karoly 1998, UW Madison-Small 2005, SPTW, WSIPP-Benefit cost).

NFP improves family outcomes, with increased time between births and fewer children (Eckenrode 2017*, Yun 2014*, Olds 2007, UW Madison-Small 2005). NFP participants appear less likely to deliver their babies preterm (Thorland 2017b*) and more likely to initiate and continue breastfeeding than non-visited mothers (Thorland 2017*, Aldrich 2016*). NFP mothers have more stable partner relationships (Olds 2010, Olds 2007), a greater sense of mastery, and are less reliant on welfare (Eckenrode 2017*, Olds 2010, UW Madison-Small 2005). Participants engage in fewer risky behaviors, with less substance abuse during pregnancy (UW Madison-Small 2005) and experience less role impairment due to substance abuse (Olds 2010). NFP appears to reduce mortality in both mothers (Olds 2014*) and children over the long term (Olds 2014*, Olds 2007).

Children of participants are more likely to be up-to-date on immunizations (Thorland 2017*) and less likely to be maltreated or abused (Eckenrode 2017*, UW Madison-Small 2005, RAND-Karoly 2005). The program leads to reductions in emergency room visits and hospital days (RAND-Karoly 2005). Nurse-visited children have fewer emotional disorders and behavioral problems than non-visited peers at age six and nine (Olds 2014b*, US DOJ-Olds 2011). In some cases, they also do better academically, and have stronger language skills and longer attention spans (Olds 2014b*, Olds 2007, RAND-Karoly 2005). They demonstrate more positive behaviors, with fewer arrests (RAND-Karoly 2005), sex partners, and reduced use of alcohol and tobacco during adolescence (UW Madison-Small 2005). Program effects persist for daughters of NFP participants: they are less likely to be arrested and convicted of a crime, have fewer children, and use less Medicaid support (Eckenrode 2010). There appear to be no such effects for sons of NFP participants (Eckenrode 2010).

The Nurse-Family Partnership is cost-effective, reducing government costs (Miller 2015d*, Brookings-Isaacs 2007), and producing positive net benefits (Miller 2015d*, Brookings-Isaacs 2007, US DOJ-Olds 2011, RAND-Karoly 2017, RAND-Karoly 2005, RAND-Karoly 1998, WSIPP-Benefit cost), except for families that were low-risk before participating in the program (Brookings-Isaacs 2007).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of August 2020, Nurse-Family Partnership (NFP) is implemented in 40 states and some Tribal communities (NFP). In response to the COVID-19 pandemic, NFP offers telehealth services, providing mobile phones and cell phone service to participating families as needed and ensuring nurses receive additional support to address sensitive issues via telehealth (NFP-COVID).

Implementation Resources

NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed.

Citations - Evidence

* Journal subscription may be required for access.

US DHHS-HomVEE NFP - US Department of Health and Human Services (US DHHS). Home Visiting Evidence of Effectiveness (HomVEE): Nurse-Family Partnership (NFP).

Blueprints - Center for the Study and Prevention of Violence (CSPV). Blueprints for healthy youth development.

Miller 2015d* - Miller TR. Projected outcomes of Nurse-Family Partnership home visitation during 1996-2013, USA. Prevention Science. 2015;16(6):765-777.

Brookings-Isaacs 2007 - Isaacs JB. Cost-effective investments in children. Washington, DC: Brookings Institution; 2007.

Eckenrode 2010 - Eckenrode J, Campa M, Luckey DW, et al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-Year follow-up of a randomized trial. Archives of Pediatrics & Adolescent Medicine. 2010;164(1):9-15.

OJJDP Model Programs - Office of Juvenile Justice and Delinquency Prevention (OJJDP). OJJDP model programs guide.

US DOJ-Olds 2011 - Olds D, Miller TR, Knudtson M, et al. Impact of the Nurse-Family Partnership on neighborhood context, government expenditures, and children’s school functioning. Washington, DC: US Department of Justice (US DOJ); 2011: Grant No.2005-MU-MU-0001.

RAND-Karoly 2005 - Karoly LA, Kilburn MR, Cannon JS. Early childhood interventions: Proven results, future promise. Santa Monica: RAND Corporation; 2005: Monograph Report 341.

RAND-Karoly 1998 - Karoly LA, Greenwood PW, Everingham SS, et al. Investing in our children: What we know and don’t know about the costs and benefits of early childhood interventions. Santa Monica: RAND Corporation; 1998: Monograph Report 898.

UW Madison-Small 2005 - Small SA, Reynolds AJ, O’Connor C, Cooney SM. What works, Wisconsin: What science tells us about cost-effective programs for juvenile delinquency prevention: A report to the Wisconsin governor’s juvenile commission and the Wisconsin Office of Justice Assistance. Madison: University of Wisconsin-Madison; 2005.

SPTW - Social Programs That Work (SPTW). Full list of programs.

WSIPP-Benefit cost - Washington State Institute for Public Policy (WSIPP). Benefit-cost results.

Eckenrode 2017* - Eckenrode J, Campa MI, Morris PA, et al. The prevention of child maltreatment through the Nurse Family Partnership program: Mediating effects in a long-term follow-up study. Child Maltreatment. 2017;22(2):92-99.

Yun 2014* - Yun K, Chesnokova A, Matone M, et al. Effect of maternal-child home visitation on pregnancy spacing for first-time Latina mothers. American Journal of Public Health. 2014;104(S1):S152-S158.

Olds 2007 - Olds DL, Kitzman H, Hanks C, et al. Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics. 2007;120(4):e832-45.

Thorland 2017b* - Thorland W, Currie DW. Status of birth outcomes in clients of the Nurse-Family Partnership. Maternal and Child Health Journal. 2017;21(5):995-1001.

Thorland 2017* - Thorland W, Currie D, Wiegand ER, Walsh J, Mader N. Status of breastfeeding and child immunization outcomes in clients of the Nurse-Family Partnership. Maternal and Child Health Journal. 2017;21(3):439-445.

Aldrich 2016* - Aldrich H, Gance-Cleveland B. Comparing weight-for-length status of young children in two infant feeding programs. Maternal and Child Health Journal. 2016;20(12):2518-2526.

Olds 2010 - Olds DL, Kitzman HJ, Cole RE, et al. Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine. 2010;164(5):419-24.

Olds 2014* - Olds DL, Kitzman H, Knudtson MD, et al. Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics. 2014;168(9):800-806.

Olds 2014b* - Olds DL, Holmberg JR, Donelan-McCall N, et al. Effects of home visits by paraprofessionals and by nurses on children: Follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics. 2014;168(2):114-121.

RAND-Karoly 2017 - Karoly LA. Investing in the early years: The costs and benefits of investing in early childhood in New Hampshire. Santa Monica, CA: RAND Corporation. 2017.

Citations - Implementation Examples

* Journal subscription may be required for access.

NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed.

NFP-COVID - Nurse-Family Partnership (NFP). Flexibility and resilience: Our response to COVID-19.

Date Last Updated