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Nurse Family Partnership (NFP)®

Meets DHHS criteria for an evidenced based model

In Brief

Last Updated

May 2016

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Evidence of Model Effectiveness

This model meets the criteria established by the Department of Health and Human Services (HHS) for an “evidence-based early childhood home visiting service delivery model” for the general population, but does not meet the criteria for tribal populations.

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Model Description

The Nurse-Family Partnership (NFP) is designed for first-time, low-income mothers and their children. It includes one-on-one home visits by a trained public health registered nurse to participating clients. The visits begin early in the woman’s pregnancy (with program enrollment no later than the 28th week of gestation) and conclude when the woman’s child turns 2 years old. NFP is designed to improve (1) prenatal health and outcomes, (2) child health and development, and (3) families’ economic self-sufficiency and/or maternal life course development. For more information, please read the Model Overview.

This report also includes a review of an alternate implementation of NFP, which had paraprofessionals, rather than nurses, conduct the home visits. The paraprofessionals received the same length of training as the nurses and carried the same caseloads, but had a higher supervisor-to-home visitor ratio.

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Extent of Evidence

Results of Search and ReviewNumber of Studies for NFP with Nurse Home VisitorsNumber of Studies for NFP with Paraprofessional Home Visitors
Released from 1979 to 2015 1745
Eligible for review 365
     Rated high 194
     Rated moderate 50
     Rated low 91
     Additional sourcesa 30

aAdditional sources overlap with another study and are not rated.

For more information, see the study database. For more information on the criteria used to determine the study ratings, please read Producing Study Ratings.

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Summary of Findings



Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 6
No effect: 65
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 17
Unfavorable or ambiguous: 1

Child Health

Favorable: 5
No effect: 26
Unfavorable or ambiguous: 1

Favorable: 5
No effect: 45
Unfavorable or ambiguous: 1

Family Economic Self-Sufficiency

Favorable: 4
No effect: 16
Unfavorable or ambiguous: 1

Favorable: 17
No effect: 78
Unfavorable or ambiguous: 1

Linkages and Referrals

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 1

Maternal Health

Favorable: 8
No effect: 18
Unfavorable or ambiguous: 0

Favorable: 18
No effect: 61
Unfavorable or ambiguous: 0

Positive Parenting Practices

Favorable: 5
No effect: 18
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 7
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment

Favorable: 7
No effect: 18
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0

Reductions in Juvenile Delinquency, Family Violence, and Crime

Favorable: 0
No effect: 5
Unfavorable or ambiguous: 0

Favorable: 9
No effect: 62
Unfavorable or ambiguous: 1


NFP with Nurse Home Visitors - Mothers with low psychological resources subgroup*
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 22
No effect: 34
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 7
Unfavorable or ambiguous: 0

Child Health Not measured Not measured
Family Economic Self-Sufficiency

Favorable: 0
No effect: 6
Unfavorable or ambiguous: 1

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Linkages and Referrals Not measured Not measured
Maternal Health Not measured Not measured
Positive Parenting Practices Not measured Not measured
Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 3
Unfavorable or ambiguous: 0


NFP with Paraprofessional Home Visitors
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 0
No effect: 30
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 4
Unfavorable or ambiguous: 0

Child Health

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 1
Unfavorable or ambiguous: 0

Family Economic Self-Sufficiency

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 2
No effect: 11
Unfavorable or ambiguous: 1

Linkages and Referrals Not measured Not measured
Maternal Health

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 3
No effect: 11
Unfavorable or ambiguous: 0

Positive Parenting Practices

Favorable: 1
No effect: 3
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 2
Unfavorable or ambiguous: 0


NFP with Paraprofessional Home Visitors - Mothers with low psychological resources subgroup*
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 3
No effect: 30
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 3
Unfavorable or ambiguous: 0

Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health Not measured Not measured
Positive Parenting Practices Not measured Not measured
Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured
*Subgroup findings have been replicated in at least two different samples.
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This table summarizes the effects found in research across outcome domains. Outcomes with a favorable impact are listed in green and outcomes with an unfavorable or ambiguous impact are listed in red. Outcomes that have high attrition or lack of baseline equivalence are excluded from this report.

Favorable Impact: A statistically significant impact on an outcome measure in a direction that is beneficial for children and parents. This impact could statistically be positive or negative, and is determined “favorable” based on the end result. For example, a favorable impact could be an increase in children’s vocabulary or daily reading to children by parents, or a reduction in harsh parenting practices or maternal depression.

Unfavorable or Ambiguous Impact: A statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents. This impact could statistically be positive or negative, and is determined “unfavorable or ambiguous” based on the end result. NOTE: While some outcomes are clearly unfavorable, for other outcomes it is not as clear which direction is desirable. For example, an increase in children’s behavior problems is clearly unfavorable, while an increase in number of days mothers are hospitalized is more ambiguous. This may be viewed as an unfavorable impact because it indicates that mothers have more health problems, but it could also indicate that mothers have increased access to needed health care due to their participation in a home visiting program.

Primary Outcome Measure: For the HomVEE review, an outcome measured through direct observation, direct assessment, or administrative data; or self-reported data collected using a standardized (normed) instrument.

Secondary Outcome Measure: For the HomVEE review, most self-reported data, excluding self-reports based on a standardized (normed) instrument.

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Criteria Established by the Department of Health and Human Services

 NFP with Nurse Home VisitorsNFP with Paraprofessional Home Visitors
Information Based on Comprehensive Review of All High- and Moderate-Impact Studies for this Model
High- or moderate-quality impact study? YesYes
Across high- or moderate-quality studies, favorable impacts in…
 
   at least two outcome domains within one sample
 
   OR
 
   the same domain for at least two non-overlapping samples?
YesYes
Favorable impacts on full sample? YesYes
Any favorable impacts on outcome measures sustained at least 12 months after program enrollment?a YesYes
One or more favorable, statistically significant impact reported in a peer-reviewed journal?a YesYes

aThis information is reported for all models, but the requirements for sustained findings and inclusion in a peer-reviewed journal only apply to models for which all findings are from randomized controlled trials.

Please read the HHS Criteria for Evidence-Based Programs for more information.

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