From Science to Practice

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

"There is a magic window during pregnancy‌it’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

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

NURSE FAMILY PARTNERSHIP

FAMILIES SERVED • Low income pregnant women –Usually teenagers

• First-time parents

In collaboration with the Prevention Research Centre for Child and Family Health, University of Colorado© Copyright 2011 Nurse-Family Partnership. All rights reserved.

Overview

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Program Goals

Key Program Components

Why Nurses?

• Improve pregnancy outcomes • Improve child health and development • Improve parents’ economic selfsufficiency

• 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

In collaboration with the Prevention Research Centre for Child and Family Health, © Copyright 2011 Nurse-Family Partnership. All rights reserved.

University of Colorado

Overview

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Home Visit Overview Personal Health Health Maintenance Practices Nutrition and Exercise Substance Use Mental Health Functioning

Maternal Role Mothering Role Physical Care Behavioral and Emotional Care

Environmental Health Home Work, School, and Neighborhood

Family and Friends Personal network Relationships Assistance with Childcare

Life Course Development Family Planning Education and Livelihood

Health and Human Services Service Utilization

In collaboration with the Prevention Research Centre for Child and Family Health, University of ColoradoŠ Copyright 2011 Nurse-Family Partnership. All rights reserved.

Prenatal Health-Related Behaviors

Child Neurodevelopmental Impairment Program

Dysfunctional Caregiving

Emotional/Behavior Dysregulation

Child/Adolescent Functioning Antisocial Behavior Substance Abuse

Cognitive Impairment Maternal Life Course Closely Spaced Unplanned Pregnancy

Welfare Dependence

Substance Abuse

Negative Peers

Programme Capitalizes On •Neurogenetic systems that promote –Survival •Food, Water, Shelter •Social Bonding •Attachment

–Protection of Offspring

In collaboration with the Prevention Research Centre for Child and Family © Copyright 2011 Nurse-Family Partnership. All rights reserved.

Health, University of Colorado

Research

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On-going trials of the Programme

1977 Elmira, NY Participants: 400 Population: Low-income whites Studied: Semi-rural area

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

In collaboration with the Prevention Research Centre for Child and Family Š Copyright 2011 Nurse-Family Partnership. All rights reserved.

Health, University of Colorado

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 In collaboration with the Prevention Research Centre for Child and Family © Copyright 2011 Nurse-Family Partnership. All rights reserved.

Health, University of Colorado

Washington State Institute for Public Policy Economic Analysis Nurse Family Partnership produced large return on investment: –Implementation costs –Benefits –Return on investment

$9, 118 $26, 298 $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. © Copyright 2011 Nurse-Family Partnership. All rights reserved.

Research

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

Research

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

Research

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

Monetary Benefits to Society Cover this gray area with one of the 8 provided filmstrip photo JPG files.

Monetary Savings

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

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

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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

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

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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

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

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Pattern of Denver Program Effects Maternal and Child Functioning

Comparison

Para

Nurse

Change in Cotinine From Intake to End of Pregnancy 100 Change In 0 Cotinine

-100

Control -36.6

Para -73.8

-200 Nurse -235.6*

-300

-400

*Pc-n < .05

Pediatrics, 2002;110: 486-496.

From Science to Practice: what helps •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

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

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

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For More Information Kate.billingham@ucdenver.edu

www.nursefamilypartnership.org

In collaboration with the Prevention Research Centre for Child and Family Š Copyright 2011 Nurse-Family Partnership. All rights reserved.

Health, University of Colorado