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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Nurse-Family Partnership

Approach. Create a home visiting program for expecting and new mothers

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Overview. The Nurse-Family Partnership (NFP) is a voluntary home visiting program that supports first-time mothers experiencing economic challenges 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.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of low-income, first-time mothers enrolled in the NFP program. (Measures the reach and scale of the program's recruitment efforts.)
  • Number of home visits completed by NFP nurses. (Quantifies the volume and frequency of the core program service.)
  • Number of community referral sources actively sending eligible mothers to the NFP program. (Tracks the extent of outreach and engagement of key partners.)

OUTCOME MEASURES:

  • Number of mothers who receive their first NFP visit during pregnancy. (Assesses the program's success in early intervention and prevention.)
  • Number of mothers who complete the full NFP program until their child's second birthday. (Measures retention and dosage of services over time.)
  • Number of children in NFP who receive timely developmental screenings and immunizations. (Links NFP to key child health and development outcomes.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of NFP services delivered in adherence to the program's core model elements. (Assesses fidelity to the evidence-based model.)
  • Percent of NFP nurses who receive specialized training in maternal-child health and home visiting. (Measures workforce competency and readiness to deliver quality services.)
  • Percent of NFP families who receive at least 50% of the recommended number of visits. (Tracks adherence to the program's dosage standards.)

OUTCOME MEASURES:

  • Percent of mothers who report a strong, trusting relationship with their NFP nurse. (Assesses the quality of the therapeutic alliance, a key ingredient for success.)
  • Percent of NFP families connected to community resources that address social determinants of health. (Measures the program's effectiveness in facilitating access to services.)
  • Percent of NFP infants born full-term and at a healthy birth weight. (Tracks the program's influence on key birth outcomes related to infant health.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of NFP implementing agencies that meet or exceed national performance benchmarks. (Measures the number of sites achieving high-quality implementation.)
  • Number of health care providers and systems with formal referral pathways to NFP. (Assesses the program's level of health system integration and coordination.)
  • Number of NFP sites offering program enhancements like mental health support or father engagement. (Tracks the customization of NFP to meet local needs.)

OUTCOME MEASURES:

  • Number of NFP mothers who initiate breastfeeding and continue for at least 6 months. (Measures a key maternal health behavior promoted by NFP.)
  • Number of NFP children meeting age-appropriate language and literacy milestones. (Assesses the program's impact on early childhood development and school readiness.)
  • Number of subsequent pregnancies spaced at least 2 years apart among NFP mothers. (Captures the program's influence on family planning and birth spacing.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • - Percent of NFP enrollees who reflect the racial, ethnic, and geographic diversity of eligible mothers in the community. (Assesses equitable access and cultural responsiveness of NFP.)
  • - Percent of NFP sites that provide program materials and services in languages prevalent in the community. (Measures linguistic accessibility and appropriateness of NFP.)
  • - Percent of NFP community advisory boards with representation from program graduates and local residents. (Tracks meaningful involvement of families in program governance.)

OUTCOME MEASURES:

  • - Percent reduction in disparities in prenatal care utilization and birth outcomes among NFP participants. (Assesses the program's impact on maternal health equity.)
  • - Percent of NFP children achieving school readiness benchmarks, compared to similar populations. (Captures NFP's impact on long-term educational and developmental outcomes.)
  • - Percent reduction in public assistance costs attributable to NFP participation, per economic analysis. (Measures the societal and economic return on investment of the program.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Nurse-Family Partnership (NFP). Helping first-time parents succeed. https://www.nursefamilypartnership.org/

2 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.

3 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.

4 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.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.