Nurse–Family Partnership (NFP) provides low-income, first-time mothers of any age with home-visitation services from public health nurses. The program addresses substance abuse and other behaviors that contribute to family poverty, subsequent pregnancies, poor maternal and infant outcomes, suboptimal childcare, and limited opportunities for the children.
NFP is based on the integration of three theories. First is the theory of human ecology that emphasizes the impact of the social context on human development. This context includes relationships with other family members, friends, neighborhoods, communities and cultures. The second is the self-efficacy theory, which posits that people are more likely to engage in a desirable behavior if they believe the behavior will produce a desired outcome. The program helps parents set realistic goals and bolsters parents’ confidence in their ability to reach those goals. The third, attachment theory, holds that children who receive sensitive and responsive parenting are more likely to embody these qualities themselves.
The nurses work intensively with the mothers to improve maternal, prenatal, and early childhood health and well-being, with the expectation that this intervention will help achieve long-term improvements in the lives of at-risk families.
The intervention process concentrates on developing therapeutic relationships with the family and is designed to improve five broad domains of family functioning:
- Parental roles · Family and friend support
- Physical and mental health
- Home and neighborhood environment
- Major life events (e.g., pregnancy planning, education, employment)
Home visits by nurses are conducted during the woman’s pregnancy and continue until the child reaches 24 months of age. Maternal and child health nurses meet with each first-time mother in 64 planned home visits over 2 ½ years. Prenatally, they focus on preventive health and prenatal practices for the mother–helping her find appropriate prenatal care, improve her diet, and reduce her use of tobacco, alcohol, and illegal substances. Additionally, maternal and child health nurses help the mother prepare emotionally for the arrival of the baby. Post-birth, they focus on health and development education, focusing on child development milestones and behaviors and teaching parents to use praise and other nonviolent techniques. They also focus on coaching the mothers and their families in planning for their future, staying in school, finding employment, and planning future pregnancies.
Although the primary client is the first-time mother, ultimately her baby and all the members of her support system (e.g., friends, parents, and the child’s father) become involved in the program.
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Overall, the Olds and colleagues (2004) study found contradictory results. There were greater effects on paraprofessional-visited mothers than on nurse-visited mothers, but for children the effects were greater in the nurse-visited families than in the paraprofessional-visited families.
Maternal Life Course
For the treatment group that received visits from paraprofessionals, results showed that 2 years after the end of the program, women who received visits from paraprofessionals were more likely to work between the child’s second and fourth birthday. They also had significantly higher scores that indicated a greater sense of mastery, and better mental health scores compared to control subjects. However, women visited by paraprofessionals were less likely than control subjects to be married and to live with the child’s biological father. There were no statistically significant paraprofessional effects on women’s educational achievement, use of welfare, use of marijuana or alcohol, behavior problems attributable to substance use, or experience of domestic violence.
When compared to control subjects, nurse-visited women had greater lapses between their first and second births, when a second birth occurred. Nurse-visited women also reported significantly less domestic violence from patterns during the 6-month time period before the 4-year interview. Nurse-visited mothers also reported enrolling their children significantly less frequently in preschool, Head Start, or licensed day care. However, there were no significant nurse effects on women’s educational achievement, employment, use of welfare, mental health, mastery, use of marijuana or alcohol, behavior problems attributable to substance use, marriage, or living with a partner or father of the child.
Home Environments, Mother–Child Interaction, and Child Development
Paraprofessional-visited mothers displayed significantly more sensitive and responsive interactions with their children during free-play sessions than the control group mothers. Low-resource paraprofessional-visited mothers (those who had low psychological resources at registration of the original study) had home environments that were significantly more supportive of early learning than their control group counterparts. There were no significant paraprofessional effects on children’s language, executive functioning, emotional regulation, behavioral adaptation, or on mothers’ reports of externalizing behavior problems.
Nurse-visited mothers who had low psychological resources at study registration also had home environments significantly more conducive to early learning, better language development, superior executive functioning, and better behavioral adaptation during testing when compared to the control group. There were no statistically significant nurse effects on sensitive–responsive mother–child interaction, children’s emotional regulation, or externalizing behavior problems.
Child Substance Use
The study by Kitzman and colleagues (2010) found that in the 30 days preceding the 12-year interview, Nurse-Family Partnership (NFP) program children were significantly less likely to have used cigarettes, alcohol, or marijuana; to have used less of these substances; and to have used these substances for fewer days.
Child Mental Health
Nurse-visited children reported fewer internalizing problems than control group children. However, there were no significant differences in children’s sustained attention, externalizing problems, and total behavior problems.
Child Academic Achievement
Nurse-visited children born to low-resource mothers had significantly higher Peabody Individual Achievement Test scores in reading and math at age 12, and significantly higher grade-point averages and group-based reading and math achievement test scores in grades 1 through 6 when compared to their control group counterparts. There was no statistical difference in conduct grades.
Child Abuse and Neglect
Eckenrode and colleagues (2000) found at the 15-year follow-up that there were significantly fewer child maltreatment reports involving the mother as the perpetrator or involving the study child for families receiving home visitations during pregnancy and infancy compared with families not receiving home visitations. For families receiving home visitations only during pregnancy, the number of maltreatment reports for the group fell between the other two groups but was not significantly different compared with the control group.
Home visitation made no impact on the incidence of domestic violence. Specifically, for mothers who received visits through the child’s second birthday, the treatment effect decreased as the level of domestic violence increased. Almost half (48 percent) of the mothers in the entire study sample report some form of domestic violence since birth of the study child. The average number of incidents over the 15 years was 22.2. For those women reporting any domestic violence, the average number of incidents was 43.1. Overall, the presence of domestic violence may limit the effectiveness of the NFP intervention to reduce incidence of child abuse and neglect.
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