WHITE PAPER:

NURSE-FAMILY
PARTNERSHIP
Rachel Neale
THE SITUATION
Maternal and neonatal deaths in the
United States are higher than most other
developed countries (Petrullo, 2023). We
need to find a way to improve outcomes
for pregnant patients, which will improve
society as a whole.
THE PROBLEM
Low-income pregnant patients are at
increased risk for adverse outcomes
including pre-term birth and low-birth
weight neonates (Sullivan et al., 2018).
THE SOLUTION
Nurse-Family Partnership (NFP), a nurse-
home visitation program is evidence-
backed to improve several different
outcomes. This program is provided to
income eligible first time parents starting
by 28 weeks gestation and continued up to
2 years postpartum.

Currently only 50 out of 67

counties in Pennsylvania offer this
program.
THE RESULTS
-improved maternal employment
-decreased child injuries and neglect
-decreased child mental health problems
(Hernandez et al., 2018)
INTRODUCTION/
BACKGROUND
Nurse-Family Partnership 7

UNDERSTANDING THE PROBLEM

• Who is affected: Everyone in society is
impacted by pregnancy/neonatal outcomes
and their long-lasting impact, but
specifically families of low socioeconomic
status are impacted
• Causes of the problem: women of low SE
status often have lower access to healthcare,
transportation challenges, childcare,
generalized stress from financial burdens,
all of which increase risks for adverse
outcomes
 NFP HISTORY
• Started in 1996, initiated in PA in 1999
• Includes 64 nurse-home visits for eligible patients: 14 intrapartum and 50
postpartum (Hernandez et al., 2018)
• Eligible patients are up to 235% of federal poverty level, must sign up by 28 weeks
of pregnancy (Maternal and Family Health Services, n.d)
• “Graduate” from program when child is 2 years old (Hernandez et al., 2018)
• First-time parents only
• Nurse provides education on pregnancy, delivery, postpartum, and early childhood
parenting
 Nurse-Family Partnership 9

RECOMMENDATION
• Increase NFP program to all counties in Pennsylvania (currently only 50 out of 67 counties have access to
NFP)
• If government cannot approve the increase in funding, consider decreasing the income requirement to 200%
of federal poverty level compared with 235%
• Could also consider making end of program a range at 1.5-2 years for those parents who appear to be at a
“saturation point” and would not benefit much from extra time in program (Hernandez et al., 2018)
Nurse-Family Partnership 10

METHODOLOGY
-Searched CINAHL database using key phrase “Nurse-Family Partnership” and
“Healthy Beginnings Plus”
-utilized peer-reviewed journal articles
-Pennsylvania Department of Human Services website
-Nurse-Family Partnership website
Nurse-Family Partnership 11

LITERATURE
REVIEW
Nurse-Family Partnership

CURRENT SUPPORTING
EVIDENCE
• Karoly et al. (2005) states that HFP has a high benefit-cost ratio for high-risk
sample patients compared with low-risk sample patients (5.70 vs. 1.26)
• Karoly et al. (2005): NFP has statistically significant achievement test scores,
positive childhood behaviors, decreased child abuse, decreased ER visits and
hospital stays for children, and fewer child arrests
• Hernandez et al. (2018) many nurses in NFP believe the number of visits and
length of program is unrealistic for their clients, reporting “chaotic lives” get in the
way of completing the full 2 years
• Hernandez et al. (2018)-many nurses report a “saturation point” for clients where
the benefits of the program max out prior to completion
Presentation title 13

EVIDENCE (CONT.)
• Thorland et al. (2017): NFP clients are more likely to have ever breastfed and more
likely to be up to date on immunizations at 6 months
• Thorland et al. (2017): NFP clients did not show statistically significant changes in
pre-term birth or low birth weight, but were less likely to be diagnosed with
gestational hypertension in pregnancy
• NFP has evidence largely supporting positive impacts and outcomes on
participants (Hernandez et al., 2018)
Nurse-Family Partnership 14

OTHER POLICIES
• Healthy Beginnings Plus is a state-funded program specifically in Pennsylvania to
support low-income pregnant patients throughout their pregnancy and up to 6
weeks postpartum. This is available for current parents, not just first-time parents.
The income eligibility is lower, at 185% of federal poverty guidelines (Sullivan et
al., 2023; Pennsylvania Department of Human Services, n.d.)
• Mixed evidence supporting its effectiveness (Sulliven et al., 2023)
Nurse-Family Partnership 15

NFP AROUND THE WORLD

• NFP supported in majority of U.S. (Hernandez et al., 2018)
• NFP also found in United Kingdom and Australia (Hernandez et al., 2018; Massi
et al., 2023)
Nurse-Family Partnership 16

POLICY OPTIONS
Recommended policy: Pennsylvanians will
have access to NFP in all counties,
allocating funds from lower-risk patients
and by decreasing the income limit to
200% of federal poverty level
Nurse-Family Partnership

PROS/CONS
PROS CONS

• Increased access to NFP resources • Increased state spending

• Improved • Significant effort to start up program in
pregnancy/postpartum/childhood new counties
outcomes • Taking away NFP from those that would
• Improved childhood readiness for school meet the income requirement prior to
• Net benefit to society financially and policy change
socially • Possible wasted funds for those that
don’t utilize NFP effectively
Nurse-Family Partnership 18

ANALYSIS OF FINDINGS

• NFP is an evidence-backed program that has net financial benefits to society as well as nonmeasurable
social benefits
• High-risk patients benefit from the program more and have higher cost-benefit ratios than the low-risk
sample
• NFP not currently available in all parts of the state
• Increase access to all high-risk patients in PA will bring about the most benefit from the program, even if
it means cutting some of the low-risk patients from the program
Nurse-Family Partnership 19

ANALYSIS (CONT.)

POPULATION COST/ ETHICS/ ADMINISTRATIVE CONSTITUENT

BENEFIT ECONOMICS QUALITY FEASIBILITY PERSPECTIVES
Providing extra Pennsylvania is Healthcare providers,
Improved childhood Though there is a resources for already funding 50 nurses, community
readiness for school significant cost to impoverished out of a total 67 members will all
will benefit all of fund NFP, evidence communities counties. It seems likely be supportive
society, help break shows there is a net improves equity, an reasonable to adjust of an evidence-
cycle of poverty benefit to society and important part of income requirements backed program to
(Karoly et al., 2005) government savings healthcare ethics. to include the improve
per family impacted remaining 17 maternal/neonatal
(Karoly et al., 2005; counties to NFP outcomes
NFP, n.d.) access.
Nurse-Family Partnership 20

ADVOCACY
(NFP, 2022)
 22

(NFP, n.d.b)
Nurse-Family Partnership 23

IMPLEMENTATION/
NEXT STEPS
 TIMELINE

PRESENT NOW-2026 2025-2026 2026-2029 2029-2031

Policy writing, meet If approved, will begin
with stakeholders, process of finding
present to government locations for NFP
offices, hire/train staff,
begin to phase out
ineligible patients (take
approximately 2.5 years)
Communicate with Begin implementing Evaluate effectivness of
community and local NFP program in new NFP initiation in new
healthcare providers counties counties (takes 3-5 years
about NFP to increase from program start to
referrals see potential benefits)
-advertise NFP in new
locations
 25

CONCLUSION
Low-income pregnant patients and first-
time mothers are at risk for long-lasting
adverse outcomes due to their
socioeconomic status. NFP is a solution to
help bridge the gap and set them up for
life-long success.
State representatives need to support this
policy to make a difference in some of
society’s most vulnerable populations.
 REFERENCES
• Hernandez, D., Topping, A., Hutchinson, C.L., Martin, A., Brooks-Gunn, J., Petitcler, A. (2018). Client
attrition in the nurse-family partnership: Revisiting metrics of impact in a home visitation program in the
United States. Health and Social Care 27: 483-493. DOI: 10.1111/hsc.12748
• Karoly, L.A., Kilburn, M.R., Cannon, J.S. (2005). Early Childhood Interventions: Proven results.
• Pennsylvania Department of Human Services (n.d.) Health Beginnings Plus. Pennsylvania Department
of Human Services. Accessed 11/9/23 from
https://www.dhs.pa.gov/providers/Providers/Pages/Medical/Healthy-Beginnings.aspx
• Petrullo, J. (2023). US has highest infant, maternal mortality rates despite the most health care
spending. AJMC. https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-
most-health-care-spending#
• Massi, L., Hikey, S., Maidment, S.J., Roe, Y., Kidlea, S., Kruske, S. (2023). “This has changed me to be
a better mum:: A qualitative study exploring how the Australian nurse-family partnership program
contributes to the development of first nations women’s self-efficacy. Women & Birth 36(6). Doi:
10/1016/j.wombi.2023.05.010
• Maternal and Family Health Services (n.d.). NFP Eligibility. MFHS.
https://www.mfhs.org/programs/nurse-family-
partnership/eligibility/#:~:text=The%20Nurse%2DFamily%20Partnership%20is,of%20the%20federal%20
poverty%20level.
• Nurse-Family Partnership (n.d.). Pennsylvania. Nurse-Family Partnership. Accessed 11/9/23 from
https://www.nursefamilypartnership.org/locations/pennsylvania/
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REFERENCES (CONT.)
• Nurse-Family Partnership (2022). Research trials and outcomes: The Gold standard of evidence. Nurse-
Family Partnership. Accessed 11/9/23 from https://www.nursefamilypartnership.org/wp-
content/uploads/2022/03/NFP-Research-Trials-and-Outcomes.pdf
• Nurse-Family Partnership (n.d.b). How are they now? 18-year follow-up on memphis families. Nurse-
Family Partnership. Accessed 11/9/23 from https://www.nursefamilypartnership.org/about/proven-
results/18-year-follow-up-study/ Future Promise.
• Sullivan, M., Lange, S., Young, A., Gass, M., Mackeen, A.D., Paglia, M.J. (2023). Pregnancy outcomes
in patients enrolled in the healthy beginnings plus program. Nursing for Women’s Health 27(2). Doi:
10.1016/j.nwh.2023.01.002
• Thorland, W., Currie, D., Wiegand, E.R., Walsh, J., Mader, N. (2017). Status of breastfeeding and child
immunization outcomes in clients of the nurse-family partnership. Journal of Maternal Child Health
21:349-445. Doi: 10/1007/s10995-016-2231-6