AHRQ Innovations Exchange | How the Nurse-Family Partnership Became a National Model for Maternal Child Health Programs: An Interview With Peggy Hill , MS, Chief Strategic Relations Officer, Nurse-Family Partnership National Service Office, Denver, CO

How the Nurse-Family Partnership Became a National Model for Maternal Child Health Programs: An Interview With Peggy Hill , MS, Chief Strategic Relations Officer, Nurse-Family Partnership National Service Office, Denver, CO

By the Innovations Exchange Team

Innovations Exchange: Can you briefly describe the Nurse-Family Partnership program and the key elements of the program model?

Peggy Hill: The partnership, which operates in 392 counties in 32 states as of March 2011, is an evidence-based home visitation program conducted by nurses that targets low-income first-time mothers.1 The program is designed to improve pregnancy outcomes and child health and development by improving the mother’s prenatal health, caregiving skills, and economic self-sufficiency. Nurses help the women develop a vision for their futures, plan future pregnancies, stay in school, and find employment.2

The program model consists of 18 elements that describe the target population, and the process, frequency, and structure for conducting home visits as well as the surrounding community supports that are critical to the program’s effectiveness and sustainability.

David Olds, PhD, a professor and researcher at the University of Rochester in New York, developed the model in 1977. The model of home visitation by nurses was rigorously tested over 30 years in three research locations representing semirural and urban settings with white, African-American and Hispanic families in the United States. In 1996, Dr. Olds saw sufficient longitudinal evidence of the program’s effectiveness to justify public funding.

What supports were needed to spread the model?

Dr. Olds knew he would need to create a series of resources and consultative supports to enable new practitioners around the country—in this case, teams of nurses—to learn how to deliver the model program in diverse families and settings.

The opportunity came following the initiation of Dr. Olds’ third randomized controlled trial in Denver, CO, beginning in 1993. The Colorado Trust provided significant funding for the study, with the additional expectation that lessons learned would benefit others throughout the state and beyond. Dr. Olds accepted an invitation to join the faculty of the University of Colorado Health Sciences Center in Denver and established the Prevention Research Center for Family and Child Health in the Department of Pediatrics. Beginning in 1996, his team of researchers and nurses created a system of support for program replication that included a clear articulation of the program model’s key elements, well-specified home visit guidelines, and education specific to the model for nurse home visitors learning to implement the program model with families in other communities. Dr. Olds and his colleagues also developed training for the supervisors of nurse home visitors to learn how to conduct reflective supervision and function as coaches for their nurses as they developed their skills.

The most critical support was a nationally led quality improvement data system that is still used today by every local agency implementing the Nurse-Family Partnership (NFP). The agencies gather data on key aspects of program implementation and outcomes that help them determine if they are conducting the program well and achieving outcomes that are comparable with those achieved in the randomized controlled trials. They use that data locally to monitor and improve their practice, and we use it nationally to inform ongoing development and refinement of the model and our consulting practice.


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AHRQ Innovations Exchange | How the Nurse-Family Partnership Became a National Model for Maternal Child Health Programs: An Interview With Peggy Hill , MS, Chief Strategic Relations Officer, Nurse-Family Partnership National Service Office, Denver, CO