Rigorous Testing, Undeniable Results

Dr. David Olds created the Nurse-Family Partnership in the late 1970s in Elmira, N.Y. The successful program benefits new mothers and has been replicated in other states.

To help improve the health, well-being and self sufficiency of low-income, first-time mothers and their children, The Duke Endowment is partnering with other private and public funders in a $42 million, seven-year effort to expand the Nurse-Family Partnership program in North Carolina and South Carolina.

Insights

• The strict protocols created by Dr. David Olds, the founder of the program, sometimes intimidate new Nurse-Family Partnership sites, but they have proven extremely valuable in terms of research to validate the program's effectiveness.
• The decision to become a Nurse-Family Partnership implementing agency isn't just dependent on securing funding. Each site also must show that it can adhere to the standards of service delivery, evaluation and other components established by Dr. Olds. The Duke Endowment invested a full year helping local communities prepare proposals that met Nurse-Family Partnership criteria, and considers that time well spent.
• Becoming a Nurse-Family Partnership site requires a great deal of community participation and strong relationships between providers and referral sources. Local partners often have to move outside their normal business and be willing to adjust to the Nurse-Family Partnership model. This sometimes proved to be a significant barrier for agencies with fewer human resources.
• In some communities, the lack of nurses, coupled with the fear in the local health department that their nurses will leave to work for Nurse-Family Partnership, is a real hurdle.
• Ongoing sustainability requires significant community support. As part of its involvement, The Duke Endowment engaged a North Carolina firm to help create and implement communications plans in North Carolina and South Carolina that will educate the community and decision-makers, and help secure long-term investments.

Impact

The Nurse-Family Partnership model is the most rigorously tested program of its kind. Randomized, controlled trials conducted over the past 30 years demonstrate multi-generational outcomes that benefit society economically and reduce long-term social service expenditure. Independent research proves that communities benefit from this model — every dollar invested can yield more than $5 in return.

In its 30-year history, Nurse-Family Partnership has shown substantial, consistent and dramatic results related to child health, child abuse and neglect, crime reduction and school readiness, including:

• 48 percent reduction in child abuse and neglect
• 56 percent reduction in emergency room visits for accidents and poisonings
• 59 percent reduction in arrests by the time the child is 15
• 67 percent reduction in behavioral and intellectual problems at age 6
• 72 percent fewer convictions of mothers by the time the child is 15

A 2007 study published in the journal of the American Academy of Pediatrics found that, among 743 women with at least two socio-demographic risk characteristics (unmarried, less than 12 years of education, unemployed), "nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes."

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Vice President
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