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The NFP program is currently being implemented and evaluated in eight countries, including the United States. Each country has made some adaptations for the specific context and population being served whilst maintaining fidelity to the program model and each is at a different phase of program testing and expansion.
| Country | Year program initiated |
|---|---|
| United States | 1997 |
| England | 2007 |
| Australia | 2008 |
| Canada | 2008 |
| Scotland | 2009 |
| Northern Ireland | 2010 |
| Norway | 2015 |
| Bulgaria | 2015 |
In Australia, the Australian Government’s Department of Health and Aged Care (the Department) is the NFP license holder that funds the National Leadership Team to support NFP program implementation at sites. Known as the Australian Family Partnership Program (AFPP), the program focuses on Australia’s First Nations people – the Aboriginal and Torres Strait Islander peoples.
The AFPP is specifically adapted for women pregnant with an Aboriginal and/or Torres Strait Islander baby. The program has been contextualised to an Australian health setting and adapted to ensure it reflects the key principles of the NFP while operating within a First Nations cultural framework. This framework aligns closely with the principles of the Aboriginal Community Controlled Health Service (ACCHS), which emphasises First Nations leadership, community control, cultural safety, and a holistic approach to healthcare.
Australia has made several adaptations to the NFP Core Model Elements, the most significant of which include:
The FPW role is an essential adaptation to the AFPP. As an identified position (requiring the role to be held by an Aboriginal and/or Torres Strait Islander person), the FPW is responsible for engaging and connecting with mothers and working closely with the Nurse to ensure that the program is culturally contextualized for participating mothers from pregnancy into infancy. The role supports cultural brokerage and is critical in fostering partnership and collaboration between the mother and their continued engagement in the program.
The AFPP’s alignment with Comprehensive Primary Healthcare Models of Care is evident in its holistic approach, addressing not only medical needs but also the social, emotional, and cultural well-being of participants. This model, integral to the ACCHS framework, emphasises prevention, early intervention, and continuous, coordinated care that considers the broader social and cultural determinants of health, such as housing, education, and employment.
From initial implementation in three sites in 2009, the AFPP is now implemented in fifteen sites in communities varying in size and locations, from urban and regional centres to remote and very remote communities across Australia.
Since inception, sites have progressed through the NFP phases at different rates and stages based on their capacity and resourcing. The majority of sites encountered unique challenges in the Australian Aboriginal and Torres Strait Islander Healthcare setting and continue to adapt and respond.
The Department undertook an evaluation finalised in February 2024, noting that participants demonstrated increased rates of healthy birthweights of babies, reduced substance use including smoking rates, and greater personal confidence and empowerment among participating mothers.
The Department and NLT continue to work towards researching and developing the evidence base for CME amendments, as well as progressing all sites through to Phase 5 integration.
Further information can be found at www.anfpp.com.au or via ANFPP@health.gov.au.
The NFP program was introduced in Bulgaria in 2016 by the Trust for Social Achievement (TSA), with financial support from the America for Bulgaria Foundation. TSA is the license holder and the implementing agency.
The program was first introduced in the capital city of Sofia, in partnership with the Second Municipal Hospital for Obstetrics and Gynecology Sheynovo, which is acting as the local delivery unit. Three years later, in partnership with St. George University Hospital, the program was expanded to Bulgaria’s second largest city – Plovdiv.
In those two sites the NFP is serving first-time mothers under 22 years of age who live in the largest Roma neighborhoods and their surroundings. Bulgaria’s Roma face significant health challenges that impact later educational outcomes and achievement. Social norms, poverty, and isolation prevent young mothers from seeking prenatal, peripartum, and postnatal services in formal health settings.
Health mediators from the same communities support family nurses in their field work and help to identify eligible pregnant women, encouraging them to participate.
The Open Society Institute-Sofia is responsible for the formative evaluation of the program. Two local NGOs – the Health and Social Development Foundation in Sofia and the National Alliance for Volunteer Action in Plovdiv, support the NFP teams with psychological supervision and social work consultations.
Funding has now been secured for a small outcomes study, and strategic work is continuing to enable the Bulgarian Government to understand how the program could be integrated within the health care system on a larger scale.
Further information about the program may be found at: http://socialachievement.org/en/what-we-do/funded-projects/FF/nurse-family-partnership-program-bulgaria/
Or by contacting:
Kamelia Tzeneva – Project Manager, TSA, ktzeneva@tsa-bulgaria.org
Maria Evgenieva – Clinical Lead, TSA, MEvgenieva@tsa-bulgaria.org
Iskra Stoykova – First Foundations Program Officer, TSA, IStoykova@tsa-bulgaria.org
The NFP program was first introduced in Canada in the City of Hamilton, Ontario in 2008 where a successful feasibility and acceptability study was led by investigators at McMaster University. Ontario was also home to the successful NFP Canadian Nurse Education (CaNE) project from 2015-2018. Since January 2019, NFP has continued in five Ontario regions under one program license, currently held by the Middlesex-London Health Unit.
In 2012, the British Columbia (BC) government began implementing NFP in most health authorities across the province and funded the BC Healthy Connections Project (BCHCP) to assess how well NFP works in BC. This randomized control trial (RCT)[1] is also the first scientific evaluation of NFP in Canada. Reports on outcome indicators are being published between 2020 and 2023. The RCT also has two adjunctive studies: a nursing process evaluation, and a biological evaluation of NFP’s potential impact on biomarkers of stress in a sub-sample of RCT participants (Healthy Foundations Study). NFP in British Columbia is overseen by Provincial Health Service Authorities’ Child Health BC and Perinatal Services BC (PSBC). CHB and PSBC work closely with the local health authorities to ensure smooth program delivery, partner engagement,and regional coordination.
Participant recruitment for NFP in Nova Scotia began in early 2024. The program is delivered through Early Years Public Health, Science and Systems Performance.
British Columbia, Nova Scotia, and Ontario work closely together on initiatives and meet regularly through their NFP Collaborative in Canada.
More BCHCP information and list of publications can be found at: childrenhealthpolicy.ca
[1] Catherine NLA, Gonzalez A, Boyle M, Sheehan D, Jack, SM, Hougham K, McCandless L, MacMillan H, Waddell C. for the BC Healthy Connections Project Scientific Team. (2016). Improving children’s health and development in British Columbia through nurse home visiting: A randomized controlled trial protocol. BMC Health Services Research, 16, 349 – 362. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1594-0
Further information regarding the program in Canada can be found by contacting:
British Columbia: Penny Liao-Lussier penny.liao-lussier@phsa.ca
Ontario: Lindsay Croswell lindsay.croswell@mlhu.on.ca
Nova Scotia: Flora Murphy flora.murphy@nshealth.ca
NFP was introduced into England (where it is known as Family Nurse Partnership or FNP) in ten sites in 2007 and is currently delivered in over 50 sites nationwide.
It is offered to young first-time mothers aged up to 24 (but mostly under 20 years) from early pregnancy until their child is aged between one and two.
The program is provided by Local Authorities, supported centrally by the 0-19 Clinical Programmes Unit with the license held by the Secretary of State for Health.
The 0-19 Clinical Programmes Unit oversees delivery of the FNP programme in England and is based within the Office for Health Improvement and Disparities, a government body. This means that the 0-19 Clinical Programmes Unit engages with policy development within the 0-19 years realm and promotes the concept of sensitive and responsive care giving across the wider public health and social care agenda. Together with the FNP programme itself, such engagement directly supports delivery of both the government’s Healthy Child Programme and Start for Life initiative.
Delivery of the FNP programme has evolved over time. Following a RCT published in 2015, adaptations were tested and introduced into the FNP programme, including a personalised delivery model. This enables family nurses in collaboration with clients to flex the programme according to the needs and circumstance of each family. In 2022 an intimate partner violence and neglect enhanced learning package was implemented across all FNP teams.
A longitudinal study published in 2021 showed that the children of mothers who were enrolled in the Family Nurse Partnership programme were more likely to reach a good level of development aged 5, be ready for school, and show improved early education outcomes.
Further information about the programme in England can be found at: http://fnp.nhs.uk or by emailing: FNPNationalunit@dhsc.gov.uk.
The program is also known as Family-Nurse Partnership (FNP) in Northern Ireland and serves first time mothers of less than 19 years. There are 5 FNP teams, one in each NHS Trust. The license is held by Northern Ireland’s Public Health Agency, which also provides the implementation support and funds the local service.
Due to the country’s small size, leaders of the program in Nothern Ireland collaborate closely with colleagues in England and Scotland, but have developed some unique program adaptations for the context of Nothern Ireland.
Further information about the program in Nothern Ireland can be found at: http://www.publichealthagency.org/directorate-public-health/health-and-social-wellbeing-improvement/family-nurse-partnership
Or by contacting: Heather Reid at heather.reid@hscni.net.
The program has been introduced into Norway by the Norwegian Directorate for Children, Youth and Family Affairs and this Government department is the license holder working with the Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP) as the implementing agency.
Phase one adaptation work commenced in 2015 and the program moved into phase three at the beginning of 2021 as the Norwegian Government decided to expand the number of sites and to conduct an effect evaluation of the program. The latter is important in order to identify how and to what extent the program adds value to the fairly strong universal services in Norway for pre-natal and post-natal follow up of first time mothers, the child and their family. The effect evaluation research will be running from 2022 till 2027.
The sites participating in phase 3 include varied geographical regions and it is anticipated that this will provide useful information about how to implement the program in different geographical contexts. In the Norwegian context, so far, the program is considered to be particularly important for its support of sensitive, responsive caregiving and the potential to avoid child neglect and transfer of child custody to government institutions.
The real -time formative evaluation study conducted during phase 2 (2016-2020) found that “…there is a need for and high acceptance of a high-intensity programme such as NFP in Norway. The programme offers close and structured guidance for vulnerable families who need extra support in a challenging life phase. No corresponding service exists in local authority services in Norway for this target population.” Further information about this study can be found here.
For further information about the program in Norway please contact:
Tine Gammelgaard Aaserud (Clinical Lead) tga@r-bup.no
Kristin Lund (Senior Advisor Implementation) kristin.lund@r-bup.no
Benedicte Petersen (Policy Lead) benedicte.petersen@bufdir.no
Scotland introduced the program (known as Family Nurse Partnership or FNP) in 2009 and following a positive formative evaluation have expanded to now have at least one FNP team in every viable National Health Service organizational area. They are the first country to expand the program comprehensively so that every first time pregnant young woman (19 and under) in Scotland is now offered the program.
The license for the program is held by the Scottish Government , who also support implementation and program quality improvements by local NHS Health Boards. Nurse and supervisor education is provided by NHS Education Scotland (NES).
Further information about the program in Scotland can be found at: https://beta.gov.scot/policies/maternal-and-child-health/family-nurse-partnership/
Or by contacting the Nurse Family Partnership central team: Family_Nurse_Partnership@gov.scot
The program was first developed in the US, with 3 RCTs taking place between 1977 and 1995. The first replication sites for the program were established in 1996 and the program has served over 340,000 families since with over 2,335 nurses delivering NFP in 40 states, the US Virgin Islands and six Tribal Nations.
The National Service Office (NSO) in Denver contracts with and provides implementation and quality monitoring support to States, agencies and Tribal Nations that deliver the Nurse-Family Partnership (NFP) program. These include a variety of organizations (private, public and non-profit) such as state/county public health departments, community-based health centers, nursing associations and hospitals.
More information regarding the NFP in the US can be found at: http://www.nursefamilypartnership.org.