Visit to Visit Guidelines

NFP Innovation

The NFP International Team is committed to developing and providing resources to assist countries in successfully implementing NFP. Please note, users downloading these resources are responsible for ensuring that they are adapted and updated if needed so that they are suitable for use within their context’ Please note the guidance documents should not be changed, however, countries may wish to adapt these for these for their own context in which case the title should be changed, to reflect this is now a country-specific document. Any use of the resources by an implementing agency is governed by that agency’s license agreement with the University of Colorado.

US Multips Study Update

In July 2022 Dr. Mandy Allison updated us on the progress of US Multips study. The video can be found here

Formative Study of NFP for Women with Previous Live Births

The PRC has begun the development and evaluation of a version of the NFP that addresses the unique challenges posed by low-resource pregnant women with previous live births in the U.S. This work, in keeping with our commitment to developing a strong evidentiary foundation for the NFP, is pointed toward testing this new version of the NFP in a multi-site randomized clinical trial in the U.S. First, however, this change to the program needs to be well developed clinically and programmatically. Parental motivation for engaging in the program especially needs to be addressed.

Some of the natural concerns and motivations experienced by pregnant women with no previous live births do not apply to this population, making it more difficult to engage them. Having delivered a child already may reduce some mothers’ natural and productive anxiety about pregnancy and childbirth; having already experienced care of a child may reduce some of the natural apprehensions about whether they can manage this. This may reduce some multiparous women’s motivations to enroll in home visiting programs.

Given these questions and potential challenges, the PRC entered into this work with a sober appreciation of the clinical and programmatic challenges involved in serving this population well and with a deep appreciation for determining with good evidence whether the program can reach and make a difference in maternal and child health for this very high-risk segment of the population. The key questions that have guided this work are posed here:

  • To what degree will multiparous women want to participate?

  • To what degree can we establish effective referral pathways that ensure connection with those in need?

  • What are the unique challenges involved in serving multiparous women well?

  • Can the NFP be adapted to address these challenges?

  • To what degree can primary care providers and community resources be marshalled to effectively to serve low-resource multiparous mothers?

  • To what extent does this adapted version of the program make a difference in outcomes of clear public health importance?

This report, Formative development of nurse-family partnership for women with previous live births, summarizes the formative qualitative and empirical research the PRC has conducted so far to help ensure that this new version of the program is well developed to effectively serve this vulnerable population. And an infographic that summarizes the PRC Multip project

NFP Strength and Risk (STAR) Framework

The NFP Strength and Risk (STAR) Framework was developed in 2015 to help NFP nurses and supervisors systematically characterize levels of strength and risk exhibited by the mothers and families they serve. Information organized with the STAR framework provides consistent ways for NFP nurses and supervisors to inform clinical decisions on visit content, visit frequency, and methods of promoting behavioral change to improve maternal and child health. framework and accomapnying nurse guidance was updated in 2019 following feedback from nurses in the field in the USA and other countries.

International documents available to support the introduction of this innovation into the NFP program are available here as follows: 

STAR Framework guidance

(This guidance document provides NFP nurses and supervisors with the guidance they need to understand and utilise STAR within their practice)

The NSO made further updates to the STAR framework Guidance in early 2022. Revisions included:

  • Updates in the STAR guidance for measurement category name
  • The consideration of adverse and positive client experiences and the impact of racism, discrimination, and implicit bias
  • Inclusive language
  • Additional nurse guidance to use relevant assessment to obtain historical information.
  • Updates in the data collection form to reflect name changes
  • Additional documentation options
  • Updates to the STAR Framework education content 

The revised guidance document can be found here along with an overview of STAR

STAR Framework Guidance – 2022 

STAR Framework Overview – 2022

STAR Framework Coding document

(This document provides the framework for summarising the nurses’ findings relating to a particular client. It is recommended that analysis of the framework be supported within reflective supervision).

STAR Data Sources guidance

(This document is an aide memoire for nurses – indicating which NFP data collection/nursing assessment forms inform the coding of specific STAR domains)

Educational materials for STAR have also been developed by a number of countries. These can also be shared on request.

Please note: Although the international version of STAR has been adapted from the version developed in USA, Clinical Leads for each country will need to make some further adaptations and decisions regarding the status of the STAR Framework Coding document within their context.Guidance to support countries commencing use of STAR can be found here:

Guidance Document – STAR Framework: International Implementation

Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE)

The Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE) was developed for the Nurse Family Partnership to better help nurses support clients in the care they provide to their children. DANCE gives nurse home visitors a strengths-based tool to objectively assess the interaction between a caregiver and child during a home visit. Nurses use information from DANCE to have conversations with caregivers, reflecting on current parenting behaviors and guiding caregivers by selecting targeted activities that address the unique strengths and opportunities for growth of each client.

DANCE was developed by Dr. Nancy Donelan-McCall at The Prevention Research Center for Family and Child Health at the University of Colorado (PRC). It is a valid, reliable, and clinically useful tool. This work was championed by Dr. David Olds in his commitment to continually improve the Nurse-Family Partnership program in community-based practice.

Intimate Partner Violence

Many of the women who enroll onto the NFP program have experienced trauma during their lives, which may include growing up in homes where violence was present or experiencing intimate partner violence (IPV), also known as domestic abuse or violence, in her current relationship. In the first US trial of NFP, conducted in Elmira, NY, one of the findings was that for women who were experiencing moderate to high levels of IPV, the program effects on preventing child abuse and neglect were attenuated.  This finding suggested that the NFP program would need to be augmented to enable nurses to identify and respond to IPV more effectively, so that program outcomes could be improved. A survey of NFP nurses in the US also identified that 40% of nurses felt they lacked the knowledge and skills to respond to IPV, and that 72% of nurses indicated that the presence of IPV in the home made it difficult for them to deliver the NFP program.

In 2009, Drs. Susan Jack, Harriet MacMillan, Jeffrey Coben, and David Olds led a study to develop a specific nursing intervention to support NFP nurses to systematically: 1) identify women exposed to current or past IPV; 2) ascertain the type of IPV a woman was experiencing; 3) develop a tailored plan of care; and 4) provide nursing interventions focused on safety, increasing awareness about IPV, self-efficacy and social support. This intervention, as well as the corresponding program of IPV education for nurses and supervisors, is being evaluated in two RCTs, one in the US (results to be published in 2018) and the other in Canada (results available in 2020).

Because of the careful developmental and research processes that have been undertaken by experts in the field to develop the NFP IPV intervention for the program, it is recommended that all NFP countries adopt the intervention over time. However, it is recognized that the intervention will need adapting by every country to take account of the legal frameworks, professional expectations, systems and services impacting on responses to IPV. Because of this, a process for adapting and testing the intervention has been developed and this is currently being undertaken in three countries (Northern Ireland, Norway and Australia).

More information about the intervention can be found at

Development of a nurse home visitation intervention for intimate partner violence.

Jack SM, Ford-Gilboe M, Wathen CN, et al.  BMC Health Services Research. 2012;12:50. doi:10.1186/1472-6963-12-50.

Identification and assessment of intimate partner violence in nurse home visitation.

Jack, S. M., Ford-Gilboe, M., Davidov, D., MacMillan, H. L. and the NFP IPV Research Team (2017), J Clin Nurs, 26: 2215–2228. 

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life A Randomized Clinical Trial.

Jack, S.M.; Boyle, B.,McKee, C.,Ford-Gilboe, M., Wathen, C.N., Scribano, P., Davidov, D., McNaughton, D., O’Brien, R., Johnston, C., Gasbarro, M., Tanaka, M., Kimber, M., Coben, J., Olds, D.L., MacMillan, H.L. JAMA, 321(16): 1576-1585.

Incorporating Intimate Partner Violence Interventions in Nurse Home Visitation Programs. In Reply

Jack, S.M., Olds, D.L., MacMillain, H.L. JAMA 2019; 322(11): 1103-1105.

Trauma- and Violence-informed Care in Nurse Home Visiting Practice.

Jack, S.M. Research Synthesis: Public Health Nursing Practice in Home Visiting. McMaster University. 2019

IPV Consulting Meeting 

January 20, 2021

Factors influencing the implementation of an intimate partner violence intervention in nurse home visiting: A qualitative descriptive study.

Jack, S. M., Davidov, D., Stone, C., Ford-Gilboe, M., Kimber, M., McKee, C., MacMillan, H. L., & For the Nurse-Family Partnership (NFP) Intimate Partner Violence (IPV) Research Team. June 2022.