Dr. David Olds (pictured) is Professor of Pediatrics, Psychiatry, Preventive Medicine, and Nursing at the University of Colorado Health Sciences Center, where he directs the Prevention Research Center for Family and Child Health. He has devoted his career to investigating methods of preventing health and developmental problems in children and parents from low-income families. The primary focus of his work has been on developing and testing in a series of randomized controlled trials a program of prenatal and infancy home visiting by nurses for socially disadvantaged mothers bearing first children, known today as the Nurse-Family Partnership (NFP). He was the first annual Mowafaghian Visiting Scholar, on January 28, 2011.
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Speaking on the topic “Exploring Nurse-Family Partnership,” University of Colorado Professor David Olds summarizes 30 years of US evidence showing the effectiveness of the Nurse-Family Partnership (NFP) in preventing child maltreatment and providing other benefits to disadvantaged young first-time mothers and their children.
Because early circumstances have a profound and lasting impact on children’s emotional and social development and later success in life, NFP has three goals:
1. Improving pregnancy outcomes by improving prenatal health (particularly reducing prenatal tobacco use);
2. Improving children’s subsequent health and development by helping parents provide more competent care in the first two years of their child’s life (particularly reducing child maltreatment); and
3. Improving mothers’ lives by helping them increase their educational achievements and attain economic independence.
During the past 30 years, the program has been tested in three separate American randomized controlled trials — in Elmira, New York, with a low-income white population; in Memphis, Tennessee, with low-income African-Americans; and in Denver, Colorado, with a sample that included a large portion of Hispanics.
Participants were limited to those with low incomes because Olds hypothesized program effects would be greater for children born into circumstances where there were more challenges and fewer resources. Participants were also limited to those who were about to experience a first-time birth because Olds believed that being in a “critical life transition” would make mothers more receptive to offers of help.
Overall, the three US trials have shown significant improvements in women’s prenatal health (especially in reducing smoking and reducing hypertensive disorders of pregnancy).
Most importantly, however, the trials have demonstrated significant reductions in child maltreatment — including reducing physical and emotional abuse and neglect — which has important and lasting consequences for children’s mental health and development.
The second two trials also showed consistent improvements in children’s school readiness, measures of language development, measures of early academic achievement, and measures of executive functioning.
In Memphis, the trial resulted in a 23% reduction in all types of health care encounters for injuries in intervention compared to control children. There was also an 80% reduction in the number of days that these children were hospitalized for injuries and ingestions.
Perhaps the most notable aspect of NFP has been the way in which the scientific evaluation has been managed over the long term. It has:
• Studied intervention effectiveness in naturalistic settings
• Assessed a broad range of maternal and child outcomes
• Followed children through critical developmental transitions up to age 19
• Maintained low attrition rates
• Used rigorous randomized control methods
In 2009, an international collaboration published findings in the Lancet concluding that NFP was the program with the best evidence for the prevention of child maltreatment, based on reduction in objective measures of child physical abuse and neglect and associated injuries in these three long-term studies.
Olds now calls for new trials outside the US to see if the same benefits can be shown elsewhere because, he says, “we need to know whether these things are really wise public investments. And if they really do work, then, we need to work together to figure out how to reliably replicate this adapted program.”