Taking preventive intervention to scale: The nurse-family partnership

We outline a program of research aimed at improving the outcomes of pregnancy, child health and development, and maternal life-course with a program of prenatal and infancy home visiting by nurses for low-income mothers having first babies. We present the theoretical and epidemiologic foundations of the program, the major findings from the randomized controlled trials employed to test the program, and our efforts to translate these findings into effective community nurse home visitor programs. Particular attention is given to our development of the National Center for Children, Families, and Communities, which serves as the organization devoted to replicating the program, now called the Nurse-Family Partnership, in new communities with fidelity to the model tested in the trials. Our national replication work revolves around three major functions: helping organizations and communities become prepared to conduct and sustain the program over time; training nurses and providing them with structured guidelines to enable them to conduct the program with a high level of clinical excellence; and research, evaluation, and quality improvement activities designed to continuously improve the program and its implementation as it is offered to a larger number of communities over time.