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Dec/Jan 2011Vol. 11, No. 10Nurse-Family Partnership Program in Spokane

To improve pregnancy outcomes, child health and development, and economic outcomes for children and families, Nurse-Family Partnership (NFP), an evidence-based home visitation program, uses trained nurses to visit and assist first-time mothers during and after pregnancy. One benefit of NFP is that it can reduce child maltreatment among families served. In 2007, the Spokane Regional Health District, in partnership with Catholic Charities of Spokane, the Spokane Child Abuse Network, and Washington State University, received a grant from the Children's Bureau to test the effectiveness of pairing an NFP program with evidence-based relationship and fathering curricula.

The grant, named Summer's Project in honor of a 4-year-old girl from Spokane who died as a result of severe child abuse, serves first-time mothers in a community facing high rates of poverty and child maltreatment. Summer's Project finds potential clients, who can be no more than 28 weeks pregnant when starting the program, through a broad referral network, including schools, WIC, and medical clinics. The women and families can receive NFP services without participating in the research study, but they can also opt into the study and receive additional services. Women in the study are randomly placed into one of four groups:

  • Receiving NFP services only
  • Receiving NFP services and the fathering curriculum
  • Receiving NFP services and the relationship curriculum
  • Receiving NFP services and the fathering and relationship curricula

Using the NFP curriculum, eight NFP-trained registered nurses visit the families' homes once or twice per week prior to the birth and then every other week until the child is 2 years old. The optional curricula also are based on evidence-based programs (Conscious Fathering, Nurturing Fathers, Within My Reach, and Within Our Reach). The fathering curricula, provided only to families in which the father is present or involved with the child, focus on infant care, the importance of fathers, and the father's relationship with the child. The relationship curricula, adapted for the mother's relationship status, focus on topics such as conflict resolution and communication.

Summer's Project is a highly sought-after program in Spokane. It received 353 referrals this year, but its maximum capacity is 200 clients. Twenty-five clients have completed the project (i.e., participated from pre-birth through the child's second year), and 17 more are expected to complete it by the end of the year. Approximately 80 percent of clients remain with the nurse, and project staff noted that once families develop a relationship with the project, they tend to remain. In satisfaction surveys, clients have rated the services an average of 4.8 out of 5 on all questions.

Below are several other preliminary observations and findings from the project:

  • The project initially had difficulty getting clients to participate in the optional fathering and relationship curricula. To increase participation, the project adapted and provided the curricula in clients' homes, which worked well. The clients later indicated that one reason for not attending the classes was that they did not want to discuss their issues in a group environment.
  • Preliminary data collected from clients after 12 months of services indicate that those who received optional curricula appear to be faring better than those receiving only NFP services. Project staff are trying to determine what may have caused the better outcomes: the curricula themselves; the additional, individual attention the clients are receiving; or other factors.
  • Participating families face a myriad of other issues. Approximately two-thirds of the mothers have unmet mental health needs. The families also have higher rates of domestic violence than other NFP sites, with the mother being the primary perpetrator in many cases. Additionally, the mothers have high rates of substance abuse, but the project has been successful at reducing smoking rates while pregnant.
  • The project staff also noted the importance of collaboration and community support for the success of Summer's Project.

For more information about the project, contact Susan Schultz at or Elaine Conley at

Many thanks to Susan Schultz and Elaine Conley of the Spokane Regional Health District for providing the information for this article.