Using public dollars wisely to support programs that work.
Evidence-based policy is based on scientifically designed studies showing conclusively that an approach is effective. While evidence of effectiveness from randomized, controlled trials is often not required for public health programs, policymakers, public health officials, and the communities they serve increasingly demand proven approaches for addressing important public health issues.
Nurse-Family Partnership is an evidence-based public health program that was developed by David Olds and rigorously evaluated in randomized, controlled trials in Elmira, New York (1977), Memphis, Tennessee (1988) and Denver, Colorado (1994). Findings from the three trials serving diverse populations living in urban and rural settings over the past three decades demonstrate that Nurse-Family Partnership produces the following outcomes:
- Improvements in prenatal health, birth outcomes (including greater intervals between births), child development, school readiness, academic achievement, and maternal employment; and
- Reductions in child abuse and neglect, early childhood injuries, mental
health problems, and crime.
The program produces statistically significant, positive program effects that are repeated and enduring for up to 15 years following the child’s birth.
Leadership of the Nurse-Family Partnership chose to offer the program for public investment only after they had:
- replicated evidence of program impact from at least two randomized controlled trials;
- evidence that the program improved outcomes of public health importance;
- evidence of enduring program impact;
- evidence of cost-savings;
- confidence that the essential elements of the program could be reliably reproduced; and
- a web-based information system that could help ensure quality program implementation, accountability, and continuous program improvement.2
These kinds of evidentiary and replication standards are advocated by the Coalition for Evidence-Based Policy,3 Blueprints for Violence Prevention,4 and the Society for Prevention Research.5 They also are consistent with those required by the Food and Drug Administration before pharmaceutical companies are allowed to market new drugs.6 They are founded on the conviction that scarce public dollars ought to be invested in programs that work and that have the infrastructure to ensure high quality implementation and on-going monitoring of performance.
Nurse-Family Partnership has consistent evidence, based upon replicated randomized controlled trials with different populations living in different contexts, that it can:
• improve prenatal health;7-9
• reduce childhood injuries;7;10;11
• reduce the rates of subsequent pregnancies and births;7;9;12-15
• increase the intervals between first and second pregnancies and births; 7;9;12-15
• increase maternal employment;7;9;14
• reduce women’s use of welfare;12-15
• reduce children’s mental health problems;15;16
• increase children’s school readiness and academic achievement;16;17
• reduce costs to government and society;18;19 and
• be most effective for those most susceptible to the problems examined.1
Footnotes are detailed in NFP Evidentiary Foundations.
For more information on evidence-based policy, please download the Nurse-Family Partnership: An Evidence-Based Program.