New Freedom Commission

Model Program: Intervening Early to Prevent Mental Health Problems

Nurse-Family Partnership


To improve pregnancy outcomes by helping mothers adopt healthy behavior, improve child health and development, reduce child abuse and neglect, and improve families' economic self-sufficiency.


A nurse visits the homes of high-risk women when pregnancy begins and continues for the first year of the child's life. The nurse adheres to visit-by-visit protocols to help women adopt healthy behaviors and to responsibly care for their children. In many states, Nurse-Family Partnership programs are funded as special projects or through State appropriations.


For mothers: 80% reduction in abuse of their children, 25% reduction in maternal substance abuse, and 83% increase in employment. For children (15 years later): 54% to 69% reduction in arrests and convictions, less risky behavior, and fewer school suspensions and destructive behaviors. This is the only prevention trial in the field with a randomized, controlled design and 15 years of follow-up. The program began in rural New York 20 years ago and its benefits have been replicated in Denver and in minority populations in Memphis.146-148

Biggest challenge

To preserve the program's core features as it grows nationwide. The key feature is a trained nurse, rather than a paraprofessional, who visits homes. A randomized, controlled trial found paraprofessionals to be ineffective.149

How other organizations can adopt

Modify requirements of Federal programs, where indicated, to facilitate adopting this successful, cost-effective model.


270 communities in 23 states.

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