title: Improving the nurse-family partnership in community practice.
abstract: BACKGROUND
  Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials.
  
  
  OBJECTIVE
  Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension.
  
  
  METHODS
  Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them.
  
  
  RESULTS
  We describe a framework used to address these issues and illustrate its use in improving nurses' skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers' care of their children, addressing parents' mental health problems, classifying families' risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation.
  
  
  CONCLUSIONS
  The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP.
authors.affiliation: Prevention Research Center for Family and Child Health, University of Colorado Department of Pediatrics, 13121 East 17th Ave, MS 8410, Aurora, CO 80045. david.olds@ucdenver.edu.
authors.forename: David
authors.initials: D
authors.lastname: Olds
authors.forename: Nancy
authors.initials: N
authors.lastname: Donelan-McCall
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Brien
authors.forename: Harriet
authors.initials: H
authors.lastname: MacMillan
authors.forename: Susan
authors.initials: S
authors.lastname: Jack
authors.forename: Thomas
authors.initials: T
authors.lastname: Jenkins
authors.forename: Wallace P
authors.initials: WP
authors.lastname: Dunlap
authors.forename: Molly
authors.initials: M
authors.lastname: O'Fallon
authors.forename: Elly
authors.initials: E
authors.lastname: Yost
authors.forename: Bill
authors.initials: B
authors.lastname: Thorland
authors.forename: Francesca
authors.initials: F
authors.lastname: Pinto
authors.forename: Mariarosa
authors.initials: M
authors.lastname: Gasbarro
authors.forename: Pilar
authors.initials: P
authors.lastname: Baca
authors.forename: Alan
authors.initials: A
authors.lastname: Melnick
authors.forename: Linda
authors.initials: L
authors.lastname: Beeber
mesh_terms: D003152:Community Health Nursing / Q000379:methods / Q000592:standards / Q000639:trends*; D003153:Community Health Services / Q000379:methods / Q000592:standards / Q000639:trends*; D006792:House Calls / Q000639:trends*; D006801:Humans; D009726:Nurses / Q000592:standards / Q000639:trends*; D011368:Professional-Family Relations; D016032:Randomized Controlled Trials as Topic / Q000639:trends
keywords: continuous quality improvement; home visiting; maternal and child health; practice-based research