Associations between Cross‐Sector Collaboration and Family Outcomes in Evidence‐Based Nurse Home Visiting
Authors: Williams V. , McManus B. , Brooks‐Russell A. , Yost E. , Olds D. , Tung G. 
Published: August 2020

Home‐visiting prevention programs must coordinate with other community providers to be most effective. However, the associations between collaboration and program outcomes are not well understood. This study aimed to examine the associations between cross‐sector collaboration in Nurse‐Family Partnership (NFP), a model home‐visiting program, and client‐level outcomes.

We used 2018 survey data with NFP supervisors that assessed agency‐level collaboration, as measured by relational coordination and structural integration with nine community provider types (including obstetrics care, substance use treatment, and child welfare). We paired the collaboration survey data with NFP program implementation data from 2014 to 2019 (n = 36,901) to examine outcomes including client retention, client smoking cessation, and childhood injury. We used random‐intercept models with nurse‐level random effects, controlling for client‐level demographics and health, nurse‐level demographics, and agency‐level administrative and geographic factors.

NFP is an evidence‐based prenatal and early infancy home‐visitation program delivered by nurses to low‐income, first‐time mothers. NFP is implemented by over 250 agencies across the United States by public health departments, nonprofit organizations, and health care systems. Sample NFP clients were on average 23 years old and predominately single. Of sample clients, 47.5% were white, 33% were African American, 11.5% reported another race, and 8% declined reporting; 31% of clients identified as Hispanic.

Consistent with past research, we found unmarried women and those visited by nurses who ceased employment with NFP prior to the client’s child’s birth were more likely to drop out of the NFP program, while older women and high school graduates were more likely to remain in NFP. Greater relational coordination with substance use treatment providers (OR: 1.148, P < .001) and stronger structural integration with CPS (OR: 1.056, P < .001) were associated with improved client retention at birth, even after adjusting for multilevel factors. Structural integration with CPS remains significantly associated with client retention at 12‐months postpartum. Greater nurse coordination with the Special Supplemental Nutrition Program for Women, Infants, and Children—WIC (OR: 1.090, P < .05) as well as with substance use treatment providers (OR: 1.115, P < .05) was associated with increased prenatal smoking cessation. Stronger nurse coordination with WIC (OR: 0.875, P < .01) and greater integration with mental health providers (OR: 0.969, P < .01) were associated with decreased probability of self‐reported emergency department (ED) use for childhood injury, while greater structural integration with WIC (OR: 1.022, P < .05) was associated with increased probability of ED use.

Improving health care through relationships with other care providers is necessary to enhance the experience and outcomes of patients, particularly among high‐need complex populations. This study provides early results suggesting cross‐sector collaboration in a home‐visiting setting that bridges health care and addresses social determinants of health has potential to improve the retention of clients. More research is needed to understand how collaboration may improve maternal‐reported behaviors like smoking cessation and ED use for childhood injury.

Our findings inform efforts to increase efficient delivery of prevention programs like NFP through intentional collaboration with cross‐sectors, as well as for future agency development for NFP expansion, especially as the program moves toward integration with health care delivery systems.

Blue Meridian Partners.