Working in a day care center in the late 1970s, David Olds saw first hand how children could be harmed by their parents’ actions. One child sticks in his mind. Bobbie, a four year-old in his class, would become very agitated at naptime and rarely sleep. Shocked by the expletives that Bobbie uttered when Olds and a colleague tried to talk about the problem, they discovered that Bobbie wet the bed at home and every time this happened his mother beat him.

Olds believed strongly that such things were preventable and that it was too late to wait until the children got to day care. It was from this point that he set off on a path to develop what is now known as the Nurse Family Partnership (NFP): a home visiting program for first-time mothers that has touched the lives of well over 100,000 families in the US.

Cautious, determined, modest, deliberate: all words used to describe Olds in the various magazine and newspaper articles written about him and his program over the 30 years that he has been nurturing NFP. They have stood him in good stead: NFP is highly regarded internationally in both the academic and policy community. Olds’ carefully planned, robust evaluations have produced results that inspire confidence. Many millions of federal, local and private dollars now support NFP implementation in the US.

Working at the day center was probably the first turning point in Olds’ career. The second was encountering the work of (and later being mentored by) Uri Bronfenbrenner, well-known not only for his work on ecological systems theory, but also as being a co-founder of HeadStart.

Thanks to a combination of his personal observations and insights through studying for his PhD at Cornell, where Bronfenbrenner taught, Olds felt confident enough to design the first version of his model (which later became the NFP). The early features of this model – the focus on first-time parents, delivery in the home by nurses, and beginning during pregnancy - remain the hallmarks of the program today.

A third turning point came when he turned down the offer of a grant from the Department of Health, Education and Welfare. After submitting the original application he realized that he was simply not ready to get the program up and running properly in his selected test site – Elmira, New York. When he reflects on this, he quips that it was the smartest decision he ever made. He took advice and re-drafted his proposal to allow for plenty of planning and piloting, and successfully re-submitted.

Despite still being a young researcher with no track record, he soon after secured federal support and a grant from a major foundation to develop and study the effects of the program in Elmira.

From early on, Olds has been determined on two big issues. The first could be described as a wish not to run before walking. He has insisted on a cycle of implementation and testing to establish whether or not his program works before taking it to other communities. His first trial in Elmira established positive effects for white, poor families living in rural communities. This garnered offers of support to replicate the program from federal government, but Olds was cautious and demurred. Worried that they would push him to tinker with his design, he felt more testing was required. That resistance to change the design rested on his belief that it was fidelity to the model that secured the best outcomes.

His second major study – an experimental trial like the first – set out to test whether the benefits seen in Elmira could be replicated in an inner city, African-American community. By 1987, the $7 million needed to fund the study had been secured and the next major test was underway in Memphis. Results were also positive, showing improvements to maternal health in pregnancy, less contact with health services for childhood injuries, and greater spacing of subsequent pregnancies.

Not only did Olds find positive results from Memphis, but also lasting effects for the children in Elmira at age 15. This could have been the point at which he yielded to requests to replicate the program, but he felt there were two more big questions to answer. First, would the NFP work for the Hispanic community, and, second, could NFP be afforded more affordably?

At roughly $4,500 per year per family, there was inevitably going to be pressure to reduce costs. An obvious way to do this was to use para-professionals instead of nurses. Olds was invited by the Colorado Trust in 1994 to test his assumption that the skills and reputation of the nurses were critical to securing good outcomes by establishing a third trial of the program.

Eight years later, in 2002, Olds’ hunch was proved correct. Sadly, the results for families visited by paraprofessionals were rarely better than for those not on the program. The message was clear: either do NFP properly with well-trained, qualified nurses or don’t bother.

In the late 1990s, after over 20 years of scrutinizing the program to understand its critical components and impact on families, Olds was ready to consider taking the next step: replication. A modest grant from the US Justice Department provided seed money for expansion into six cities. At the same time, conversations were underway with a small number of individuals who were to prove critical to the carefully managed roll out of the program.

Long-term supporters of Olds, the Robert Wood Johnson Foundation, awarded $10 million to expand the reach of NFP to 10,000 families in 100 communities. Clay Yeager, with the support of Governor Tom Ridge, secured $20 million in federal funds to reach 20 communities across Pennsylvania. Bob Hill and Bob Rosser (prominent Colorado attorneys) established a nonprofit, Invest in Kids, which secured $19 million per year in state funding to introduce NFP to 30 counties in Colorado.

By the start of the new millennium NFP was facing a new set of challenges: how to go to scale, maintain fidelity and manage costs. In 2005 Olds passed this challenge to Clay Yeager, when he was appointed as president and CEO of NFP, now a nonprofit.

Yeager’s appointment allowed Olds to focus his efforts on his research as director of the Prevention Research Center, University of Colorado. His team is looking at the long-term impact of the program by following up the families from Elmira, Memphis and Denver, as well as testing the impact of the increased use of the program, and advising on implementation outside of the US, which is currently occurring in six countries.

Today, the NFP is serving 22,000 families per year in 380 counties in the US, is operating in 56 local health authorities in England, and is being tested in the Netherlands and Australia, where it is being adapted for aboriginal families.

Thanks to Olds’ cautious, modest, deliberate and determined approach thousands of families benefit from his model. And, today, his aspirations for the program remain the same as those which first inspired him to develop his model: “I hope that the learning from our work can help inform the development of effective interventions for vulnerable children and families. We need to continue to invest in quality program development and rigorous research, and connect programs that work for those who need help throughout the life-cycle.”

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This profile drew heavily on the special report prepared by Andy Goodman, “The Story of David Olds and the Nurse Home Visiting Program” (2006) Robert Wood Johnson Foundation.

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Links:
www.nursefamilypartnership.org

http://www.ucdenver.edu/academics/colleges/medicalschool/departments/ped...