Washington State Institute for Public Policy
Nurse Family Partnership
Public Health & Prevention: Home- or Family-based
Benefit-cost estimates updated May 2017.  Literature review updated December 2015.
The Nurse Family Partnership program provides intensive visitation by nurses during a woman’s pregnancy and the first two years after birth. The goal is to promote the child's development and provide support and instructive parenting skills to the parents. The program is designed to serve low-income, at-risk pregnant women bearing their first child.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $7,489 Benefits minus costs $8,988
Participants $8,995 Benefit to cost ratio $1.88
Others $5,931 Chance the program will produce
Indirect ($3,257) benefits greater than the costs 61 %
Total benefits $19,157
Net program cost ($10,170)
Benefits minus cost $8,988
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $2,163 $0 $4,593 $1,080 $7,836
Child abuse and neglect $398 $1,269 $0 $198 $1,865
K-12 grade repetition ($44) $0 $0 ($22) ($66)
K-12 special education ($151) $0 $0 ($73) ($223)
Property loss associated with alcohol abuse or dependence $0 $1 $1 $0 $1
Health care associated with disruptive behavior disorder $13 $4 $16 $7 $41
Labor market earnings associated with child abuse & neglect $2,284 $5,030 $0 $91 $7,404
Costs of higher education ($292) ($247) ($81) ($146) ($766)
Subtotals $4,371 $6,056 $4,529 $1,135 $16,092
From secondary participant
Crime $88 $0 $144 $44 $276
Labor market earnings associated with high school graduation $1,794 $3,951 $1,803 $0 $7,549
Public assistance $675 ($287) $0 $338 $726
Health care associated with educational attainment $428 ($117) ($469) $215 $58
Food assistance $412 ($372) $0 $206 $246
Costs of higher education ($280) ($236) ($77) ($140) ($734)
Subtotals $3,118 $2,939 $1,402 $663 $8,121
Adjustment for deadweight cost of program $0 $0 $0 ($5,055) ($5,055)
Totals $7,489 $8,995 $5,931 ($3,257) $19,157
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $5,383 2007 Present value of net program costs (in 2016 dollars) ($10,170)
Comparison costs $0 2007 Cost range (+ or -) 10 %
The number of nurse visits participants received in the studies in our meta-analysis varied from 27 to 33 on average, spread over about a two-year period. We based our average annual per-family cost on expenditures per family and average length of program participation in Washington State, provided by Kristen Rogers at Nurse Family Partnership, Northwest Regional Office July, 2008.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Child abuse and neglect Primary 2 206 -0.355 0.141 15 -0.355 0.141 17 -0.626 0.012
Crime Primary 1 37 -0.252 0.209 15 -0.252 0.209 25 -0.700 0.001
Disruptive behavior disorder symptoms Primary 2 329 -0.075 0.076 12 -0.036 0.042 15 -0.208 0.006
K-12 grade repetition Primary 3 313 0.048 0.102 12 0.048 0.102 17 0.130 0.407
Internalizing symptoms Primary 3 526 -0.083 0.079 12 -0.060 0.066 14 -0.229 0.005
K-12 special education Primary 3 313 0.023 0.122 12 0.023 0.122 17 0.030 0.894
Test scores Primary 3 368 0.021 0.067 10 0.014 0.073 17 0.059 0.374
Crime Secondary 2 266 -0.034 0.114 31 -0.034 0.114 41 -0.265 0.472
Employment Secondary 3 423 0.036 0.062 26 0.036 0.062 36 0.120 0.176
Food assistance Secondary 3 470 -0.054 0.059 28 -0.054 0.059 38 -0.223 0.143
High school graduation Secondary 2 401 0.035 0.086 23 0.035 0.086 23 0.097 0.271
Public assistance Secondary 3 470 -0.054 0.059 28 -0.054 0.059 38 -0.191 0.086
Substance misuse^ Secondary 3 470 -0.080 0.128 28 -0.080 0.128 38 -0.274 0.377
Citations Used in the Meta-Analysis

Eckenrode, J., Henderson, C.R., Jr., Powers, J., Campa, M., Lucky, D.W., Olds, D., . . . Sidora-Arcoleo, K. (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of Pediatrics and Adolescent Medicine, 164(1), 9-15.

Kitzman, H.J., Olds, D.L., Cole, R.E., Hanks, C.A., Anson, E.A., Arcoleo, K.J., . . . Holmberg, J.R. (2010). Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine, 164(5), 412-418.

Mejdoubi, J., van, . H. S. C. C. M., van, L. F. J. M., Crone, M., Crijnen, A., HiraSing, R. A., & Special Sections: Focus on Infant Feeding and Postnatal Health and Well-being. (2014). Effects of nurse home visitation on cigarette smoking, pregnancy outcomes and breastfeeding: A randomized controlled trial. Midwifery, 30(6), 688-695.

Mejdoubi, J., van, . H. S. C. C. M., van, L. F. J. M., Heymans, M. W., Crijnen, A., Hirasing, R. A., & Carlo, W. A. (2015). The Effect of VoorZorg, the Dutch Nurse-Family Partnership, on Child Maltreatment and Development: A Randomized Controlled Trial. Plos One, 10(4).

Olds, D.L., Eckenrode, J., Henderson, C.R., Jr., Kitzman, H., Powers, J., Cole, R., . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial. JAMA, 278(8), 637-643.

Olds, D., Henderson, C.R., Jr., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., . . . Powers, J. (1998). Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. JAMA, 280(14), 1238-1244.

Olds, D.L., Holmberg, J.R., Donelan-McCall, N., Luckey, D.W., Knudtson, M.D., & Robinson, J. (2014). Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years. JAMA Pediatrics, 168(2), 114-21.

Olds, D.L., Robinson, J., O'Brien, R., Luckey, D.W., Pettitt, L.M., Henderson, C.R., Jr., . . . Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110(3), 486-496.

Olds, D.L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R.K., . . . Henderson, C.R., Jr. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114(6), 1560-1568.

Olds, D.L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D.W., . . . Holmberg, J. (2004). Effects of nurse home- visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial. Pediatrics, 114(6), 1550-1559.

Olds, D.L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., . . . Bondy, J. (2007). Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics, 120(4), 832-845.

Olds, D L., Kitzman, H.J., Cole, R.E., Hanks, C.A., Arcoleo, K.J., Anson, E.A., . . . Stevenson, A. (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine, 164(5), 419-424.

Sidora-Arcoleo, K., Anson, E., Lorber, M., Cole, R., Olds, D., & Kitzman, H. (2010). Differential effects of a nurse home- visiting intervention on physically aggressive behavior in children. Journal of Pediatric Nursing, 25(1), 35-45.

Eckenrode, J., Henderson, C.R., Jr., Powers, J., Campa, M., Lucky, D.W., Olds, D., . . . Sidora-Arcoleo, K. (2010). Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Archives of Pediatrics and Adolescent Medicine, 164(1), 9-15.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov