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Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program

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Abstract

The study aimed to examine the association between cross-sector collaboration in Nurse-Family Partnership (NFP), a model home visiting program, and participant retention. We used the 2018 NFP Collaboration Survey that measured agency-level collaboration, operationalized as relational coordination and structural integration, among nine community provider types (including obstetrics care, substance use treatment, child welfare). This dataset was linked to 2014–2018 NFP program implementation data (n = 36,900). We used random-intercept models with nurse-level random effects to examine the associations between provider-specific collaborations and participant retention adjusting for client, nurse, and agency characteristics. The adjusted models suggest that stronger relational coordination between nurses and substance use treatment providers (OR:1.177, 95% CI: 1.09–1.26) and greater structural integration with child welfare (OR: 1.062, CI: 1.04–1.09) were positively associated with participant retention at birth. Stronger structural integration between other home visiting programs and supplemental nutrition for women, infants, and children was negatively associated with participant retention at birth (OR: 0.985, CI: 0.97–0.99). Structural integration with child welfare remained significantly associated with participant retention at 12-month postpartum (OR: 1.032, CI: 1.01–1.05). In terms of client-level characteristics, clients who were unmarried, African-American, or visited by nurses who ceased NFP employment prior to their infant’s birth were more likely to drop out of the NFP program. Older clients and high school graduates were more likely to remain in NFP. Visits by a nurse with a master’s degree, agency rurality, and healthcare systems that implement the program were associated with participant retention. Cross-sector collaboration in a home visiting setting that bridges healthcare and addresses social determinants of health has potential to improve participant retention. This study sets the groundwork for future research to explore the implications of collaborative activities between preventive services and community providers.

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Data Availability

The data that support the findings of this study are available upon reasonable request from the corresponding author, (VW). The data are not publicly available due to their containing information that could compromise the privacy of research participants. 

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Acknowledgements

Thanks are due to the nurse home visitors who work tirelessly to implement the program and their community partners, as well as the Nurse-Family Partnership National Service Office for supporting this research.

Funding

This study was partially supported by funds from the Nurse-Family Partnership® (NFP) National Service Office through the Blue Meridian Partners.

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Authors and Affiliations

  1. Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, USA

    Venice Ng Williams & David Lee Olds

  2. Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, USA

    Beth McManus & Gregory Jackson Tung

  3. Department of Community Behavioral Health, Colorado School of Public Health, Aurora, USA

    Ashley Brooks-Russell

  4. National Service Office for Nurse-Family Partnership and Child First, Denver, USA

    Elly Yost

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  1. Venice Ng Williams
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Correspondence to Venice Ng Williams.

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Disclaimer

The funders had no role in the design of the study; collection, analysis, and interpretation of data; writing the manuscript; or the decision to submit the manuscript for publication.

Ethics Approval

This study was approved by the Colorado Multiple Institutional Review Board as not human subject research under protocol no. 18–0575. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Not applicable.

Conflict of Interest

DLO is the founder of NFP and, with the University of Colorado, owns the NFP intellectual property. The University of Colorado receives royalties from governments and organizations outside of the USA that implement NFP and has contracts with those entities to guide the implementation of NFP with quality. DLO could receive personal royalties and fees, but none of the royalties or fees go to DLO personally; they are used to support the Prevention Research Center for Family and Child Health research and NFP implementation guidance. EY is an employee of the NFP National Service Office. All other authors declare no competing or financial interests.

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Williams, V.N., McManus, B., Brooks-Russell, A. et al. Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program. Prev Sci 24, 1209–1224 (2023). https://doi.org/10.1007/s11121-023-01538-w

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