Trends in demographics and needs for nurse-family partnership clients enrolled between 1997 and 2022

Demographics and needs of nulliparous, Medicaid-eligible pregnant individuals, the target profile for Nurse-Family Partnership (NFP), have shifted over recent decades as teen pregnancy rates have dropped and Medicaid eligibility has expanded.

We examined trends in the proportion of NFP clients with demographic characteristics and needs impacting client and child outcomes.

Participants were nulliparous, pregnant individuals (N = 349,935; 33 % Hispanic, 30 % non-Hispanic Black, 30 % non-Hispanic White) enrolled between 1997 and 2022 in NFP, a national public health intervention aimed at improving client and child outcomes through in-home nurse visitation.

Generalized linear models and time-varying models examined change over time.

Later enrollment year predicted enrollment of: more racially/ethnically diverse clients with older age (β = 0.24 ± 0.002, P < .0001) more educated clients (college degree vs. high school diploma/GED OR 1.195, 95 % CI 1.194-1.195), more married/cohabiting clients (OR 1.131, 95 % CI 1.129-1.132), clients with higher mastery scores (β = 0.007 ± 0.0001, P < .0001), and increased client needs (pre-pregnancy mental/physical health diagnoses, substance use/addiction, IPV exposure, and homelessness; ORs 1.082 to 1.300, all P < .0001). The average summed needs of clients increased from 1.17 in 1997 to 1.36 in 2022. Non-Hispanic White clients had greater summed needs compared to Hispanic and non-Hispanic Black clients, driven by higher rates of health diagnoses and substance use.

The demographics and needs of NFP clients have shifted over time. Compared to the original trials and earlier program replication, recent clients are older and more educated but have greater needs in a variety of domains increasing risk of poor client and child outcomes.