ANFPP FREQUENTLY ASKED QUESTIONS
Theme
Why the NFP?
Frequently Asked
Question
What is the evidence
base of the program?
In what ways is this
program relevant to
Aboriginal and Torres
Strait Islander people?
Response
ANFPP is a licenced adaptation of the Nurse-Family Partnership (NFP) program. The NFP is a preventative
and early intervention program which has been designed and researched over the last 30 years with
evaluation research providing strong evidence of positive outcomes for mothers who participate in the
program and their families. Research has demonstrated positive pregnancy outcomes for women and
children, improvements in the quality of parental care giving and in mother’s life course development.
Articles on the research underpinning the program can be found in the ANFPP website: anfpp.com.au.
Findings from formative evaluations in Australia suggest that the program model is acceptable in the
Australian Indigenous Health context. Since 2008, ongoing monitoring of program outcomes in Australia
have also been promising. A randomised controlled trial – regarded as the gold standard in research – will
be needed to evaluate if ANFPP has the same program results as the model has been proven to have in
other societies implementing the same model.
The program was initially adapted to the Indigenous health setting by including an Aboriginal or Torres Strait
Islander specific position within the home visiting team, including multiparous women, and adapting
program material. Adaptation is ongoing and is done through relationships with implementing
organisations, most being Aboriginal Controlled Community Health Organisations (ACCHO).
This is a relationship based program and service delivery embraces the five client-centred principles:
The woman is the expert on her own life
The home visits follow the woman’s heart desire
Only small steps are necessary
Conversations are focused on solutions
Work is strength based.
The program is also underpinned by three major theories and home visiting teams engage in regular
Reflective Practice to align actions and decisions to them. The theories are:
Attachment theory: early connections to carers are important.
Self-efficacy theory: by ‘doing’ we learn and in turn this returns our power.
Human Ecology theory: individuals interact, influence and are influenced by people and systems
around them.
Are there any
alternative programs
that could be
implemented instead?
How is it being
delivered?
The program is very
prescriptive and rigid –
it can only be delivered
in a particular way.
What do clients think of
the program?
What do staff and
managers at sites
running the program
think of the program?
What challenges have
been faced in
In Australia, the decision to implement ANFPP or other programs, rests fully with implementing
organisations who decide if the program is the right fit for their community.
There are other programs also working in this space however, ANFPP is currently the only program of its
kind in Australia based on strong empirical evidence that the model results In better outcomes for
participating mothers and their families
Research shows that, compared to similar mothers, those in the program are more aware of community
services, are more likely to attend childbirth classes, are more likely to use nutrition programs and improve
their diets, have fewer kidney infections, reduce smoking, and have longer gestation (for some mothers).
Unlike other programs, the program is well defined and supported by materials to guide home visiting
teams in their practice. The program has core elements that guide practice and ensure outcomes for
mothers and families. As ANFPP staff develop their experience in implementing the program, their ability to
deliver the program in a way that is flexible and maintains alignment to the models core elements is also
increasing.
Observations and qualitative information from mothers and families support the continuation of the
program. Mothers participating in the program have given a number of presentations at conferences (e.g.
Chronic Disease Network Conference 2011, Infant and Early Childhood Social and Emotional Well-being
Conference 2013) and have participated in local marketing campaigns. They have explained how it has
benefitted them and express increased confidence in their own abilities as mothers and demonstrate
connected and responsible care giving.
Boards of ACCHOs, staff, members of Community Reference Groups, representatives from other agencies
and mothers using the service are consistent in their view that the ANFPP was acceptable to Indigenous
communities.
This is a novel model of service delivery in primary health care settings for nurses in Australia. Introducing
the program requires organisations and teams to explore and better understand how the program fits into
the local service delivery context. The model does not replace existing and known services, it is designed to
work together with existing services for the benefit of participating mothers. Program implementation is
supported by intensive program specific education and this can enhance the skill base of organisations at
local levels.
Adapting the program model to suit the Australian Indigenous Health context was the first challenge faced
when the program was introduced in 2008. Part of the licenced adaptation includes an additional role within
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implementing the
program in Australia?
What is it
achieving?
What outcomes have
been observed in
Australia so far?
the program - an Aboriginal or Torres Strait Islander Family Partnership Worker. FPWs are essential to
engendering and maintaining community interest and trust in the program. In partnering with nurses in the
home visits, they can influence culturally safe practice.
Organisational and community readiness is a significant element in the successful implementation of ANFPP.
Program requirements need to be well understood by staff at all levels of implementing organisation and
the organisation needs to be ready to support such.
Program staff are required to participate in intensive program education which takes place over a period of
time. Staff often report that it takes a long time to really understand the program and how it works. The
program is delivered in an Indigenous Health setting and staff are required to work effectively in crosscultural client and organisational environments.
This is a relationship-based program in an Indigenous health setting and staff can experience the work as
emotionally draining. Staff also report the rewarding nature of the work. Reflective Practice in supervision is
one way the program supports staff retention. Cultural orientation and support is required from the
implementing organisations and colleagues.
Data collection and client assessment is critical to service delivery in ANFPP and can prove challenging to
staff new to these requirements. Core education and ongoing support is provided by the ANFPP National
Program Centre to help staff and implementing organisations become competent in this area.
The program requires ongoing adaptation to local cultural contexts and this is only possible through
collaborative relationships with program staff at implementing sites
There are significant costs associated with the program’s establishment and maintenance if there is high
staff turnover in the program. However, cost effectiveness has been shown in the UK and US with an
average of <$7 return for every $1 spent in the program. Similar cost-effectiveness studies would need to be
conducted in Australia.
As of June 30 2016, there were 169 active clients across four ANFPP sites. Three of the four ANFPP sites are
established sites and have seen a combination of 206 clients complete the program.
Analysis of the data from 2014-2015 shows significant improvement with woman smoking during their
pregnancy. With 28% of clients reporting smoking in the two days prior to enrolment in the program. This is
a significant difference compared to the previous reporting year with 39% of woman reporting their
smoking behaviours.
ANFPP have reported that only 3.6% of singleton babies born within the program had low birth weight. This
is a significant outcome for women and infants within the program as the national statistic is 11.8% for all
Aboriginal and Torres Strait Islander women birthing in Australia in 2012.
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The program has also seen a high acceptance of first time mothers, with 98% of clients being first time
mothers.
Data analyses for 2014-2015 shows that 97.6% of infants were fully immunized at 12 months of age and
100% by the child’s second birthday. This exceeds the Australian averages for Aboriginal and Torres Strait
Islander children.
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