Increasing collaboration between Nurse-Family Partnership and Child Protective Services: A multiple case study

Background: The Nurse-Family Partnership (NFP) is a voluntary maternal and early childhood program designed to improve the health and development of mothers and their babies.  In a series of randomized controlled trials, NFP has improved prenatal health, child health and development, and maternal life-course, as well as decreased the incidence of child abuse and neglect. The effectiveness of NFP in decreasing child maltreatment is influenced by nurses’ collaboration with Child Protective Services (CPS).  The objective of this project was to explore the spectrum of collaboration practices and factors perceived by NFP and CPS workers as barriers and facilitators to effective collaboration in Colorado. 

Methods: We conducted a multiple case study informed by focus groups and qualitative interviews with NFP nurses, CPS workers, and other stakeholders. A grounded theory approach was used to iteratively identify new themes and explore those themes in subsequent cases and analysis.  Seven NFP sites involving 12 counties were purposely selected to participate in the research. 

Results: Levels of collaboration between NFP and CPS varied significantly.  Perspectives and attitudes surrounding what constitutes effective collaboration also varied across sites and organizations. Key factors associated with closer collaboration include: co-location, open communication on joint cases, established relationships, mutual understanding of roles, and common philosophy in supporting families.

Conclusion: Our results highlight both models of effective collaboration and associated facilitators and barriers.  This information should be used to design training and educational opportunities for both NFP and CPS workers as well as to design system-level interventions to facilitate effective collaboration.