Aligning Health and Social Systems to Improve Maternal Behaviors and Birth Outcomes Among Clients Engaged in Evidence-Based Home Visiting.

Objectives. To examine the association between system alignment among Nurse-Family Partnership (NFP) home visitors and other community service providers and maternal behaviors and birth outcomes among NFP clients. Methods. NFP implementation data from 2015 to 2021 were matched to the 2018 to 2021 NFP Collaboration Panel Survey (n = 102 690). We used Poisson-based general estimating equations to examine a measure of cross-sector collaboration (based on relational coordination and structural integration) and the relationship with prenatal smoking cessation, breastfeeding, low birth weight, and preterm birth after adjustment for client-, nurse-, and agency-level covariates. Results. Stronger coordination with women's care providers (relative risk [RR] = 1.010; 95% confidence interval [CI] = 1.00, 1.02) and greater integration with mental health providers (RR = 1.002; 95% CI = 1.00, 1.00) were slightly positively associated with initiation of breastfeeding. The slight positive association with greater integration with mental health providers was sustained for continued breastfeeding at 6 months postpartum (RR = 1.004; 95% CI = 1.00, 1.01). System alignment was not related to prenatal smoking cessation, low birth weight, or preterm birth. Conclusions. Future implementation studies should explore whether strategies to increase system alignment result in changes in quantitative measures of cross-sector collaboration and meaningful improvement in maternal and child outcomes at a population level. (Am J Public Health. 2026;116(S3): S181-S191. https://doi.org/10.2105/AJPH.2026.308457).