Nurse-Family Partnership: Working Together for Healthier Families
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Peggy Hill's presentation at the Center for High Impact Philanthropy Donor Education Seminar.
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Nurse-Family Partnership: Working Together for Healthier Families
- 1. Working Together for Healthier Families Nurse-Family Partnership Overview
- 2. © Copyright 2010 Nurse-Family Partnership. All rights reserved. 2 “There is a magic window during pregnancy…it’s a time when the desire to be a good mother and raise a healthy, happy child creates motivation to overcome incredible obstacles including poverty, instability or abuse with the help of a well-trained nurse.” David Olds, PhD, Founder, Nurse-Family Partnership
- 3. © Copyright 2010 Nurse-Family Partnership. All rights reserved. 3 Program Goals •Improve pregnancy outcomes •Improve child health and development •Improve parents’ economic self- sufficiency Key Program Components •First pregnancy, women living in poverty •Frequent home visits over 2 ½ years •Focus on behavior, skills, confidence •Flexible, structured intervention •Monitoring of implementation and outcomes Nurses •Knowledge, judgment and skills •High level of trust, low stigma •Credibility and perceived authority Program Design
- 4. © Copyright 2010 Nurse-Family Partnership. All rights reserved. Home Visit Overview 4Program Design Personal Health Health Maintenance Practices Nutrition and Exercise Substance Use Mental Health Functioning Environmental Health Home Work, School, and Neighborhood Life Course Development Family Planning Education and Livelihood Parental Role Identity: Mothering/Fathering Physical Care Behavioral and Emotional Care Family and Friends Personal Network Relationships Assistance with Childcare Health and Human Services Service Utilization
- 5. © Copyright 2010 Nurse-Family Partnership. All rights reserved. Trials of the Program 1977 Elmira, NY Participants: 400 Population: Low-income whites Studied: Semi-rural area 5 1988 Memphis, TN Participants: 1,139 Population: Low-income blacks Studied: Urban area 1994 Denver, CO Participants: 735 Population: Large portion of Hispanics Studied: Nurse versus paraprofessional visitors Dr. Olds’ research & development of NFP continues today… Using Research to Test Program Effectiveness
- 6. © Copyright 2010 Nurse-Family Partnership. All rights reserved. Using Research to Test Program Effectiveness Women’s Health and Development – Various improvements in pregnancy health and health behavior – 79% reduction in pre-term births among women who smoke – 32% fewer unintended subsequent pregnancies – 72% fewer criminal convictions of the mother Children’s Health and Development – 56% reduction in emergency room visits for injuries/ingestions – 48% reduction in child abuse – 50% reduction in language delays at child age 21 months – 67% reduction in behavioral/cognitive problems at child age 6 Family Stability and Economic Self-Sufficiency – 20% reduction in months on welfare – 83% increase in labor force participation by child’s fourth birthday – 46% increase in father’s presence in the household
- 7. © Copyright 2010 Nurse-Family Partnership. All rights reserved. 7 Nurse-Family Partnership is Cost-Effective •Nurse-Family Partnership returns more than $18,000 over and above program costs for each family enrolled (Washington State Institute of Public Policy 2008) •Savings accrue to government from decreased spending on: health care criminal justice child protection mental health education public assistance Using Research to Test Program Effectiveness
- 8. © Copyright 2010 Nurse-Family Partnership. All rights reserved. July 2010 [select all, copy and paste] Going to Scale 32 states 385 counties 21,494 families currently enrolled 52 1 77 52 40 1 3 1 1 1 1 1 11 12 7 1 2 4 3 17 9 10 23 13 21 3 1 12 2 2 1 1
- 9. © Copyright 2010 Nurse-Family Partnership. All rights reserved. Going to Scale •Consider the complexity of what you’re trying to reproduce, where, and with whom •Outline the essentials clearly, so others can understand •Scaffolding helps (planning, training, manuals, coaching) •Money and its “strings” have power •Evaluation is essential
- 10. © Copyright 2010 Nurse-Family Partnership. All rights reserved. 10 The Nurse-Family Partnership National Service Office Accountable for Quality and Results • State and community planning: financing, implementation • Contracts with agencies who conduct the program locally • Nurse education in the model – home visitors and supervisors • Quality monitoring and coaching for improvement • Advocacy support • Service-related revenue fosters our own sustainability Going to Scale
- 11. © Copyright 2010 Nurse-Family Partnership. All rights reserved. Three Big Ideas…. 1. Well-designed services that matter to those they serve… 2. Carefully evaluated… 3. Taken to scale with necessary supports… Improved health for families living in poverty
- 12. © Copyright 2010 Nurse-Family Partnership. All rights reserved.
- 13. © Copyright 2010 Nurse-Family Partnership. All rights reserved. 13 For more Information Peggy Hill, Chief Strategic Relations Officer Nurse-Family Partnership National Service Office 1900 Grant Street, Ste 400 Denver, Colorado 80203 peggy.hill@nursefamilypartnership.org Toll-free 866.864.5226 www.nursefamilypartnership.org Contact Us
Editor's Notes
- “Working Together to Ensure Healthier Families.” Every year 600,000 children are born to first-time mothers who are from low-income households. I’m here today to talk with you about a unique community health program, Nurse-Family Partnership, that has been developed specifically to transform the lives of these first-time mothers and their children. These are tough times and we are all facing hard choices. As a result, we are all looking to invest in programs that work. I’m proud to say that Nurse-Family Partnership works - more than 30 years of randomized controlled clinical trials prove that it works, and a number of independent studies also show that the program can more than pay for itself.
- Nurse-Family Partnership knows that women who are pregnant for the first time and living in deep poverty experience a kind of vulnerability that can be overwhelming. It’s a time when women are receptive to the care of a nurse whose only agenda is to make sure each participant discovers within herself the determination and capability to build a life for herself and her child that is healthy, stable, and full of greater opportunities than she has known to this point in her life. In South Carolina… our partners here have estimated that there are over 10,000 women living in poverty who give birth to their first child in a year’s time (2007 data). Poverty alone is associated with a host of other risks to health and economic well-being; and our founder wanted to design Nurse-Family Partnership to attend skillfully to those risks that conspire most powerfully to entrap families in inter-generational poverty, risks for chronic disease, injuries and maltreatment, violence and substance abuse, educational failure and welfare dependence. He knew that in order for NFP to make sense to families living in the most dire circumstances possible, we would have to be prepared to face all of what stands in the way of a healthy developmental trajectory. And that is exactly what we do.
- Well-Designed Programs: Relevant and appealing to those it will serve Based in the best evidence available about what works to produce desired change – clear logic Clear connection between what staff do, and what actually helps those served make changes Simple, built-in evaluation
- Home visits focus on six core areas beginning with the mother’s personal health and the maternal role. Nurses also work with mothers on issues that can affect their development and their child including environmental health issues and the influence of family and friends. Life course development focuses on the mother’s future, and nurses also help their clients navigate the health and human services system to take advantage of resources that can benefit both mother and child.
- Why bother evaluating programs? What we think should work, doesn’t always actually work What works in one context won’t automatically work elsewhere Failures can be highly informative if you pay attention Evaluation fosters discipline and better programs
- A study conducted by the Washington State Institute of Public Policy estimated a return on investment of $18,000 for each family enrolled, and a 1998 study by the Rand Corporation found that savings accrue in areas such as health care delivery, child protection, education, criminal justice, mental health and welfare and public assistance. In addition, communities also realize a benefit through increased taxes paid by employed parents.
- Nurse-Family Partnership has grown from its initial research study locations in NY, TN, and CO to become a national program currently operating in 31 states, and a total of 378 counties. We are optimistic that a portion of federal funds available through health care reform will help communities serve as many as an additional 40,000 women over the next five years. One of the most important keys to that success will be the influence of our champions in the private sector who can encourage state and community leaders to consider NFP as a programmatic option well-suited to the legislation that created this funding opportunity. Indeed, it is our partnership with BCBS-SC that has helped teach us just how many ways the private sector can help keep NFP true to its mission, strong in its implementation, and growing.
- Our national service headquarters exists to make sure that every one of our state and local partners (public and private) succeeds with the implementation of Nurse-Family Partnership – and achieves the improvements in the health of women and children that were seen in the scientific studies that demonstrated the program’s effectiveness. From up-front planning, nursing practice development, QI efforts and policy advocacy – we are here to make sure NFP is conducted properly and is sustainable for the long term. Local programs are funded now from close to 20 different sources, public and private – but I will tell you that private funding – from individuals and foundations, is often what leverages attention to EBPs, additional and sustainable funding, and the needed commitment from people of influence to keep programs going that are actually making a difference.
- Little girls like Harmony, and her parents, are full of everything worth hoping for in our world today. I’ve given you a lot of information, a snapshot of what you are making possible in South Carolina, and yet if I didn’t give you a glimpse of the way in which you are touching the lives of the people of South Carolina, I would not be doing your contributions justice. I’m going to show you a very short video that was done by the NFP nurses at the YWCA in Dallas, TX. Just know that their stories, with a little different accent, are the stories of families in Columbia and Anderson and Greenville and Conway. Please… give them your attention now… [run 6 minute video] …………………………………. Each year 400,000 women living in deep poverty in our country give birth to their first child… We want each one of them to have a Nurse-Family Partnership nurse home visitor. Breaking cycles, empowering parents, making children healthy THANK YOU, for your commitment to the health and future of South Carolina’s children.
- Thank you for your time today – I welcome the chance to answer any questions you may have.