NURSE - FAMILY PARTNERSHIP
Program Overview
The first program Invest in Kids identified and chose to advocate throughout Colorado was Nurse-Family Partnership (formerly known as the Nurse Home Visitor Program). Invest in Kids chose this model because it has been shown to produce truly life changing outcomes for families through scientifically controlled, randomized trials, over the course of nearly 30 years. The program’s remarkable results have been the subject of numerous articles published in the Journal of the American Medical Association and other peer reviewed journals.
Conceived by Dr. David Olds and his colleagues in the 1970s, Nurse-Family Partnership sends specially trained nurses on weekly or bi-weekly visits to low-income, first-time mothers starting as early as possible in pregnancy and continuing until their children's second birthdays. Under this voluntary program, nurses help mothers improve their health and nutrition during pregnancy, learn effective early parenting skills, and reach goals like completing school and finding employment.
The program has visit by visit guidelines that provide for a client-centered approach that uses solution focused techniques with the goal of achieving enduring behavioral changes. The intervention centers around six program domains: personal health, environmental health, life course development, maternal role, family and friends and health and human services. It is the focus on these domains that enables the clients to achieve the program goals: to improve pregnancy outcomes, promote child health and development and impact parental life course development.
Research Trials
Nurse-Family Partnership has been carefully tested through ongoing, longitudinal randomized trials in Elmira, New York (begun in 1977) and in Memphis, Tennessee (begun in 1987). A third trial in Denver, Colorado has been concluded; the data is being analyzed; and results will soon be published.
In a 15-year follow-up of the Elmira sample among low-income, unmarried, mostly Caucasian women and their children, the program also produced:
- 48% reduction in child abuse and neglect
- 25% reduction in smoking by the mothers during pregnancy
- 61% fewer arrests of the mothers
- 44% reduction in maternal behavioral problems due to drugs and alcohol
- 56% reduction in children’s emergency room visits where injuries were detected
- 83% increase in the work force participation of the mothers by their children’s fourth birthday
- 31-month increase in the interval between the first and second children
- 30-month reduction in mother’s use of welfare 15 years after delivery of first child
- 51% fewer days consuming alcohol among the children at age 15
- 57% fewer sexual partners among the children at age 15
- 28% reduction in smoking by the children at age 15
- 54% reduction in crime by the children at age 15
Similar patterns have begun to emerge among the outcomes for families in the Memphis trial, who were largely African-American. Through the child’s second year of life, nurse-visited families had, compared to the control group:
- 25% fewer hypertensive disorders of pregnancy
- 25% fewer injuries among the children
- 78% fewer days of hospitalization for injuries or ingestions among the children
- 30% fewer subsequent pregnancies and live births
Data from the Memphis trial also indicate greater spacing between births of first and second children; reductions in women’s use of welfare and food stamps; women living more often with the fathers of their children; women living more often with men who are employed; and higher marriage rates.
While long-term follow-up data are not yet available for the Denver trial, to date, the data confirm that the program has produced statistically significant effects on its targeted outcome domains (women's prenatal health, infant health, maternal life-course). Additionally, the Denver trial included a control group and two intervention groups, one with paraprofessionals delivering the service and the other with nurse visitors. While the model had already been through the two clinical trials outside of Colorado, never before had the deliverer of the service been tested, and the initial data shows clearly that the nurses are unquestionably the most effective.
Program Costs and Benefits
Program services are usually funded through a variety of public sources (see "Promoting Sustainability" for funding in Colorado). The average annual program cost is approximately $4,500 per family, with variation in cost dependent primarily upon local nurses' salaries.
Nurse-Family Partnership drastically reduces child abuse and neglect, use of welfare, criminal activity and substance abuse by supporting first-time parents in developing the tools they need to better care for themselves and their children. By helping participants increase their earnings, reduce their dependency on welfare, and avert costs related to crime, Nurse-Family Partnership returns $4 to society for every dollar invested, (according to a 1997 Rand Corporation study) and pays for itself by the time the children are 4 years old.
Facilitating Implementation
Invest in Kids acts as a catalyst and resource for communities interested in implementing Nurse-Family Partnership. By convening meetings and making presentations to community groups, Invest in Kids supports local leaders who have chosen to bring the program to their community to identify a strong implementing agency and assess where the program fits on their continuum of services. By collaborating with other programs, communities can maximize service offerings for Colorado’s most vulnerable children.
Invest in Kids assists each implementing agency in building a broad based coalition at the local level, whose involvement helps support a successful high-quality implementation of the program. Once a site is funded, Invest in Kids provides technical assistance to support program implementation and on-going program success.
Promoting Sustainability
Invest in Kids knew that the success of its efforts to bring the Nurse-Family Partnership to as many eligible families as wanted to participate depended on long-term, sustainable funding for the program. Consequently, Invest in Kids worked with Colorado legislators and helped convey the importance and effectiveness of the program to them. As a result of Invest in Kids’ work, a passionate and committed sponsor, State Senator Norma Anderson, and the hard work of several other interested parties and legislators, the Colorado General Assembly passed the Nurse Home Visitor Act (the "Act") in the 2000 legislative session. The Act allocated Colorado’s share of the proceeds from the Master Settlement Agreement negotiated between the States’ Attorneys General and the tobacco industry.
The Act allocates 3% (or roughly $2.3 million) of the tobacco settlement proceeds in fiscal year 2000-2001 to local communities to fund the implementation of the Nurse-Family Partnership. According to the Act, the Nurse-Family Partnership receives additional funding each subsequent fiscal year until it receives 19% (roughly $19 million) in 2011-2012. After that, the program will continue to receive 19% per year. At that point, this voluntary program will be available to thousands of low-income, first-time mothers and their families.
According to the Act, The Colorado Department of Public Health and Environment (CDPHE) administers the program.Local communities must apply to the CDPHE and compete for funds to implement the program. CDPHE works closely with the National Nurse-Family Partnership, Dr. David Olds and Invest in Kids to oversee the program's implementation in Colorado. The National Nurse-Family Partnership National Service Office also oversees the dissemination of the program throughout the country and ensures that the program is implemented with fidelity to the original model (training, guidelines, computer system, evaluation and reporting mechanisms). Nationally, the Nurse-Family Partnership is serving families in over 200 counties across 22 states.
|
