Lum, a refugee from Burma, was about 12 weeks pregnant when she accepted a referral to the Nurse-Family Partnership at the Visiting Nurse Services of Iowa.
She said she knew little about babies but wanted to be a good mother, said Marcia Allen, RN, BSN, the NFP nurse home visitor paired with Lum.
More than 23,000 families across the country are enrolled in the NFP, a national nonprofit program that aims to improve the health and lives of low-income, first-time mothers and their babies. Allen helped Lum learn about parenting, decipher complicated Medicaid forms, get prenatal care and go to beauty school, all of which tied into the NFPs goal to improve pregnancy and economic outcomes.
With Allens guidance, Lum gave birth to a healthy boy and made other changes, including starting her own business.
Tested for decades
The NFP started as a research study in 1977 in Elmira, N.Y., said Joan Barrett, RN, MSN, nurse consultant with the NFP National Service Office in Denver. The study measured the programs effects on low-income, first-time mothers maternal health and their childrens health and development, according to an NFP fact sheet. Program participants ages 14 to 16 had newborns who were, on average, 395 grams heavier than those in the comparison group, according to a report, “Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation,” which was published in the journal Pediatrics in 1986. The women also were more aware of available community services, attended childbirth classes more frequently and made greater dietary improvements than those in the comparison group.
The program was tested again in 1988 and 1994 and had similar results. As of July 2012, NFP programs had begun in 41 states.
Working toward goals
Nurses work to determine what motivates a mother and to help her identify her dreams, said Barrett. The “strongly client-focused” program allows mothers to set their own goals, she said.
“We follow their lead as much as we can,” Barrett said.
Nurses plan visits by asking what the mother wants to focus on during the next meeting. To help guide new moms, nurses provide information packets on how to make a budget, write a resume, return to school and set goals.
Before and after a baby is born, nurses visit the mothers frequently, Barrett said. Visits taper off as the child nears age 2, though nurses can increase or decrease the visit frequency based on the mothers needs.
For one 15-year-old NFP client in San Francisco County, the materials packet helped her reconnect with her mother, said Asheley Epperson Gardner, RN, BSN, PHN, nurse supervisor for the San Francisco program. “[The packet] became a talking point between the client and [her] mom,” Gardner said. “They connected over what the nurse showed her at the visit.”
Each local NFP establishes an advisory board of community members who can support life-course development, Barrett said. They can help mothers earn their GED certificate and write resumes, provide them with professional clothes or help them access community college grants and scholarships, she said. At the Visiting Nurse Services of Iowa, the NFP board members include social workers, a pediatrician, a community child advocate, a nurse practitioner and a prenatal services specialist.
Allen said to help achieve Lums dream of owning a beauty salon, the two developed a business plan and worked at getting a small business loan. Lum graduated from beauty school seven days before giving birth.
“Shes so industrious and hardworking,” Allen said. “She had such a desire to succeed.”
The road is not easy for the young mothers, who can suffer setbacks. “Clients are making choices all the time [that we wish they didnt make],” Barrett said. In the case of a mother struggling to quit smoking, the nurse would set a goal of cutting back to just one cigarette per week, then affirm that change when the client makes it, Allen said. “You dont look for change overnight,” she said. “Change comes slowly. You have to be really positive with them.”
Many of the roughly 1,400 nurses come from community health or maternal/child backgrounds, but the job requires them to take a more comprehensive approach to patient care. “It takes all of you, all of your heart and your brain,” Barrett said. “If [nurses are] the right fit for the program, they dont want to leave.”
Each nurse has weekly one-on-one meetings with a supervisor to share successes and frustrations and to discuss ways to support the client.
The NFP teams meet weekly to brainstorm about client attrition rates, engaging clients during visits and refueling emotionally to prevent burnout, Gardner said. They meet every other week for case conferences during which a nurse describes a client profile and asks for help. “Its a way we learn as a group,” she said.
Ensuring nurses needs are met is important to the success of the program, Gardner said. Her program has built a culture of self-care. “We built a team that is very open and is tightly bonded.”
That openness allows nurses to be fully engaged at their visits with clients, she said.
The NFP National Service Office oversees the community organizations that implement the programs.
Funding sources vary by community. For example, some states provide funding via a cigarette tax. Funding also comes from the Affordable Care Act, which allots states $1.5 billion over five years through the Maternal, Infant and Early Childhood Home Visiting Program.
Money also comes from Medicaid, the Title V Maternal and Child Health Services Block Grant, Temporary Assistance for Needy Families, a Child Care and Development Block Grant, Healthy Start, juvenile justice prevention funds and child abuse prevention funds from the Administration for Children & Families, NFP stated on its website.
Funding is vital because the program costs an average of $4,500 per family per year, according to NFP. The highest costs typically are found in urban areas on the East and West Coasts and in hospital-based programs.
Creating economic self-sufficiency
Though a family graduates from the program when the child is age 2, mothers develop long-term life skills and economic self-sufficiency. Because nurses encourage mothers to complete their education or seek employment, the program contributes to a long-term reduction in welfare use, Barrett said.
The results have positive effects on the children. At age 15, the children of mothers visited by NFP nurses in the Elmira study, had 48% fewer officially verified incidents of child abuse and neglect, according to a report by the Coalition for Evidence-Based Policy. By age 19, they were 43% less likely to have been arrested.
By the time their children reached age 15, the mothers in the Elmira study had spent 20% less time on welfare and had 61% fewer self-reported arrests than those not enrolled in the program, according to the report.
After graduating from beauty school and giving birth to her son, Lum opened Amazing Beauty Salon and is now a self-sufficient mother of two, Allen said. “Its been wonderful for me to watch her grow,” Allen said. “Its probably the most challenging work Ive ever done, but the most rewarding job Ive ever had.” •