Nurse Family Partnership: Busting Poverty and Crime, Changing Futures Two at a Time

My life was a mess – dad in jail, no job, nobody to turn to, everything going wrong, I couldn’t manage anything and here I had this baby coming. I was going to make a mess of another life.

~ Nafessa, with Noah age 1, on her lap at meeting at Nurse Family Partnership (NFP) Philadelphia, Nov. 10, 2015

This job is the best nursing job I ever had. You’re so busy in a hospital job, running back and forth, no time for a relationship. The patients don’t come back. Here we build a relationship, a two-year relationship. I have a hand in building a future, two futures! Really, they’re not clients. They become part of a family. This is not a job, it’s a calling.

~ Joy Ahn, BSN, RN, Nurse Home Visitor, at same meeting

I visited NFP’s program offices on Delaware Avenue in Philadelphia. One enters a light-filled, open space flanked by a kitchen (the alluring smell of chili) and tables both large, for adults and small, for kids. I met with a roomful of about 15 nurses, their supervisors and their administrator, Dr. Katherine Kinsey, “a recovering academic.” We were joined by two young mothers, one with Noah in her lap. It felt like the best of church: open, honest, mutually supportive, a profound sense of mission, fun and joyous. Everyone should be so fortunate just to be able to inhale the atmosphere.

All this in the face of the tough work NFP nurses perform. The life prospects for a first time, low-income mother bearing a child out of wedlock are grim, prospects portending a life of trouble – onset or continuation of poverty, conflict and despair for each. Statistics tell the story: children born in such circumstances have a dramatically higher incidence of abuse, neglect, foster care placement, dropping out of school and justice system involvement.

Nurse Family Partnership: The Model

She wouldn’t let me go. She kept calling me. I thought she was crazy. Why would she care about me? Finally I gave up. I said yes. I was so alone. When we sat down, she listened to me. Listened to me for two hours! She gave me so much advice. I didn’t feel like a client. She’s not really a nurse, she’s a friend.

~ Samia, young mother and NFP client

While working in an inner-city day-care center, Dr. David Olds, a young professor of pediatrics, psychiatry and preventive medicine, realized that children born in compromised circumstances needed help much earlier – at home with their mothers, and before birth. Olds spotted brain development difficulties at 4 years of age. He saw brains awash in cortisol, which triggers fight-or-flight, hair trigger patterns. Such children, so alert to uncertainty and danger, so unable to escape toxic stress, cannot concentrate, cannot learn well, cannot easily forge bonds of affection.

Olds began a nurse home visiting program, refining it over the years. He believed that the experiences of trained, registered nurses could have a huge impact on both mother and child. He was right.

NFP has three goals: improved pregnancy outcomes, health practice, prenatal care, diet, stress; improved child health and development by helping parents provide responsible and competent care; improved economic self-sufficiency of the family by helping parents plan for their future.

Subject to multiple randomized control group testing – evaluation’s gold standard – NFP shows eye-popping results for both mother and child. Of 46 early childhood programs studied by the Coalition for Evidence-Based Police, NFP is one of only two meeting the “Top Tier” criteria. NFP shows reduced healthcare encounters, reductions in child abuse and neglect, and reductions in arrests and adjudication. It increases the mother’s labor force and/or educational participation, and it saves money: The RAND Corporation reports that for every dollar a community invests in NFP, they can see up to $5.70 in return.

A study published in the August 2015 Issue of Prevention Science by Dr. Ted Miller, researcher with the Pacific Institute for Research and Evaluation, projects that by 2031 NFP will prevent an estimated 90,000 violent crimes by youth, 594,000 property and public order crimes and 36,000 youth arrests.

NFP adheres to an instructional curriculum for the health of both mother and child. Nurses provide a lot of “nurse-type” advice such as checking vital signs, advising on medical care, diet, smoking and alcohol, and helping to train for the arrival of a new baby. Most important, they provide first-time expectant mothers with a relationship they can count on.

I tell the nurses that they are the unconditional listeners, the one positive voice. Most of these first time moms are trashed, told they are lazy, irresponsible or just not given any guidance. These nurses may be the only nurturer the mothers have ever met.

~ Mary Beth Haas, Nurse Supervisor Team I, NFP, Philadelphia, PA.

Building trust with young women who have not experienced trust is an essential aspect of the work. “Oh, we stalk them, we won’t let them go,” said Haas. Others cited praise, listening, presence, persistence and follow through as trust builders.

Julie is the only person who told me I could do something. She believed in me. She wanted to grow with me. She gave me confidence.

~ Nafessa, NFP client

Formal evaluations cannot quantify a vital, even loving relationship where one of the partners can be vulnerable, knowing they are safe, thrilled by progress (or lack of it) they can share with someone who knows what it means. I think of my own daughter (the world’s best mother, of course) who calls frequently with reports both thrilling and vexing about her one year old – “Guess what: I think he said ‘pa-pa! today!” “He has a favorite book, and he knows which one it is!” – Or the troubling: “What happened? He reverted to soft foods! He threw food on the floor. It’s so frustrating. What am I doing wrong?”

NFP nurses love this particular branch of nursing, thrilled at the prospect of “having a hand in the future of both mother and child.” But the work is not easy. NFP nurses carry a caseload of about 25 mothers whom they visit weekly for the few months, then taper off, every few weeks, then monthly. They stay with the moms for two years. Most young mothers with whom nurses work face a cascade of issues that have little to do with nursing – lack of food, abusive boyfriends, lack of access to school or jobs, living in high crime areas, or as Nafessa put it, everything. Finding and connecting moms to essential resources such as food stamps, and drug abuse counseling or GED programs is a significant part of the work.

But mission trumps all:

“This is the job I’ve wanted all my life. This is everything I’ve wanted to do in nursing. My clients give to me as much as I give to them. This work is so inspiring. I get to witness changed lives.”  

~ Joy Ahn