NFP Community Presentation_2010


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Nurse Family Partnership_"Partners" Community Presentation

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  • Introduce self Introduce and here to talk about the NFP PFHP program
  • Nurse-Family Partnership was developed over 30 years ago by founder, David Olds who after working in an inner-city day-care center in the late 1970’s suspected that by age four or five many children who come from disadvantaged homes were already in trouble. His experiences led him to develop a program for first time mothers. I think you may have read the quote by now, which helps you to understand why Dr. Olds and our program are so committed to first-time mothers.
  • Consistent program effects were found in at least 2 of the 3 trials: Improved prenatal health Fewer childhood injuries Increased intervals between births Increased maternal employment Improved school readiness
  • We are an evidence-based community health program with more than 30 years of evidence that shows it WORKS! We transform the lives of our clients – first-time, low-income mothers. Most of these moms come from generational poverty, are single, unemployed, low education level and in unhealthy relationships. Many have substance abuse issues and other pschosocial issues including mental health diagnoses that put themselves and their infants at risk.
  • Today, Nurse-Family Partnership has a presence in 29 states and in over 350 counties in the U.S. NFP also has expanded internationally. Piloting programs in Great Britain, Germany and elsewhere.
  • Longitudinal follow-ups look at program effects on maternal economic self-sufficiency, substance abuse and children’s adaptive functioning including mental health, criminal behavior and productive life course These are conducted at program sites around the country and include studies of interventions to help nurses deal more effectively with maternal depression and to more fully engage participants . In past four years PRC has five contractual agreements to consult on research and development of NFP programs abroad.
  • Nurse-Family Partnership is a disciplined program. Every nurse receives extensive training to ensure that they focus on three goals: 1. Improve pregnancy outcomes: Help women practice sound health-related behaviors, including: obtaining good prenatal care from their healthcare provider; improving their diet; and reducing personal health behaviors that can affect a child such as the use of cigarettes, alcohol and illegal drugs.   2. Improve the child’s health and development: Help parents provide responsible and competent care for their children.   3. Improve families’ economic self-sufficiency: Help parents develop a vision for their own future, plan future pregnancies, continue their education and find jobs. The program features five program components essential to the successful implementation of the program: It begins with the clients we serve – first-time, low-income mothers. We focus on families with limited resources because they are more likely to experience increased risk factors. As I have noted, nurses are a central component and the intensive services they provide helps women to learn skills as well as acquire knowledge. Why nurses? Pregnant women have many questions and concerns about their health and the baby's health, and highly value the expertise that nurses can bring to them during this critical life transition. One nurse who works with us noted that many times our clients don’t understand what’s going on and they can be intimidated by a doctor. Working with their nurse on a continual basis allows them the time they need to build trust and ask questions. This relationship is an important part of our program’s success. Nurse-Family Partnership is a rigorous program. During each visit, a nurse collects information which is fed into a database that our national office in Denver maintains. This enables your local agency to monitor the program, using the information to ensure the same results that we have seen during the first 30 years are realized in your community. Visit-by-visit guidelines are also provided to help our nurses structure each engagement so that it adheres to key components of our program but remains adaptable to each family’s needs.
  • 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.
  • 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.
  • Characteristics of our population include: LIST AS NEEDED Race?
  • NFP PFHF Outcomes (Slide #12) Significant reduction in domestic violence in pregnancy Significant reduction in cigarette smoking during pregnancy Immunization rates higher than the state average NFP PFHF Outcomes(Slide # 13) Initiation of breastfeeding rate higher than the CO and National NFP rates, state and national rates for all mothers Still breastfeeding at six months is higher than the National NFP rate Low birth rate lower than the CO and National NFP, Colorado and Jefferson County rates for all mothers Preterm birth rate lower than CO and National NFP, Colorado and Jefferson County rates
  • Today we have a team of 8 nurses and two half time administrative support staff, some of whom are here, please stand up…. It is their hard work and commitment that has made this program as successful as it is today.
  • PFHF host site for Great Britain in 2006, BBC Broadcast in 2008; multiple legislators and NFP visitors.
  • PFHF host site for Great Britain in 2006, BBC Broadcast in 2008; multiple legislators and NFP visitors.
  • Finally, many agencies, organizations and independent “think tanks” have strongly endorsed Nurse-Family Partnership in recent years. Each of these organizations recommends Nurse-Family-Partnership because of our strong scientific foundation and our published findings. In short – they endorse Nurse-Family Partnership because it works.
  • While Nurse-Family Partnership remains focused on the mothers we serve and the communities and agencies that partner with us, we are gaining increased attention at the national level. We believe this interest is part of an ongoing trend to identify and invest in community health programs that work and we welcome the chance to talk with you about how we can work together to benefit mothers and our community. Or as some might say – Nurse-Family Partnership is real change.
  • Thank you for your time today – I welcome the chance to answer any questions you may have.
  • NFP Community Presentation_2010

    1. 1. Working Together to Ensure Healthier Families Presented by: Cynthia Farkas, RN, FNP, MS JCPH NFP Partners for Healthy Families Supervisor February 2010 NFP Partners for Healthy Families
    2. 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. 3. Trials of the Program <ul><ul><li>1977 </li></ul></ul><ul><ul><li>Elmira, NY </li></ul></ul><ul><ul><li>Participants: 400 </li></ul></ul><ul><ul><li>Population: Low-income whites </li></ul></ul><ul><ul><li>Studied: Semi-rural area </li></ul></ul><ul><ul><li>1988 </li></ul></ul><ul><ul><li>Memphis, TN </li></ul></ul><ul><ul><li>Participants: 1,139 </li></ul></ul><ul><ul><li>Population : Low-income blacks </li></ul></ul><ul><ul><li>Studied : Urban area </li></ul></ul><ul><ul><li>1994 </li></ul></ul><ul><ul><li>Denver, CO </li></ul></ul><ul><ul><li>Participants: 735 </li></ul></ul><ul><ul><li>Population: Large portion of Hispanics </li></ul></ul><ul><ul><li>Studied : Nurse and paraprofessionals </li></ul></ul>Dr. Olds’ research & development of NFP continues today… Research
    4. 4. Nurse-Family Partnership is… <ul><li>An evidence-based, community health program </li></ul><ul><li>Transforming lives of vulnerable first-time mothers living in poverty </li></ul><ul><li>Improving prenatal care, quality of parenting and life prospects for mothers by partnering them with a registered nurse </li></ul>Overview
    5. 5. Nurse-Family Partnership is a growing, national program # Number of counties NFP is serving Where we work 52 1 77 52 40 1 1 1 1 1 1 1 11 10 7 1 4 5 3 17 9 9 11 14 17 3 1 9 States that NFP serves States where NFP is a state initiative
    6. 6. The National Service Office How It Works . . . NFP Colorado Coordination Team <ul><li>Educates nurse home visitors and nurse supervisors in the NFP model </li></ul><ul><li>Advocates for national political support and long-term resources </li></ul><ul><li>Collects and evaluates data to ensure quality services and to guide quality improvement </li></ul><ul><li>Invest in Kids: </li></ul><ul><li>Nurse Consultation </li></ul><ul><li>Site development </li></ul><ul><li>Program Advocacy </li></ul>
    7. 7. How It Works . . . NFP Colorado Coordination Team <ul><li>Colorado Department of Public Health and Environment: </li></ul><ul><li>Fiscal agency </li></ul><ul><li>Annual State Tobacco Appropriation </li></ul><ul><li>Annual Grant Application and Funding Selection </li></ul><ul><li>Annual Report </li></ul><ul><li>Prevention Research Center for Family and Child Health: </li></ul><ul><li>Longitudinal follow-ups of the three clinical trials </li></ul><ul><li>Conducting research aimed at improving NFP Program model </li></ul><ul><li>International work </li></ul>How It Works . . . NFP Colorado Coordination Team
    8. 8. <ul><li>Program Goals </li></ul><ul><li>Improve pregnancy outcomes </li></ul><ul><li>Improve child health and development </li></ul><ul><li>Improve parents’ economic self-sufficiency </li></ul><ul><li>First-time, low-income, at-risk mothers </li></ul><ul><li>Registered nurses </li></ul><ul><li>Intensive services (intensity, duration) </li></ul><ul><li>Focus on behavior </li></ul><ul><li>Program fidelity (Clinical Information System) </li></ul><ul><li>Knowledge, judgment and skills </li></ul><ul><li>High level of trust, low stigma </li></ul><ul><li>Credibility and perceived authority </li></ul><ul><li>Nursing theory and practice at core of original model </li></ul>Overview Key Program Components Why Nurses?
    9. 9. Home Visit Overview . . . The 6 Domains Overview 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 Maternal Role Mothering Role Physical Care Behavioral and Emotional Care Family and Friends Personal network Relationships Assistance with Childcare Health and Human Services Service Utilization
    10. 10. Nurse-Family Partnership is Cost-Effective <ul><li>Nurse-Family Partnership returns more than $18,000 over and above program costs for each family enrolled (Washington State Institute of Public Policy 2008) </li></ul><ul><li>Savings accrue to government from decreased spending on* </li></ul><ul><li>health care criminal justice </li></ul><ul><li>child protection mental health </li></ul><ul><li>education public assistance </li></ul><ul><li>Savings also accrue to government from increased taxes paid by employed parents - $5.70 per dollar invested * (RAND Corporation 1998, 2005) </li></ul>
    11. 11. NFP PFHF Client Demographics <ul><li>892 women enrolled in the program since inception in 2000 (CO 11,000) </li></ul><ul><li>667 infants have been born to NFP mothers (CO 7,342) </li></ul><ul><li>Median age of clients is 20 years of age (CO 19) </li></ul><ul><li>$17,500 is average annual household income (CO 13,500) </li></ul><ul><li>83% of clients were unmarried at program intake (CO 80%) </li></ul><ul><li>65% unemployed at program intake (CO 63% Unemployed) </li></ul><ul><li>53% non-Hispanic white; 34.3% Hispanic; 5.8% multiracial/other; 1.9% African American; 2.4% Native American; 2.6% Asian (Colorado 41%; 47%; 5%; 3%; 2%; 1%) </li></ul>
    12. 12. NFP Outcomes -42% -46% -57% Reduction in domestic violence in pregnancy National NFP Colorado NFP NFP PFHF 9.7% 8.8% 8.2% Premature birth weight (< 37 wks) 9.3% 9.1% 8.2% Low birth weight (<5 lbs 8 oz) 27% 34% 31% Breast feeding at 6 months 77% 87% 90% Initiation of breast feeding 91% 91% 84% Immunization rates at 24 months -15% -20% -20% Reduction in cigarette smoking during pregnancy
    13. 13. 2010 . . . 10 Year Anniversary for Colorado NFP and NFP Partners for Healthy Families <ul><li>Implementation- 2 nurses </li></ul><ul><li>2 more nurses </li></ul><ul><li>Program expansion grant for 4 more nurses; Broomfield County added </li></ul><ul><li>FY2004-05 Medicaid reimbursement </li></ul>
    14. 14. <ul><li>National Recognition and NFP Emerging Practices: </li></ul><ul><li>Survival Guide – Strategies to promote nursing excellence </li></ul><ul><li>Annual Client Picnic </li></ul><ul><li>Integrating mental health and public health </li></ul><ul><li>Client success stories </li></ul><ul><li>Model site for NFP visitors (local, national, international) </li></ul><ul><li>Other Successes: </li></ul><ul><li>Collaboration with Jefferson County Criminal Justice Planning </li></ul><ul><li>Continuous mental health case conference consultation </li></ul>10 Years of NFP PFHF Success
    15. 15. <ul><li>Other Successes: </li></ul><ul><li>Poster presentation at Colorado Public Health Association (2004) </li></ul><ul><li>PFHF Moms' Support Group (2000-2006) </li></ul><ul><li>Jeffco F.I.T. Coalition (Families, Infants, Toddlers) </li></ul><ul><li>Lactation Consultant on team </li></ul><ul><li>PFHF Representation in Colorado NFP Nurse Practice Council since inception in 2006 </li></ul>10 Years of NFP PFHF Success
    16. 16. Nurse-Family Partnership is Endorsed as a Model Program by National Institute on early Education Research World Health Organization Office of Juvenile Justice & Delinquency Prevention
    17. 17. &quot;This program saves money. It raises healthy babies and creates better parents. It reduced childhood injuries and unintended pregnancies, increased father involvement and women's employment, reduced use of welfare and food stamps, and increased children's school readiness.&quot; Barack Obama, U.S. President
    18. 18. For More Information <ul><li>Cynthia Farkas, RN, FNP, MS </li></ul><ul><li>[email_address] </li></ul><ul><li>303-239-7074 </li></ul><ul><li>Michelle Neal RN, MS </li></ul><ul><li>[email_address] </li></ul><ul><li>303-839-1808 x 101 </li></ul><ul><li> </li></ul>