“ Working Together to Ensure Healthier Families.” [alternate title – “It Begins with Trust” Every year 500,000 children are born to first-time mothers who are from low-income households. [Presentation note: If applicable… Here in [state/community in which presentation is being made] that number is __________. 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 was developed over 30 years ago. Our founder, David Olds, was a young man who taught in an inner-city day-care center in the late 1970’s. That experience caused him to suspect that by age four or five some children who come from disadvantaged homes were already in trouble. He began to think hard about when to get involved to help these children and his investigation led him to develop a program for women like the one pictured here – 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.
It’s important to know that this is a proven opportunity for you and your community. Before I go into the presentation, I want to start with four important points: We are an evidence-based community health program. This is important. We are in tough times and you need to know that with Nurse-Family Partnership you will invest in a program with more than 30 years of evidence that shows it WORKS! We transform the lives of our clients – first-time, low-income mothers. Mothers who work with their nurse will do better in school, improve their economic well-being and become an active and involved parent who is present for her child. We are unique in that each mother is partnered with a registered nurse who is trained in the exacting standards of NFP by the National Service Office. This unique relationship between nurse and mother begins early in her pregnancy and each mother receives ongoing visits that continue through her child’s second birthday. Finally, independent research shows that every dollar invested in Nurse-Family Partnership can yield as much as five dollars in return. (RAND corp. 2005)
This is a quote from an NFP in Pennsylvania. For those of us in the room who are mothers, and for any of us who are parents, I think this resonates. Having a first child is a remarkable experience, but it is not without anxiety. Women in the high-risk population we serve already face enormous challenges – including poverty, a dangerous physical environment, isolation, being young and lacking education. For them, the anxiety is even greater and the generational risk even more profound… What is remarkable about our nurses is that they establish a powerful relationship with each young mother that helps them transform their lives and connect with their children.
But why start during the first trimester when the mother is still pregnant with her first child? As this chart shows, during the first 30 months of a child’s life – the period in which Nurse-Family Partnership works with our clients – basic functions related to vision, hearing, and language develop, and it is during this time period that trained registered nurses can have a huge impact on both mother and child. Women can enroll in Nurse-Family Partnership as early in their pregnancy as they wish, but no later than their 28th week. By starting early in pregnancy, the nurse has time to develop a strong relationship with the mother and has time to work on improving the mother’s own health, and therefore the health of the newborn. Our program is intense – with up to 64 visits over the course of 30 months. Planned visits include: 14 visits during pregnancy; 28 visits during infancy; and 22 visits during toddlerhood.
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.
You have heard me talk a lot about the importance of evidence, and I think it’s worth taking time to make clear why evidence-based community health programs are important. 30 years of evidence from randomized, controlled trials prove that Nurse-Family Partnership works. The process that our founder David Olds followed is the same process used in the field of medicine. Well-designed randomized, controlled trials are an accepted research practice in medicine and are essential in producing valid, actionable evidence about what does and does not work. Medical breakthroughs that are the result of randomized, controlled trials include vaccines for polio, measles, and hepatitis B, as well as cancer treatments that have dramatically improved survival rates from leukemia, Hodgkin’s disease and breast cancer. For public health programs, evidence from clinical trials often is not required. This is changing as policymakers, public health officials and the communities they serve increasingly demand proven approaches for addressing public health. I’m here to tell you that if you invest in Nurse-Family Partnership, you can be assured of the value of your investment. With results from three randomized, controlled trials over three decades with diverse groups in Elmira, NY, Memphis, TN, and Denver, CO, Nurse-Family Partnership has set itself apart as one of the leading evidence-based programs in the country. In fact, NFP was just named one of only two “Top Tier” early childhood programs identified by the nonprofit, nonpartisan Coalition for Evidence-Based Policy as meeting the highest standards of scientific evidence [in case asked, the other progam is Success for All for grades K-2 (a school-wide reform program, primarily for high-poverty elementary schools, with a strong emphasis on reading instruction).]
This slide provides an overview of the three locations – Elmira, NY, Memphis, TN, and Denver, CO – where Dr. Olds conducted the randomized, controlled trials. The Elmira study was conducted through a community non-profit agency focused on promoting child development. This was a poor impoverished community with high rates of child abuse, and a mostly white population. The Memphis study was conducted through a county health department with African-American women. The Denver study included over 40% Hispanic women through a University outreach program in a highly fragmented health care system. Varied setting and populations were important to test the program carefully and assure replicability. Follow-up studies with participants from all three trials continue today - many of the children are now parents and grandparents themselves. Please see the website, Proven Results section for access to the published research.
We believe this slide helps to make clear why 30 years of evidence is important to you. Nurse-Family Partnership’s evidence and track record of successful replication of the program are why so many communities across the nation are confident that investing in NFP makes sense!
Let’s look at some specific outcomes from the trials: The first graph shows the results of children born to mothers in Memphis who had low psychological resources. The children had better reading and math achievement at age 9 than their counterparts who were not in the program. The graph on the right shows results from the Denver trial of children born to mothers who had low psychological resources – the children in the Denver trial who participated in the program showed better language development at age 4, making them better prepared to start school.
The children of mothers participating in the Memphis trial had fewer healthcare encounters for injuries and ingestions, including fewer days hospitalized in their first two years of life. The mothers also had greater intervals between births of first child and second child. The reduction in unplanned, closely-spaced pregnancies is extremely important in reducing risks for other negative outcomes such as child maltreatment and injuries, and enmeshment in poverty.
Nurse-visited mothers in the Memphis trial also spent fewer months using welfare and food stamps. Each study has been reevaluated and participants have undergone subsequent interviews and follow-ups to find out if the program effects seen while families were receiving home visits faded out once the program ended, or were sustained over time. The good news is that Nurse-Family Partnership is a program with lasting impact – the results of each follow-up study continue to show positive outcomes [Note to presenter: At the time of Memphis study, the assistance program was called “Aid to Families with Dependant Children” (AFDC); today it is known as TANF.]
These are indeed difficult times and we all need to make careful choices. As we consider how and where we should invest, I’d like to take some time to talk about the return on investment you can realize when you invest in Nurse-Family Partnership and bring the program to your community.
Nurse-Family Partnership benefits don’t end at the family-level. This slide shows the return on investment for communities that invest in NFP – and it shows why we serve the most vulnerable families. You can see that for lower risk families – those who are middle class, married and have other resources – NFP provides benefit. But look at the second group –higher risk families. An analysis conducted in 2005 by the Rand Corporation found a net benefit to society of $34,148 per higher-risk family served (high risk=low socioeconomic status and unmarried). That’s a return of $5.70 for each dollar spent on the program. For those higher-risk families, the analysis found that communities recovered the cost of the program by the time the child reached the age of four. And there were additional savings through the lives of both mother and child.
A study conducted by the Washington State Institute of Public Policy estimated a return on investment of more than $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. [Note to presenter: Various cost-benefit analyses have been conducted, and they often-times vary on the amount of total return estimated depending on which outcomes were monetized and included in the calculation.]
This information is from a 2008 report by the Pennsylvania State University that shows savings to Fayette County, as well as the entire state of Pennsylvania. The study estimates that the 25 Nurse-Family Partnership sites in operation in 2005 were collectively saving the state $119 million. The pie chart shows where those savings come from -- 74% from reductions in crime -- and another 24% of the savings come from the prevention of child abuse and neglect, and from education savings due to improvements in the children’s school readiness. It should be noted that this particular study focuses on criminal justice-related savings so it does not include savings from health care.
In a 2004 report the New York City Department of Health and Mental Hygiene, examined the cost savings they could reasonably project if they were to implement Nurse-Family Partnership at large scale. Using local statistics on health indicator and local costs, they concluded the program would be highly cost-effective and are now in a multi-year effort to bring Nurse-Family Partnership to thousands of New York City women living in poverty.
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.
It’s important to note that one of the primary reasons we are successful is because of the agencies we work with. They are exceptional and all of our agency partners across the country share eight common characteristics: They have a strong reputation for serving low-income families They have excellent working relationships with referral sources and early childhood programs They are committed to innovation and to evidence-based programs They are committed to growing and expanding the program They are effective at recruiting and retaining nurses They are flexible and focused on enabling nurses to succeed They are financially strong and stable Finally, we work together well and share a strong alignment with mission and priorities
During the past 15 years, Nurse-Family Partnership has successfully expanded to communities throughout the U.S. In doing so, our National Service Office staff work with agencies to identify funding sources. That’s because public funding is essential if we are to reach every eligible mother. As this slide shows, states rely on highly varied funding streams from public and private organizations. We can get funding from many sources because we are an innovative community health program with profound broad benefits. While our most common funding stream is Medicaid – Nurse-Family Partnership has so much potential for positive impacts as children grow older, that we can tap a variety of public funding sources to support the program. In 2010, the National Service Office successfully advocated for federal funding with the help of NFP champions across the country, resulting in the historic Federal Maternal, Infant and Early Childhood Home Visiting Program created by Congress.
Our local agencies benefit from a close relationship with the National Service Office of Nurse-Family Partnership and its partners. This is a unique element of our program. Because we are evidence-based and feature a program that require rigorous and disciplined training, Nurse-Family Partnership has an office in Denver, Colorado with full-time staff that work to train and educate nurses, provide ongoing clinical support, and also provide operations support to agency partners. Support from the national service office includes a national database that allows us to ensure that the results in your community match up with the results we have documented from 30 years of randomized, controlled trials. This is important in that it helps the communities we serve to make clear to residents the benefit of a Nurse-Family Partnership.
Nurse-Family Partnership has had tremendous growth since the National Service Office was founded in 2003 with a mission of replicating the program in communities across the country. As of February 2013, Nurse-Family Partnership programs are in 42 states, the U.S. Virgin Islands and in more than 500 counties. But we have much work to do – approximately 600,000 children are born to eligible mothers every year. And while we have accomplished a lot, we still have a long way to go to make this program available to all eligible mothers.
So, here in [NAME GOES HERE] we currently serve… enter data as needed. Characteristics of our population include: LIST AS NEEDED
We are seeing tremendous success here in [COMMUNITY NAME]… Outcomes we have observed to date include: LIST AS NEEDED
In closing, I wanted to provide you with examples of other voices that endorse Nurse-Family Partnership. These include U.S. Senators and mayors… [we will create several versions of this slide with people of interest in specific areas of the country…]
They also include national and local media that have covered our success across the country. Samples of these articles, and other stories, are included in the packet I will give to you today. Also, we provide a News Center on our Web site that lists media coverage from around the country.
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.
Thank you for your time today – I welcome the chance to answer any questions you may have.
Working Together to Ensure Healthier Families
Working Together to Ensure Healthier Families
Nurse-Family Partnership Overview
"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
poverty, instability or
abuse with the help of a
David Olds, PhD, Founder,
"The great thing about
Nurse-Family Partnership is
that it works. To put it
about everything you
want to decrease and
everything you’d want it
Dr. Thomas R. Frieden, former New
York City Health Commissioner
(now Director, CDC, and
Administrator, Agency for Toxic
Substances and Disease Registry)
"If communities are truly
interested in making sound
investments that will yield
high public and private
gains in both the long and
short run, they would fare far
better by investing in
evidence-based, early child
development initiatives like
than in professional sports
stadiums or office towers."
Associate Economist, Federal
Reserve Bank of Minneapolis
"This program saves
money. It raises healthy
babies and creates better
parents. It reduced
childhood injuries and
involvement and women's
employment, reduced use
of welfare and food
stamps, and increased
Barack Obama, U.S. Senator
mothers with the
which children can
reach their full
Former U.S. Senator
Arlen Specter (R-PA)
"The success of the
program should be
expanded to every
community in this
country, not just a
Ken Salazar, former
U.S. Senator (now
"I am very proud
was chosen to be
because this is a
investment in the
“If there is any hope that Congress' new
health care bill will put some restraints
around the growth in medical costs, it
rests in the part of the proposal that calls
for rewarding programs that reshape
how medicine gets practiced…the
Administration has the chance to invest
in one such program – the Nurse-Family
Partnership – when it starts giving out
$1.5 billion in home health care grants...”
Full coverage: www.nursefamilypartnership.org > About > News
“Infant development strategies, like
other forms of social capital, are
perversely distributed in America -
fetishized in places where babies are
fundamentally secure and likely to
prosper, undervalued in places
where babies are not. The NFP aims,
in a fashion, at equalization.”
Katherine Boo 2.6.06
“If you want to invest societal resources
where they will have the biggest benefit
for all of us, clearly the evidence is there
now that protecting children from the
worst kinds of deprivation in their
youngest years will result in more
functional, capable, prosocial citizens.”
Martha Farah, director of the Center for
Cognitive Neuroscience at the University of PA
“ We're all better off if we make the
investment upfront. I would rather see
us be involved early and have it be an
educational situation, as opposed to
no involvement and then become part
of the criminal justice system.”
Patrick Perez, sheriff of Kane County, IL and
member of Fight Crime: Invest in Kids 4.14.10