Working Together to Ensure Healthier Families Nurse-Family Partnership Overview

David Olds, PhD, Founder, Nurse-Family Partnership "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 Nurse-Family Partnership was developed over 35 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.

Nurse-Family Partnership is… Overview Nurse-Family Partnership is… An evidence-based, community health program Transforming lives of vulnerable first-time mothers living in poverty Improving prenatal care, quality of parenting and life prospects for mothers by partnering them with a registered nurse 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 © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Overview 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. © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Key Program Components Program Goals Why Nurses? Overview Key Program Components Program Goals Improve pregnancy outcomes Improve child health and development Improve parents’ economic self-sufficiency Why Nurses? First-time, at-risk mothers Registered nurses Intensive services (intensity, duration) Focus on behavior Program fidelity (performance management system) Knowledge, judgment and skills High level of trust, low stigma Credibility and perceived authority Nursing theory and practice at core of original model 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. © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Home Visit Overview Personal Health Maternal Role 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 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. © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Monetary Benefits to Society Based on a review of evidence from 30 NFP evaluation studies, including randomized controlled trials, quasi-experimental studies and large-scale replication data, Miller’s analysis predicts that when NFP is brought to scale, it can achieve the following outcomes in Utah: 23% reduction in smoking during pregnancy 58% reduction in infant mortality (3.3 fewer infant deaths per 1,000 families served) 30% reduction in closely-spaced second births (within 2 years postpartum) 36.4 fewer subsequent preterm births per 1,000 families served 37% reduction in emergency department use related to childhood injuries(ages 0-2) 30% reduction in child maltreatment (through age 15) 38% reduction in language delay 45% reduction in youth crimes and arrests (ages 11-17) 51% reduction in alcohol, tobacco & marijuana use (ages 12-15) © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Monetary Benefits to Society Dr. Miller’s model predicts that on average, enrolling 1,000 low income families in NFP will prevent: • 28 first preterm births and 37 subsequent preterm births to young mothers • 58 cases of preeclampsia • 3.3 infant deaths • 83 cases of child maltreatment • 132 child injuries treated in emergency departments • 88 instances of youth substance abuse • 238 youth arrests i Ted Miller, Ph.D., Pacific Institute for Research and Evaluation, Nurse-Family Partnership Home Visitation: Costs, Outcome, and Return on Investment, April 30, 2013 and associated Return on Investment Calculator dated 5/5/2014. The national report is accompanied by a state-specific return on investment calculator that modifies national estimates to project state-specific outcomes and associated return on investment. The calculator is updated periodically to reflect major research updates. © Copyright 2013 Nurse-Family Partnership. All rights reserved.

Salt Lake County NFP Outcomes Where we work Salt Lake County NFP Outcomes Data as of (insert date) 93% of babies were born full term 94% of babies were born at a healthy weight- at or above at 2500 g (5.5 lbs.) 94% of mothers initiated breastfeeding 90% of children received all recommended immunizations by 24 months 40% reduction in cigarette smoking among NFP moms during pregnancy © Copyright 2013 Nurse-Family Partnership. All rights reserved.