Michigan and Nurse Family Partnership Implementing an Evidence-Based Preventive Intervention for Families

Why We Did It  To impact the health disparity of African American families in Michigan.  To replicate Nurse-Family Partnership, an evidence-based program with proven outcomes for families.

Nurse-Family Partnership Outcomes: 1. Improve health during pregnancy & improve birth outcomes 2. Improve child health and development 3. Improve families’ economic self- sufficiency

NFP Model Elements  Serve low-income, first time mothers  Early enrollment of pregnant women  Implement program with nurses, prefer BSN  Utilize visit guidelines that focus on personal health, caregiving skills and life course development  Duration of program is 2.5 years

Nurse-Family Partnership Provides  Professional Development for nurses  Web-Based Clinical Information System Program Evaluation  State Reports  Continued support to refine implementation  Prepare for NFP growth overtime

Michigan and Nurse-Family Partnership Department of Community Health and NFP partners together:  Community and organizational planning  Site Selection  Nurse training and consultation  Evaluation and reporting program data  Program advocacy, visibility and support

Creative Funding Partnerships  Three way partnership: The Michigan Department of Community Health Department of Education Department of Human Services and Nurse- Family Partnership Michigan Department of Community Health initially funds program  Graduated local contribution of 10%, 20% 25% over the first 3-year cycle

State of Michigan Funding  State Nurse Consultant.5 FTE  State Infant Mental Health Specialist.5 FTE  Sites funded in 4 communities Detroit Benton Harbor Pontiac Grand Rapids. 5 Supervisor.5 Data Entry 4 nurses serve 100 families

Community Support in Detroit NFP Steering Committee  Skillman Foundation  Wayne County Department of Human Services  Wayne State University College of Nursing  Infant Morality Project  Detroit Public Schools  Southwest Counseling and Development Services  Several health plans  County Commissioner  Community resident  Office of School Social Work Services

What We Found Gestational age at program enrollment: n = 572 Michigan clients 47% enrolled before 16 weeks 53% enrolled between 17 – 28 weeks 4% enrolled at 29 weeks or later

Mothers’ Health Problems Identified at entry into the program:  Asthma = 17% NFP National Data Asthma = 14%  Urinary Tract Infections = 7%  Underweight before pregnancy = 6%  High Blood Pressure = 6%  Heart Problem = 5%  Mental Disorder = 5%

History of Domestic and/or Family Violence Self report at intake:  History of physical or emotional abuse = 26%  Physical abuse in past year = 16%  Physical abuse during pregnancy = 8%  Forced sex in past year = 3%  Afraid or partner/someone else = 5%

Premature Infants All NFP Births 339 African American Infants:  NFP Michigan (222) = 10.4%  Michigan African American = 16.5%  Detroit African American = 15.6% Michigan & Detroit Residents

Low Birth Weight Infants African American Population: NFP Michigan (226) = 11.9% 29% of low birth weight infants were lbs Michigan African American =14.2% Detroit African American = 14.5% Michigan & Detroit Residents

Successes  Early gestational age enrollment  Accessing care early  Utilizing community services  6.1% decrease in preterm births  2.3% decrease in low birth weight infants

Barriers & Challenges  Establishing a new program  Establishing referral system  Recruitment and retention of nurses suited for long-term and intensive services for vulnerable families  Adequate community support and advocacy  Sustainability of program

What We Think About What We Found  Improved pregnancy and child health outcomes  Early access to care and services  Increased clinical skills for nurses  Creative partnerships & funding  Improved local community collaboration and support

Take Home Message  Improve pregnancy and child health outcomes with evidence based NFP  Support sites to develop best practices  Renew community partnerships  Be creative with current funding sources

NFP Supervisor Quote  “It’s an evolution, the development comes over time. Once we got the word out to the community and nurses began to learn how to deliver the NFP the momentum has been enormous – and now its pure love for the program and the relationships with clients.”