Nurses & Moms Partnering for Health Success: How Babies Benefit

240513_Conversations_NurseFamilyPartnership_01.mp3

Speaker 1 [00:00:04] Americans consistently rate nurses as the most trusted profession in
the country. That's probably accounts for some of the success of Nurse Family
Partnership. NFP has been growing its Community Health program across the country that
focuses on first time moms and their babies.

Speaker 2 [00:00:21] It begins in pregnancy, before the 28th week of pregnancy, and goes
up until the child dies aged two. There's no financial cost to this. However, the biggest,
commitment to being available for in-person visits that began early in pregnancy and goes
up into the chapter is age two.

Speaker 3 [00:00:42] Sharon Sprinkle is a registered nurse and the co-director of nursing
practice for Nurse Family Partnership. Jenny Harper is a Washington veteran and
government affairs director for Nurse Family Partnership.

Speaker 2 [00:00:53] We continue to have different evaluations done were, you know,
continuing to innovate the program and the model and look at how we can best serve
families and communities. You know, many years later. And so, you know, we have
continued research coming out on different aspects of the program.

Speaker 3 [00:01:07] This is conversations on health care.

Speaker 1 [00:01:18] Sharon Sprinkle and Jenny Harper with the Nurse Family
Partnership. Welcome to Conversations on Health Care.

Speaker 2 [00:01:26] Thank you. Thanks for having us.

Speaker 1 [00:01:27] Absolutely. Sharon. Maybe we start with you. I suspect there are
some in our audience who yearn for the old days when doctors made house calls. But
Nurse Family Partnership is in that spirit, I think. NFP focuses on helping first time parents
succeed right in their homes. I wonder if you could just share with our audience how it
works.

Speaker 2 [00:01:52] Sure absolutely happy to do that. As you know, you mentioned it a
couple of times that that's to be partnership is an evidence based community health
program, with over 45 years of research showing significant improvements in the health
and lives of first time moms and their children affected by social and economic inequality.
How do we do that? We do that by aiming for three overarching goals, which is to improve
pregnancy outcomes. By partnering moms with nurses to focus on improving their health
related behaviors such as cessation of smoking, improving their diets, going to their
prenatal visits. A second goal of ours is improve child health and development by assisting
parents to understand normal child growth and development so that they can provide
healthy and competent care. And the third goal is to improve economic self-sufficiency of a
family by supporting the client to create a vision for what she wants our future to be either
completing school or continuing in work. So nurses meet families in the home where the
action is, where they live. To be able to provide support to achieve these three overarching
goals.

Speaker 1 [00:03:02] Sharon, that's so great. Tell me, is there a is is this free? Is there any
income eligibility. And and I understand this continues into the child's is it second birth
date.

Speaker 2 [00:03:15] It is. It begins in pregnancy, before the 28th week of pregnancy, and
goes up until the child turns 18. There is no financial cost to this. However, there is a
commitment to being available for in-person visits that began early in pregnancy and goes
up into the chapters H two. We focus on economically disadvantaged families. We use the
term low income, and that we use Medicaid as a proxy in terms of determining eligibility.
So not only eligibility in terms of income, but other social factors that can impede healthy
pregnancy, such as the settings such as age, such as education, such as substance
abuse, all of those things that are ad that can adversely impact a healthy outcome. Those
overlapping adversities that get in the way of healthy pregnancies and, healthy child
rearing.

Speaker 3 [00:04:14] Well, Jenny David Olds is the, person considered the visionary
founder of Nurse Family Partnership, and I understand that he got his inspiration after
working at a daycare center. Share the founding story of your organization with us.

Speaker 2 [00:04:30] Hello. So Doctor David Olds had, graduated from Johns Hopkins,
and he was working at a daycare in the inner city, and he was working with kids who, you
know, will experience a lot of those overlapping adversities that Sharon was talking about.
And, you know, seeing the impacts that were already happening on those kids at that
point. And so he thought, how can we move as far upstream as possible to really provide
this, you know, prevention and intervention for these families? And so that led him to
designing nurse family partnership and beginning in that prenatal period, to, you know, to
to get to those families as soon as possible. And so originally there was, there were trials
done in Elmira, New York, in Memphis, Tennessee, and in Denver, Colorado to, you know,
test the model and to look at how it was, you know, achieving the results that he thought it
could. And so those, trials were really successful. And in 1996, began implementing the
program more widely across the country. And today, our family partnership is in 40 states
plus DC, the U.S. Virgin Islands, and a number of tribal communities.

Speaker 3 [00:05:33] And was David Olds, a, just recent grad teacher clinician. What did
he bring to this that allowed him to have these insights?

Speaker 2 [00:05:42] Yeah. I mean, he's, his his background is in pediatrics. He's
currently a professor of pediatrics. So that's that's what he really brought to it. I said.

Speaker 1 [00:05:51] Jenny, I want to pull the thread on, the trials that happened. But
also, the Nurse Family Partnership program has been independently reviewed and
evaluated where those part of the trial or were they separate? I'm wondering if you could
just take us through the findings that led experts to say this home visiting program really
works.

Speaker 2 [00:06:13] Great question. And there's been a lot of different, independent
review, I would say over the years, the trials in particular had, you know, specific outcomes
that they were looking at. And, you know, I think some of the main outcomes that we talk
about from that were reductions in child abuse and neglect, reductions in ER visits due to
accidents and poisoning, reductions in speech delays, reductions in behavioral problems,
increases in months employed and then reductions in arrests of the mother as well as of
the children. And so those were some of the main outcomes that I think really led to the,
you know, then trying to bring this, this more widely since then, there's been a lot of
additional, look at things like, the, like the, the return on investment, looking at how, you
know, the program, you know, dollars invested in the program have return on investment.

So we continue to have different evaluations done. Were, you know, continuing to innovate
the program and the model and look at how we can best serve families and communities,
you know, many years later. And so, you know, we have continued research coming out
on different aspects of the program.

Speaker 1 [00:07:24] I would think the return on investment would be important to
Medicaid partners and others across the country. And, how successful has it been for you?

Speaker 2 [00:07:37] It's been very successful. You know, I think it's always hard to get
those exact, numbers sometimes that I think policymakers always want to have. But, we've
begun really expanding Medicaid financing for home visiting programs over the last, you
know, many years now and looking at how we can find those building pathways and states
and it looks very different state by state. But we know a lot of those costs associated with,
you know, a child being in the nick, you, for an extended amount of time or a child having
an er visit are some really high dollar costs, you know, to the Medicaid program. And so
we know when we can have avoidance of those, or reductions in those that, you know, the
program does have a really strong return on investment.

Speaker 3 [00:08:17] Well, let me ask you a question. Really, to either of you, I, I haven't
heard, within our discussion so far whether there is a screening qualifier threshold for risk
factors, social circumstances, adverse social determinants of health that lead one to be
referred. Is it a referral process because, someone has determined that there are concerns
or more risk? Is it really open to anybody in the community? Tell us about that.

Speaker 2 [00:08:46] So that's a great question, Margaret, and thank you for asking it. We
support network partners across the 40 states and the District of Columbia and tribal
communities that Jenny mentioned, and is at the network partner level, where the referral
is generated from toe to toe nurse family partnership and the the characteristics, overlap
and characteristics that I mentioned earlier were age, educational level, substance abuse
issues, substance misuse or abuse issues, as well as other overlapping adversities.
Where we look for, we ask our network partners to look for three or more of those
overlapping adversities and social determinants and have that you mentioned, because
research has found that those are the families that are going to benefit. The greatest
benefit from NFP intervention when you have three or more of those overlapping
characteristics. We recently just refined our criteria, our recruitment criteria, in terms of
providing 13 different characteristics that referral sources to look for, screened for before
referring to nurse family partnership.

Speaker 1 [00:09:58] Sharon, let me ask a follow up to that. Is it that a mom goes through
the, third party agency, or can they sign up on their own? And and I'm wondering, just in
general, how you deal with, you know, individuals, perhaps a reluctance to sign up. What
what are your strategies around that? But first of all, the pathway from if there's a mom
listening now, is this is this a direct or is there a third party, player here that they, sign up
with?

Speaker 2 [00:10:33] It's usually a third party provider. However, they can sign up directly.
Most referrals at the local level come through. Obstetricians, come through work, come
through various social service agencies that our moms typically go to for support, or NFP
moms or a mom that's pregnant typically goes to for support. Looking for resources such
as Medicaid, where, obstetricians word of mouth from a current or past NFP participant.

Speaker 1 [00:11:06] So those are the main NFP. So those are the independent groups
you work with. A work program might be the, somebody who would be your strategic
partner.

Speaker 2 [00:11:16] Absolutely.

Speaker 1 [00:11:17] Oh that's great.

Speaker 2 [00:11:19] Shelters as well as shelters. Any, any, any agency that support
homeless individuals can refer as well.

Speaker 3 [00:11:28] Well, it seems like there's a, another, outcome that I've read about,
that I found very fascinating, which is that 82% of the parents engaged in this, program
who received the benefit, see an increase in the, through their months of employment
throughout this, I think pregnancy and early childhood, period, which, of course, is help in
terms of, financial, stability for the family. I don't think the nurses are doing employment
counseling. So I'm curious, what do you, with all of your expertise, what do you think is
connected to that particular outcome? What's the what's the connection there?

Speaker 2 [00:12:09] So one of the core tenets of Nurse Family Partnership is really
meeting the family where they are and helping that person identify what we've called the
client's heart's desire. So the client's heart's desire is to seek employment. We work with
the nurse, work with the client to explore what excites the client about employment, what
type of employment is the client look for, and then they work together to create that vision
that the client has created in her mind, in terms of what they want to do with employment
and or education. Why initiate is a partnership and help move forward. Workforce
employment.

Speaker 1 [00:12:56] You know, one to to both of you, Sharon and Jenny. What an
exciting program. And to lead with nurses is so important. All but all of a sudden, the
pandemic rolls around and we have lost 100,000 nurses. We have this huge shortage
that's happening in the country. It must have caused enormous amount of gyrations within
your organization. I'm wondering how you dealt with that. And are there, other players that
the community health workers, peer counselors or others that, you've tested with that
might be, equally effective? Though obviously nurses are, the foundation of the program.
But given all the changes that have happened societally, what's happening in terms of the
organization internally as you're trying to adjust to these changes?

Speaker 2 [00:13:52] Great question. I'll start in. Jenny, please, please chime in. We see
nurse family partnership as part of a continuum of care as it relates to early childhood
development and prenatal care. I think we were uniquely positioned during the pandemic,
because telehealth has been a part of NFP intervention since 2017, so it was easy for us
to pivot to telehealth because it was already a part of the model. We took that framework
by experience, and delivering the model for telehealth made some revisions in terms of
recruitment efforts as well as delivering the model virtually. Yeah, I mean, I oh, I would say
it's the the workforce shortage has been an issue certainly for us. And, you know, one of
the things that we know is when our families have the best outcomes from going through
the program, it's because they have that same nurse for the duration of the program. So,
you know, it's really important to retain, you know, the nurses that are in the program. We
also see nurses leave the hospital setting to come work for nurse family partnership or to
work for the network partners who are implementing Nurse Family Partnership. You know,
because they're able to use the full scope of their clinical practice and work with these

families for this duration of time and really see that benefit. Another issue has, you know,
been the compensation. Certainly. And, you know, when there's a lot of competing, you
know, jobs for nurses. It's been a priority for us to try to increase the funding in a number
of these programs that support nurse family partnerships so that, you know, compensation
can be addressed as well. Well, I.

Speaker 3 [00:15:29] I have so many questions for you, but let me, just ss one that's been
on my mind certainly, since you were founded 45 years ago. The needs of, mothers and,
their, their children have been, in front and center of many discussions. But certainly in the
last couple of years, it's been about maternal mortality, and it's been about maternal
mortality, particularly in the, within the childbirth period and the year afterwards, and
particularly among our African American, population. And I'm I'm curious, with all the effort
that's been brought to bear on that, has that led to a renewed, focus on, nurse family
partnerships and the kind of empowerment work that you do in making sure that women,
have the tools to speak up for themselves and to communicate their needs and, their
concerns.

Speaker 2 [00:16:22] I would say absolutely. Agency is really important in helping clients
voice their concerns and also supporting clients around health literacy as well as. Helping
expectant parents to understand the signs and symptoms of preterm labor, or any adverse
symptoms that they may have. Part of what we do is. Use our nursing knowledge around
maternal child health issues to help educate the client so that they, in turn, can be better
advocates for themselves as they navigate the health and human services arena.

Speaker 1 [00:17:03] You know, I'd be interested in sort of the finance model behind the
program and just remind me, are all the encounters done by telehealth? Are there any face
to face encounters?

Speaker 2 [00:17:18] We're almost entirely back at face to face.

Speaker 1 [00:17:20] Okay, you are not back. Okay.

Speaker 2 [00:17:23] Some things are done via telehealth. It provides some flexibility,
certain, but certainly, particularly when we're serving families in maybe rural areas or
through inclement weather type situations. But, in general, we're back in person.

Speaker 1 [00:17:36] And then is that our main source of revenue, or are there grants
supporting the work that you're doing as well?

Speaker 2 [00:17:44] The way that we're structured is. So we're part of the National
Service office. So we're, you know, where the model is housed. We are helping to provide,
you know, support and funding and training and technical assistance and all that. But the
program is implemented through what we call our network partners. And those can range
from a federally qualified health center to a county public health agency to a hospital
system. And they're the ones who are, you know, having the funding for the program. And
that can be a variety of different funding streams. You know, largely that's, funding from
the maternal, infant, Early Childhood Home Visiting program, or mikveh, as it's known,
which is a federal program that grants money to states to implement home visiting
programs. Also a lot of Medicaid financing. There's a lot of state line items supporting
home visiting, sometimes specifically NFP across the country. And we also have funding
support from philanthropic supporters as well.

Speaker 1 [00:18:37] So Medicaid, is it approved in all states for Medicaid encounter?

Speaker 2 [00:18:42] No. So the way Medicaid works right now is essentially Medicaid can
support some components of the Nurse Family Partnership program, but not holistically,
the whole program. And so, you know, more of the clinical pieces as opposed to some of
the, you know, care coordination side of it. And so state by state, it looks very different.
States have found very sometimes creative ways to finance home visiting services through
Medicaid. A lot of times using waivers use it in using targeted case management, and then
have different reimbursement rates set up per visit. There's a lot of, you know, challenges
sometimes that it only begins, you know, pain, pain reimbursement once the child's born
or, you know, before the child is born or up until the child is born. So, you know, we're
looking at how we can streamline that better. But right now I would say there's about 20,
you know, just over 20 states where there's a medicaid billing pathway that covers some
portion of that.

Speaker 1 [00:19:36] Is there is there a best practice state you like to point to and say,
hey, everybody should follow this state or what?

Speaker 2 [00:19:44] There's a few out there. I mean, Alabama is a state that's really done
a lot to, you know, have a really a really nice reimbursement rate that covers more or less,
you know, the fully burdened cost of the program. Yeah, yeah. Idaho is another state that's
done a lot in the past few years and is working on kind of getting all of the different
components of it. Right. Pennsylvania is a state that's done a lot with, with, Medicaid
financing. Ohio actually is another state that's really expanding nurse family partnership
through Medicaid. So there's a lot out there. But there's a lot of work to be done so.

Speaker 3 [00:20:18] Well. Sharon, Jenny just mentioned a number of programs, and,
they fit together. It seems like maybe under a nurse family partnership, but I'd be curious if
you could tell us a little bit about the Child First program. It's a program with certainly heard
about in our, area of the country. I understand it's, maybe more oriented towards, mental
health, behavioral health services. But tell us what Child First is and how the nurses of
Nurse Family Partnership would work together with child first or is it an either or it.

Speaker 2 [00:20:49] So there are two distinct programs. They're both evidence based
home visiting programs. Child first is much more on the mental and behavioral health side.
So they're programs that are both, you know, considered eligible for the maternal infant,
Early childhood home visiting program, and can receive funding through a lot of the same
types of sources. But what child first does, so it's a distinct program from the family
partnership. So it's not being administered by Nurse Family Partnership nurses. So in child
first case, you've got a master's level mental health clinician as well as a care coordinator
working with the family. That can begin anywhere from prenatal, through the child's, sixth
birthday. And a lot of times that team is working with that family for the duration of about
nine months to a year. That can, you know, vary. A lot of times it's a more intensive
duration of meeting the family, sometimes several times a week. It provides child parents
psychotherapy as part of the intervention. And it's really, you know, similarly to nurse
family Partnership, it's looking at the holistic needs of the family. Right. It's it's not just kind
of the clinical side. It's also really getting into those social determinants of health. But yes,
a lot of times it's really focus on children who've experienced adverse childhood
experiences, families who've experienced trauma, and providing that support to, you know,
build, resilient, you know, strong relationships between that child and the caregiver. Okay.
So I should also add child first is in seven states currently, it was developed in
Connecticut. And about three years ago, child first came on board with Nurse Family

Partnership. So we have this overarching national office that supports both programs. And
what we're trying to do is help child first grow and have a similar footprint to Nurse family
Partnership. Moving forward. There are some states where we are, you know, working to
co-locate nurse family partnership and child first programs. There might be families that
you know, would benefit from receiving nurse family partnership services and then moving
on to Child First Services. It's going to look different, but we want to have kind of a variety
of programs and interventions that can support families. And, you know, having the right
program for the right family at the right time.

Speaker 1 [00:22:57] Well, we're proud that we're in Connecticut and have a great deal of
experience with Child First. It's such a remarkable program as as is the, nurse family
program as well. Sharon, I want to ask you to tell us about the importance of moms
advocating for themselves and others like them. How is that occurring through your, parent
ambassador program? And maybe tell our listeners what the results are that you're seeing
so far.

Speaker 2 [00:23:26] We had a wonderful parent ambassador program that is led by a
former NFP client. They receive trainings and education on how to advocate for
themselves and for nurse family partnership. They've gone to Capitol Hill several times.
They meet frequently to talk about issues around advocacy, and it's working wonderfully. I
can't speak more highly of it. It's a great way of giving back. They really understand this
family partnership because they, they were former participants in the program. So they
know how it works. They know how it feels. They understand the relationship that the
nurse and the client has. They understand the need for funding to sustain NFP. And who
better to speak to the benefits of NFP other than someone who has actually received the
services of NFP? And any parent ambassador will tell you that the nurse and the
relationship with the nurse made the difference in terms of where they are today. Some
parent ambassadors will tell you that the nurse literally saved their lives. It is a component
of the program that was long overdue and has returned. Made a huge return on
investment, since it since it was inducted into Nurse Funding Partnership and Sacramento
County Partnership.

Speaker 3 [00:24:59] Well, Jenny, we recently talked to the chief medical advisor at the
Bipartisan Policy Center. And, it strikes, me this is very much in line with what you're
saying, that, home visiting programs for mothers and babies might be one of the few
nonpartizan issues that we have going in the country these days. They seem to attract
support on both sides of the aisle. And I wonder if that really is still true. Do you find this
funding? You know, issues always being present, but do you find this generally to be a
truly bipartisan issue that people recognize the need for these programs?

Speaker 2 [00:25:35] It really is. And, you know, even over the past couple of decades is
Partizanship has, you know, been more rampant, you know, nurse family partnership and
home visiting programs in general have continued to enjoy a strong amount of bipartisan
support. You know, I think everything from the way the, the McPhee program was
structured, you know, makes a lot of sense to people on both sides of the aisle. It has
those components of, you know, really just strong, funding that has a lot of, you know,
evidence and rigor to it. So we know that, you know, those dollars are going to be invested
in what works. And, you know, I think people have just seen the impact of what these
programs have done in their own communities. And that's and like, like Sharon said, when
we bring our parent ambassadors and other, you know, program advocates to the Hill,
people understand the value of it. And, you know, some people might see it more as we
like this for the maternal health aspect, aspects of it. Some people might see it more as we

like it for the economic mobility aspects of it, but there's really something for everyone. And
we had a recent, at the end of the last Congress, there was a bipartisan reauthorization of
the mikveh program, and it had overwhelming support at a time that was really challenging
to get legislation through. It had overwhelming support that it just had invested. Investing
and home visiting is investing in a brighter future for America, I believe.

Speaker 1 [00:26:51] Well, you're I think you're both spot on in terms of building bipartisan
support. It's a program that helps, all Americans across the country, no matter where,
where you live or, or your political persuasions. But. Sure. And I want to focus in on the
moms who might be listening in close with this quote from, your founder, David Olds. He
says there's magic window during pregnancy, a time when the desire to be a good mother
and raise a healthy and happy child creates motivation to overcome incredible obstacles,
including poverty, with the help of well-educated nurses. And I'm just thinking about the
mom who might be listening to the conversation. What's the first step to bring NFP to their
community?

Speaker 2 [00:27:38] So bringing NFP to a community involves community support. It
involves an organization deciding that they want to bring NFP to their community. That's
where it begins. Utilizing the Health and Human Services arena. As a referral source is the
pathway to get to NFP. Moms by themselves can go out if they're pain ambassadors or
have received NFP services and ask about NFP. Why don't we have NFP in our
community? They can reach out to their legislators to ask, where is NFP in our
community? We need NFP in our community.

Speaker 1 [00:28:17] Well, you know, community health centers, federally qualified health
centers all across America. The majority of their boards are patients and moms. So there's
a lot of power, in the voices of moms, whether they're through their community action
program, their work program, their community health center program. You're absolutely
right. There there's those voices will be heard when they speak up.

Speaker 3 [00:28:43] Sharon Sprinkle and Jenny Harper with Nurse Family Partnership.
Thank you for your inspiring work and thanks to our audience for being here. Be sure to
subscribe to our videos on YouTube, find us on Facebook and X with our account name,
CHC radio. And as always, you can go online to CHC Radio.com to sign up for email
updates and also share your thoughts and your comments about this program. Sharon and
Jenny, thank you so much for being here and best of luck to you.

Speaker 2 [00:29:10] Thank you. Pleasure. Thank you.

Speaker 3 [00:29:15] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
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