Helping First-Time Moms Cited as Example of Effective Healthcare

Andrew Kitchenman | April 14, 2014 | Health Care
Policy experts, advocates cite Nurse-Family Partnership as example of type of program that deserves Medicaid funds

Colleen Nelson, vice president of clinical operation for the Children and Family Institute at the Visiting Nurse Association of Central Jersey.
Advocates for improving healthcare in New Jersey are pointing to a program in which nurses visit first-time mothers in their homes as a good example of how to spend public healthcare funds wisely.

The Nurse-Family Partnership (NFP), a model that has been used throughout the country since the 1970s, brings nurses to the homes of low-income women, where the nurses can observe and interact with the women’s entire families and help them through the challenges of pregnancy and early motherhood.

It is one of several programs being highlighted by the Good Care Collaborative, an alliance of healthcare providers, advocates and policy experts that was organized over the winter.

The collaborative aims to reform Medicaid spending so that more funding goes toward programs with a track record of being effective.

The NFP organization provides training for registered nurses with through nine regional organizations that implement the program in every New Jersey county.

In the program, registered nurses visit mothers in their homes throughout the pregnancy and through the first two years of the baby’s life. The visits take place weekly for the first four weeks – no matter when in the pregnancy the visits start — and in the first six weeks after the baby is born, then take every other week, finally being cut back to monthly visits in the last three months before the child turns 2 years old.

“These nurses have experience, years of experience sometimes in maternal-child (health), labor and delivery, pediatric, mental health, community health — they bring all of that experience when they’re going out to the homes,” said Colleen Nelson, vice president of clinical operation for the Children and Family Institute at the Visiting Nurse Association of Central Jersey, one of the local lead agencies for the program.

The three goals of the nurse visits are to improve pregnancy outcomes by helping women engage in good preventive health practices; to improve child health and development by helping parents provide competent care; and to improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.

During the 60- to 90-minute visits, the nurse checks the mother’s health, provides information on diet and breastfeeding, checks the baby’s health and language development, conducts various screening tests, and provides referrals to other providers, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

The NFP, developed by Colorado-based professor David Olds, was shown to be beneficial during a series of control trials conducted in the 1970s and 1980s.

The program won a federal grant to be offered throughout the state. While the state also provides $2 million in funding, it is not funded through the state’s Medicaid program. Program advocates and Good Care Collaborative members see Medicaid as a more stable source of money and would prefer to see the program funded through it.

Lisa Reyes, NFP director of business development, pointed to South Carolina as a potential model for New Jersey. That state provides financial incentives for insurers that serve as Medicaid managed care organizations to hire NFP agencies.

Reyes said NFP aims to be a key member of patients’ care teams, providing reports on the babies’ health to their pediatricians.

“The work that the nurses are doing is so key and can help the primary care folks in many, many ways,” said Reyes, noting that data from every home visit is tracked and measured against state and national standards for child health.

Reyes pointed to a NFP study by the Pacific Institute for Research and Evaluation that projected long-term government savings of 1.7 times the cost of the program, with 55 percent of the savings accruing to Medicaid. Providing evidence of savings will be essential to Good Care Collaborative members as they ask the state to fund NFP and similar programs.

Most of the women in the program are referred by local health clinics, although referrals have also come from Planned Parenthood and WIC offices, as well as from the mothers of the first-time mothers.

“During a supportive time, they go from just learning how to be a mom, to learning how to be a mom within their community and speaking up for their child,” said Mary Remhoff, a VNA official.

Remhoff said that connecting the care that the nurses provide during home visits to that given by other providers makes the women more confident in seeking out care.

Dr. Steven Landers, president and CEO of the VNA Health Group, said the specialized skills that the nurses acquire through the NFP training and home visits make them particularly valuable.

“They have a special skill and technique” that would be lost if the state relied on nurses in schools or doctors’ offices, said Landers, whose organization is the parent organization of the Visiting Nurse Association of Central Jersey. It serves as the NFP lead agency for Monmouth and Ocean counties. It also serves as the subcontractor for the United Way of Central Jersey in Middlesex and Somerset counties.

Nurse Adriana Gonzalez described the trust that is built up between her and the families during the two-year relationship.

“There’s really no topic that’s off-topic,” Gonzalez said, adding that the lengthy home visits provide a unique window into the lives of the mothers and babies.

Citing one example, she noted that she can observe whether the baby’s crib is set up in a way that would minimize the risk of Sudden Infant Death Syndrome, then point to scientific evidence that backs up the advice she provides mothers.

She also cited the benefits of her weekly meetings with seven other nurses, who share advice.

Good Care Collaborative members who visited the Visiting Nurse Association of Central Jersey office in Red Bank on Friday were impressed with the NFP program, pointing out that the holistic, team-based approach was similar to that of the Program for Assertive Community Treatment, a program for people with severe mental illnesses that the collaborative highlighted in February.

Other organizations serving as local lead agencies for Nurse-Family Partnership are: Southern New Jersey Perinatal Cooperative in Camden and Burlington counties; Robins’ Nest Inc. in Atlantic, Cape May, Cumberland, Gloucester and Salem; Children’s Futures Inc. in Mercer; the Partnership for Maternal and Child Health of Northern New Jersey in Bergen, Passaic and Hudson and as a subcontractor in Union; United Way of Central Jersey in Middlesex and Somerset; YCS Institute for Infant and Preschool Mental Health in Essex and Morris; United Way of Greater Union County in Union; and Project Self-Sufficiency in Hunterdon, Sussex and Warren counties.