Working Together to Ensure Healthier Families Nurse-Family Partnership Overview

2 “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

3 “They always say babies don’t come with instruction manuals, but if there was one, the Nurse-Family Partnership would be it.” Andrea, Mom from Pennsylvania

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Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 5 Program Goals Improve pregnancy outcomes Improve child health and development Improve parents’ economic self- sufficiency First-time, at-risk mothers Registered nurses Intensive services (intensity, duration) Focus on behavior Program fidelity (Clinical Information System) Knowledge, judgment and skills High level of trust, low stigma Credibility and perceived authority Nursing theory and practice at core of original model Overview Key Program Components Why Nurses?

© Copyright 2009 Nurse-Family Partnership. All rights reserved. Trials of the Program 1977 Elmira, NY Participants: 400 Population: Low-income whites Studied: Semi-rural area Memphis, TN Participants: 1,139 Population : Low-income blacks Studied : Urban area 1994 Denver, CO Participants: 735 Population: Large portion of Hispanics Studied : Nurse and paraprofessionals Dr. Olds’ research & development of NFP continues today… Research

© Copyright 2009 Nurse-Family Partnership. All rights reserved. The Coalition for Evidence-Based Policy has identified Nurse-Family Partnership…. 7 Research “as one of only two interventions meeting the Top Tier, and if implemented more broadly, could help spark rapid progress against major national problems.”

“The great thing about Nurse-Family Partnership is that it works. To put it simply…it decreases about everything you want to decrease and increases about everything you’d want it to increase.” Thomas Frieden, Commissioner New York City Dept. of Health & Mental Hygiene

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 9 Consistent Program Effects* Improved prenatal health Fewer childhood injuries Fewer subsequent pregnancies Increased intervals between births Increased maternal employment Improved school readiness * Effects observed in at least 2 of the 3 trials (Elmira, Memphis, Denver) Research

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“ 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 Nurse-Family Partnership than in professional sports stadiums or office towers.” Rob Grunewald, Associate Economist, Federal Reserve Bank of Minneapolis

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Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 15 Nurse-Family Partnership is Cost-Effective Washington State Institute for Public Policy 2008: NFP returns more than $18,000 over and above program costs for each family enrolled. RAND 1998, 2005: Savings accrue to government from increased taxes paid by employed parents and decreased spending on health carecriminal justice child protectionmental health educationpublic assistance $5.70 per dollar invested, costs recovered by child age 4 PIRE 2009: When Medicaid pays for NFP, net savings in federal spending of 54% over 10 years. Monetary Benefits to Society

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 16 Anticipated Program Effects per 100 Participating Families: NYC 50% decrease in language delays at 21 months, resulting in a savings of $133,000-$440,000 * 50% reduction in child abuse and neglect among children from birth to two years, resulting in a savings of $38,500 * 29% reduction in subsequent births within two years after the birth of the first child and a 14% increase in time between first and second births, reducing risk of premature delivery and saving $80,933 for every premature birth that was prevented * * Source: New York City Department of Health and Mental Hygiene 2004 Monetary Benefits to Society

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 17 Monetary Benefits to Society Used with permission from the Prevention Research Center for the Promotion of Human Development/2005 data Fayette County, PA Number of families served280 Benefit minus cost per family$37,367 Per dollar return on investment$3.59 Total economic benefit for Fayette County $10,462,707 State of PA Estimated number of NFP programs statewide 25 Estimated number of families served statewide 3200 Total potential economic benefit statewide $119,574, 400

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 18 Nurse-Family Partnership is a growing, national program States that NFP serves States where NFP is a state initiative # Number of counties NFP is serving Where we work

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 19 The National Service Office How It Works Insert photos from office not nurse and mom Prepares communities and agencies to implement Nurse-Family Partnership model with fidelity Educates nurse home visitors and nurse supervisors Provides ongoing clinical support Provides ongoing agency management and operations support Advocates for political support and long-term resources Provides resources for marketing and community outreach Collects and evaluates data to ensure quality services and to guide quality improvement

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 20 Sources of Nurse-Family Partnership Funding Medicaid TANF/Public Welfare Title V/Maternal and Child Health Initiatives Child Abuse Prevention Juvenile Justice/Delinquency Prevention Substance Abuse and Mental Health Tobacco Settlement United Way State, City and County General Funds Private Philanthropy School Readiness How It Works

“ This program saves money. It raises healthy babies and creates better parents. It reduced childhood injuries and unintended pregnancies, increased father involvement and women's employment, reduced use of welfare and food stamps, and increased children's school readiness. And it produced more than $28,000 in net savings for every high-risk family enrolled in the program.” Barack Obama, U.S. President

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 22 Makes a Down Payment on the President’s “Zero to Five” Plan... “The Budget also creates the Nurse Home Visitation program, which will provide funds to States to provide home visits by trained nurses to first-time low-income mothers and mothers-to-be. The program has been rigorously evaluated over time and proven to have long-term effects including substantial reductions in child abuse and neglect, preterm births, and arrests for both parents and adolescents who participated in the program as children, putting estimates of its return-on-investment between $3 to $6 per dollar invested. This Budget builds the foundation for a program that could ultimately serve all eligible mothers who seek services.” President Obama’s Proposed FY2010 Budget

23 “The Nurse-Family Partnership empowers first-time mothers with the resources and knowledge to provide an environment in which children can reach their full potential.” U.S. Senator Arlen Specter (R-PA) “ The success of the Nurse-Family Partnership is undeniable: this program should be expanded to every community in this country, not just a select few.” Ken Salazar U.S. Interior Secretary and former U.S. Senator (D-CO) “ I’m very proud that Milwaukee was chosen to be a Nurse-Family Partnership site because this is a proven cost- effective investment in the well-being of children and families.” Milwaukee Mayor Tom Barrett

24 “Studies show the program is a resounding success - improved prenatal health, fewer cases of child abuse and neglect, and babies who do better when they grow up.” Full coverage: - News Center “[NFP] aims, in a fashion, at equalization.” “[NFP] is one of the few social programs that has been scientifically shown to work.” “The Nurse-Family Partnership's work is crucial.” “These programs usually involve having nurses or mature women make a series of home visits to give young mothers the sort of cajoling and practical wisdom that in other times would have been delivered by grandmothers or elders.” “the [NFP] effort stands as a testament to what health care can accomplish by focusing on families. It can change whole life trajectories… ”

© Copyright 2009 Nurse-Family Partnership. All rights reserved. 25 Nurse-Family Partnership is Endorsed as a Model Program by National Institute on early Education Research World Health Organization Office of Juvenile Justice & Delinquency Prevention

Cover this gray area with one of the 8 provided filmstrip photo JPG files. © Copyright 2009 Nurse-Family Partnership. All rights reserved. 26 For more information: Tamar Bauer Chief Policy & Government Affairs Officer Nurse-Family Partnership National Service Office (303) Renée Nogales Nurse-Family Partnership Regional Program Developer Public/Private Ventures (215)