1. NYC Nurse-Family Partnership Westchester Children’s Association 2009 Advocacy Breakfast March 27, 2009 Deborah L. Kaplan, PA, MPH Assistant Commissioner Bureau of Maternal, Infant and Reproductive Health NYC Department of Health and Mental Hygiene

2. NYC DOHMH Program Implementation Strategy Implement programs that are: –Evidence-based/proven to work –Highly structured, program evaluation –Scalable –Sustainable Nurse-Family Partnership “fits the bill” – DOHMH implemented NFP as key public health strategy to improve maternal and child health outcomes in NYC –From the start, a vision of citywide scale-up

3. NYC Nurse-Family Partnership Expansion 2003-Present July 2003 – DOHMH launched demonstration site in Jamaica East, Queens to serve 100 families 2004-2007 - Contracted with outside agencies to serve families in Harlem, Central Brooklyn and South Bronx 2006 – Developed special team of DOHMH nurses – Targeted Citywide Initiative - to serve mothers in foster care, shelters & Riker’s Island January 2008 – Expanded NFP services to all 5 boroughs to serve 1,500 more families

4. Special team of 8 DOHMH nurses Serves vulnerable, first-time mothers in: –Foster care (teens) –Homeless shelters –Riker’s Island Lower caseload (15 clients/nurse) as nurses follow clients as they move from borough to borough Works closely with Administration for Children’s Services, Dept. of the Homeless and Riker’s NYC Nurse-Family Partnership Targeted Citywide Initiative (TCI)

5. NYC NFP is a partnership between the DOHMH & other Implementing Agencies throughout NYC Harlem Hospital Public Health Solutions Richmond Home Need Services SCO Family of Services The Brooklyn Hospital Center Visiting Nurse Service of New York

6. NYC NFP Expansion: Nurses Serving Clients 2006-2008

7. NYC NFP Expansion: Active Clients 2006-2008

8. NYC Nurse-Family Partnership February 2009 1,844 clients citywide 97.4 nurse home visitors 9 sites across NYC 13 teams of nurses - soon to be 19 teams

9. NYC NFP: the largest urban NFP site in the country!

10. BMIRH Role: NYC NFP Implementation, Program Fidelity, Expansion and Sustainability Direct Program Provision Partnership with National NFP to Assure Program Fidelity Site Selection Staff Training/Professional Development Technical Assistance & Staff Support Program Monitoring – assure consistency and quality Citywide Program Coordination Link to Public Health System Evaluation Secure Public and Private Funding

11. NYC NFP Client Demographics at Intake NYC NFP Implementation Report Data through 12/31/08 Median age: 20 Primary language - 69.3% English, 22.6% Spanish Race/ethnicity –42.5% - Hispanic/Latina –41.7% - Black/African American –6.7% - Multiracial/Other –4.3% - Asian/Pacific Islander –3.9% - White Non-Hispanic 85.48% - Unmarried 54.1% - With HS Diploma or GED 34.4% - Enrolled in school 73.4% - Unemployed $13,500 - Median household income

12. Positive Program Outcomes in NYC NFP Preliminary Outcomes: Subsequent Pregnancy Breastfeeding Workforce Participation Immunizations

13. Cumulative Percent of Women with Subsequent Pregnancy 6 Months & 18 Months Postpartum New York City NFP vs. US Source: US: CDC 2006 Pregnancy Nutrition Surveillance System (PNSS); NYC: Nurse-Family Partnership (NFP) Data through 12/30/2008 PRELIMINARY DATA RESULTS

14. Breastfeeding Initiation Rate, NYC NFP, NYC and US Source: NYC NFP: Nurse-Family Partnership Data through 12/30/2008; NYC: First time births on Medicaid from PRAMS, 2006; US: National Immunization Service (NIS), 2004 PRELIMINARY DATA RESULTS

15. At 24 months, percent of NFP clients in workforce is 32% higher than at intake Source: Nurse-Family Partnership (NFP) Data through 12/30/2008 Percent Workforce Participation: PRELIMINARY DATA RESULTS

16. At 24 Months Percent of NYC NFP Infants Up-to-Date with Immunizations Compared to Citywide Source: NYC: National Immunization Survey (NIS) 2007; http://www.cdc.gov/vaccines/stats-surv/nis/tables/07/tab09_24mo_iap.xls NYC NFP: Nurse-Family Partnership Data through 12/30/08 PRELIMINARY DATA RESULTS

17. NYC NFP Public Funding Update Medicaid State Plan Amendment to feds – April 09 LHCSA application approved for DOHMH Jan 09 Time Study completed in Dec 08 COPS Lobby Day Email blast Site Advocacy –Client thank you letters –Postcard drive

18. Private Funding: Key Program Enhancements Nurse recruitment/retention activities Key NFP staff lines DVD libraries to all new teams Certified Lactation Counselor Training Client retention projects: milestone markers Heart’s Desire Scholarship Fund

19. Waiting Room DVD – English version completed 1/09 - now available on DOHMH website. NFP Advocacy Day in Albany – 2/09 Comic Book – Estimated print date 4/09 Citywide NFP Advisory Board – Planning 1st meeting for 4/09 Client Success Stories Newsletter – Estimated print date 5/09 Public-Private Ventures publication of client stories Outreach Efforts are Key

20. NFP Expansion Challenges Recruiting and retaining nurses Building city-wide awareness of NFP for client enrollment/retention Developing effective avenues for automatic referrals Ensuring fidelity to NFP model in context of rapid scale-up Coordination with other community-based programs

21. Lessons Learned Public-private partnership Use data to inform program and advocacy Recruit pregnant women as early as possible Develop and maintain strong relationships with referral sources Use media opportunities to build awareness about your program Build strong relationships at all levels – community, city and state Target interests of targeted agency/group - child abuse, criminal justice, etc

22. Lessons Learned Use creativity and a personal approach to nurse recruitment Recognize and show appreciation for nurses’ work; provide ongoing staff development Expect expansion challenges to happen. Plan extra time for each step Provide a thorough introduction to all partners & agree on expectations early on Be focused and relentless!!

23. A Quote from an NYC NFP Mom “I foresee a better future for me and my daughter from the NFP program because they have helped me see the importance of staying in school and focusing on the future. First I will go finish school. I should get my high school diploma by June this year and then go for my RN.”