The Nurse-Family Partnership Program
When new moms lack financial resources, caring for a baby is more challenging. A desire to empower these first-time, low-income mothers attracted Noelia Blanco to the Nurse-Family Partnership (NFP) over a dozen years ago. And there is nowhere else this registered nurse would rather be.
“I stayed with it because NFP works,” says Blanco, a NFP nurse home visitor in Philadelphia. “I’m privileged to be a part of it.”
Public health nurses like Blanco are the backbone of a national program spotlighted for providing measurable differences in the lives of new mothers and their children. The program’s main goals include a healthy pregnancy, better child health, and improved parenting skills. Nurses conduct home visits with women from early on during their pregnancy until the child turns 2 years old. They provide expectant and new mothers guidance and education on a number of topics, such as positive prenatal practices, nonviolent child-raising techniques, and life coaching. Nurses also help mothers find jobs and obtain other resources.
Nearly 40 years old, NFP’s evidence-based outcomes include improved health and development of children, better school readiness, and increased maternal employment. In short, NFP, now in 43 states, has a track record for helping parents change their lives and the lives of their children.
Nurses help parents achieve a positive life course by developing long-term relationships and serving as mentors. In-home visits for the voluntary program are key to getting to know the mothers.
“It’s a different story when you work in the community,” says Blanco. “When you are in the home, you get a very comprehensive picture of the client. You know if they have heat, if they have electricity or food. It’s a whole different world.”
Nurses visit weekly, or every other week, until the child turns 21 months, and then scale back the visits to monthly checkups.
New parents are not the only people getting an education. “It has taught me to never give up on someone,” says Blanco. “I’ve always been an optimistic person, but I have seen these clients go through some real tragedies and succeed. I just love the program!”
She’s not alone.
Working with NFP is “one of the most validating and rewarding experiences in my nursing experience, which is why 13 years later I’m still involved with the model,” says Sara Eldridge of Philadelphia, who worked as a NFP nurse home visitor for five years, and then as a NFP nurse supervisor for five years.
“As I became more culturally responsive, it was just validating to see the relationship with the client develop for two and a half years and see the powerful outcomes. It is personally and professionally rewarding. It changed me,” says Eldridge, who now works for the NFP National Service Office as a nurse consultant providing support to NFP agencies in Florida, Georgia, Tennessee, Alabama, Virginia, and the Virgin Islands. A commitment to the evidence-based model, as well as flexibility, autonomy, and continuing education, attracts maternal and child health nurses to the program, she explains.
A public health nurse for 18 years, Maria Solomon joined NFP in Fairfax County, Virginia, several months ago, in part because of its proven results. “You know the outcomes will be good. And I feel I am supported,” she says. “They want feedback and they always want to improve the program, and that is very appealing.”
She is also thrilled to have an opportunity “to do what I love—and that is building relationships with people and helping them. . . while giving them the tools they need to become better parents. As the adage goes, ‘if you love your job, you will never work a day in your life.’ That’s how I feel about this job.”
After 18 years, Solomon is still learning and growing. The home visits provide many lessons.
“You go into someone’s house and it really humbles you. You learn to respect people more. I thought I did, but I think I do more now. The things that we learn and the skills that we gain, and the training we had, doing motivational interviewing—those sort of things make you a better nurse, and they also make you a better person because you are actually putting yourself in your client’s position. You are on their side. You are not poking your finger and telling them what to do, you are guiding them,” explains Solomon.
“I think a lot of women who are in this program want the best for their children, and that is such a force in itself. And if that becomes the starting point—that ‘I want this for my child’—then it’s amazing what you can do and where you can go. You go along this journey with someone. As far as changing me as a nurse, it’s very challenging, but it’s challenging in such a good way because I learn something new every day.”
The NFP program in Virginia began in June 2013, says Laura Suzuki, maternal child health coordinator for the Fairfax County Health Department, who oversees the state’s program and was involved in bringing it to Virginia.
Fairfax County is one of three locations in Virginia to start the program within the past 18 months. “The Affordable Care Act created the Maternal, Infant, and Early Childhood Home Visiting Program, and the money for many of these programs has come out of this pot of money and has enabled a lot of areas to expand their home visiting services,” says Suzuki. “So we were able to pursue that through our state.”
Three other states to recently implement NFP are Idaho, Montana, and Kansas.
Testing of the program in a randomized, controlled trial began in 1977 and was replicated in 1996. NFP’s strength has been its emphasis on the client-nurse relationship.
“The nurse role has been enhanced [over the years], but it has always been a therapeutic one-on-one client relationship that contributes to the outcomes,” says Eldridge. “It’s the powerful nature of what we do.”
Among the enhancements that will be rolled out in more states this year is a parent-child interaction tool—the Dyadic Assessment of Naturalistic Caregiver-child Experiences (DANCE)—that will enable nurses to observe areas of strength and growth. “The great things about the tool is the integration with other things we use, including educational materials,” says Eldridge. Training for NFP agencies to implement DANCE began in 2012 and will continue throughout this year.
What will remain unchanged is the commitment of nurses to their clients and their ability to gain trust, says Blanco.
“They know they can depend on us and we believe in them. Some of their family members are not their biggest fans, and they don’t have the support. If you have one person’s support, it can go such a long way. I’ve seen it over and over.”
Robin Farmer is a freelance writer based in Virginia.