Gwen Perry-Brye, DNP, RNC, APNP Strengthening Care for Moms and Babies Clinical Services Director/ Assistant Health Officer Kenosha County 1 2 The true measure of a nation s standing is how well it attends to its children their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born. UNICEF, Child poverty in perspective: An overview of child wellbeing in rich countries, Innocenti Report Card 7, 2007, UNICEF Innocenti Research Centre, Florence. 3 4 WISCONSIN INFANT MORTALITY RATES BY RACE/ETHNICITY 1986-2008 (3-YEAR ROLLING AVERAGES) The Life Course Perspective (Lu and Halfon on, 2003) Protective factors Risk factors Wisconsin Births and Infant Deaths, 2008 1
Life Course Perspective LIFECOURSE PERSPECTIVE Lu, 2003 Reproductive Potential Reproductive Potential Pregnancy Pregnancy 7 Lu, 2003 8 LIFECOURSE PERSPECTIVE LU, 2003 Good Birth Outcome LIFECOURSE PERSPECTIVE LU 2003 Good Birth Outcome Poor Nutrition Stress Abuse Tobacco, Alcohol, Drugs Poverty Lack of Access to Health Care Exposure to Toxins Early Intervention Primary Care for Children Prenatal Care Poor Birth Outcome Primary Care for Women Prenatal Internatal Care Care Poor Birth Outcome 0 5 Puberty Pregnancy 0 5 Pregnancy Puberty Impactful change is possible (see last page of handout) Implementing Home Visitation Programming Nurse Family Partnership Parents as Teachers Long term commitment 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, Ph.D., Founder, Why Nurse-Family Partnership Our nurses change the future for the most vulnerable babies born into poverty in the United States, and their mothers. Nurse-Family Partnership Goals Improve Pregnancy Outcomes Improve Child Health and Development Improve Economic Self-Sufficiency of the Family The How EXPERT: Specially-trained nurses PROVEN: Extensive and compelling evidence INTENSIVE: Pregnancy through age 2 TIMELY: First 1000 days Nurse-Family Partnership Nurses Registered Nurses Specializing in Community Health Nursing Practice Receive Extensive Education in the Model The First 1,000 Days Early experience influence the developing brain Toxic affects of chronic stress Adversity can lead to lifelong problems Early intervention can prevent consequences Stable, caring relationships essential for development 3
Human Brain Development Synapse formation dependent on early experiences Nurse-Family Partnership Research 1977 Elmira, NY Participants: 400 Population: Low-income, white Studied: Semi-rural area 1990 Memphis, TN Participants: 1,139 Population: Low-income, black Studied: Urban area 1994 Denver, CO Participants: 735 Population: Large Hispanic representation Studied: Nurse and paraprofessionals Trial Outcomes Memphis Trial Outcomes Memphis Trial Outcomes (Cont) Every dollar invested in NFP can yield up to $6.20 in return. 4
Projected Outcomes PIRE Report by Dr. Ted R. Miller Based on 177,517 pregnant women enrolled in NFP from 1996-2013, Miller projects that by 2031, NFP will prevent an estimated: 500 infant deaths 10,000 preterm births 13,000 dangerous closely-spaced births 42,000 child maltreatment incidents 36,000 intimate partner violence incidents 90,000 violent crimes by youth 41,000 cases of youth substance abuse Funding Sources MIECHV Medicaid/Managed Care Reimbursement Title V/Maternal and Child Health TANF/Public Welfare Child Abuse Prevention Juvenile Justice/Delinquency Prevention Substance Abuse and Mental Health Tobacco Settlement State, City and County General Funds Private Philanthropy School Readiness Pay for Success/Social Impact Bonds Health Systems 26 National Service Office Support Business Development Nursing Policy & Government Affairs Information Systems Planning & Analytics Research & Evaluation Finance Marketing Communications Number of families served since replication began in 1996: 273,833 Number of families currently enrolled: 33,512 Number of nurse home visitors: 1,904 Number of counties where the program is serving clients: 599 Number of states where the program is serving clients: 42 + U.S. Virgin Islands Numbers on the map represent the number of families currently enrolled Data as of 12/31/17 Kenosha s Focus Program Outcomes Kenosha County Outcomes 4/2017-3/2018 (25 %) reduction in cigarette smoking among NFP moms during pregnancy Immunization rates for NFP infants are over (94 %). WI state immunization rate of (91 %) at 24 months. (84 %) of NFP mothers report breastfeeding at birth and nearly (50 %) continue to breastfeed at 6 months 5
Kenosha County Outcomes (98 %) of NFP infants and toddlers met NFP objectives for language and developmental progress (10 %)of NFP mothers had subsequent pregnancy at 24 months. Over 13 % of clients in WI had subsequent pregnancies at 24 months. children s programs are most successful when they leverage the most important and difficult job in the world: parenting Nicholas Kristof and Sheryl WuDunn Editorial Board noted that the Federal Commission to Eliminate Child Abuse and Neglect Fatalities found few examples of evidenced-based solutions to reduce child abuse. One notable exception is the home-based.. The Center for Progress estimates expanding to Medicaid-eligible first-time mothers nationally would prevent 20,000 deaths and more than 400,000 premature births over 10 years... References Questions? Aronson, R., (2008). Paper for Wisconsin Partnership Program Special Funding Initiative: Elimination of Racial and Ethnic Disparities in Birth Outcomes in Wisconsin. Collins, J. (2004). Very Low Birthweight in Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination. Journal of Public Health, Vol.94(12). Lu, M., Kotelchuck, M, Hogan, V.,(2010). Closing the Black- gap in birth outcomes: A Life- Course Health Development Approach, Lu, MC, Halfon, N., (2003).Racial and ethnic disparities in birth outcomes: a life course perspective. Maternal and Child Health Journal. Miller, T., (2015). Projected outcomes of Nurse Partnership home visitation during 1996-2013, USA. Prevention Science. 16(6) 765-777. 6
References Nelson, C., (2000). Neural plasticity and human development: the role of early experience in sculpting memory systems. Developmental Science, 3(2), 115-136. Institute of Child Development and Department of Pediatrics, University of Minnesota, USA. Olds, D., Kitzman, H. (2007). Effects of Nurse Home Visiting on maternal and child functioning: 9 follow up of a randomized trial, 120 (4), e826-e831. DOI: 10.1542/peds.2006-3189. Olds, D., Kitzman, H., (2008). Preventing child maltreatment and crime with prenatal and infancy support of parents: the Nurse Family Partnership. Journal of Scandinavian studies in criminology and crime prevention, 9(S1), 2-24. http://doi.org/10.1080/14043850802450096 Shonkoff, J. P., Phillips, D. A., & National Research Council (U.S.). (2000). From neurons to neighborhoods: The science of early child development. Washington, D.C: National Academy Press. UNICEF, (2007), Child poverty in perspective: An overview of child well-being in rich countries, Innocenti Report Card 7, UNICEF Innocenti Research Centre, Florence. 7