Partnership targets high-risk mothers
Addresses health, life skill issues
Prenatal and infancy home visitations to high-risk mothers do produce positive results that decrease government spending, improve the lives of the mothers,1 and improve academic achievement of children2 according to studies published in the Archives of Pediatrics and Adolescent Medicine.
Staff members at Visiting Nurse Service of New York in New York City have firsthand knowledge that nurse visits that emphasize health education are successful, says Carol Odnoha, RN, BSN, MPA, director of the Nurse-Family Partnership Program at the agency. Since the implementation of the Nurse-Family Partnership Program in 2006, the agency has "graduated" close to 150 clients in the South Bronx area, she says. "These are high-risk, first-time mothers, who we started visiting during their pregnancy and continued visiting until the child was 2 years old," she explains. The agency currently has between 750 and 800 clients who live in two New York boroughs.
"We decided to offer the Nurse-Family Partnership program because it fit with our home health agency's mission to promote health and wellness in all areas of our community," says Odnoha. "In fact, the agency started over 100 years ago to provide services to poor women and children, so Nurse-Family Partnership is a way to enhance a service we've offered from our beginnings."
Nurse-Family Partnership is an evidence-based community health program offered in 31 states through organizations such as state and county public health departments, community-based health centers, nursing associations, home health agencies, and hospitals. A national office that provides support to agencies and ensures that care is delivered in the same manner throughout all programs oversees the implementation of the program.
"The national office reviews each application from agencies that want to implement the program to make sure that the organization is reputable and fiscally sound," says Lisa A. Ritchey, RN, director of community services and Nurse-Family Partnership at Home Nursing Agency in Altoona, PA. The key focus is on patient education to foster a healthy pregnancy, to teach parenting skills, to establish contact with necessary social and economic support, and to help the client develop life skills that will help them support their families.
Her 25 years of experience in prenatal, maternity, and high-risk newborn care in hospitals is one reason Ritchey is enthusiastic about a community program that takes patient education and care into the home. "In the hospital, we would send a mother home after two days on a wing and a prayer," says Ritchey. "Now, we know these mothers not only received prenatal care, but they also learned how to take care of the baby after they leave the hospital," she says.
Clients are referred to the program by community prenatal providers, such as physicians, nurses or nurse practitioners in health clinics, school nurses or guidance counselors, family members, family resource center staff members, or staff members of assistance offices such as the Women, Infants and Children (WIC) program, says Ritchey. "Although our clients must meet income guidelines, our income limitations are higher than programs such as Healthy Beginnings and WIC, so more women qualify," she says. Other admission criteria include being a first-time mother in the first or second trimester with the intention of keeping the child.
Visits meet client needs
"A nurse visits the client once a week in the first month of the program, then drops to one visit every two weeks until the birth of the baby," says Ritchey. After birth, the nurse visits once a week for the first 6 to 8 weeks. The first visit is usually 90 minutes, and other visits may last up to an hour at first, she says. "The visits are very client-focused and vary according to the client's needs," she says. Nurses and clients will finish each visit by setting goals for the next visit.
Visits during pregnancy focus on how to have a healthy pregnancy and then move into parenting skills, says Ritchey. Although the nurse will monitor blood pressure and weight, evaluate diet, check for swelling, listen to the fetal heartbeat, and assess the patient for any potential medical problems, the primary purpose of each visit is patient education. "The first part of the relationship is developing trust and establishing credibility," she explains. "This is especially important when the nurse begins to teach strategies for self-sufficiency," she says. Just as clients learn how to be healthy, have a healthy baby, and be a good parent, nurses also work with them to look at ways to complete their education, find a job, and take care of their family, she adds.
Because a good relationship between the client and the nurse is important for success, nurses stay with the same client throughout the program, says Odnoha. "About 50% of our clients are teenagers, so they need extra guidance to prepare for their futures," she says. "We also involve any family members, such as the baby's father, an aunt, grandmother, or mother, who might be able to provide extra support for the client," she says. Inclusion of family members results in more involvement of the father, as well as other family members, which leads to more opportunities for the client to return to school or find a job, she adds.
Reimbursement for the program comes from a variety of public grants, private foundation grants, and charitable contributions from the home health agency, says Odnoha. "We are also just beginning to bill Medicaid for some of the services," she says.
Staffing the program with the right people is important, Ritchey points out. "We hire RNs, preferably with a bachelor's degree," she says. All of the nurses have some maternal/child experience, with at least two years of experience in a hospital, she adds. "More importantly, the nurse has to buy into the concept of the program and want to work with a client for a long period of time," she says. It is not hard to find nurses, because many maternal/child health nurses want a chance to see how their involvement affects a client and her child, she adds. "It is also helpful if a nurse has some family practice or behavioral health background, but not necessary," she says. "Everyone I hire does, however, have strong clinical skills and is able to make decisions independently," she adds.
The program is well-received by physicians, other staff members, and the community, but there are challenges when first implementing the service, admits Odnoha. "We did not realize that social service organizations and hospitals that offered similar programs would see us as a competitor and refuse to refer to us," she says. "Once we educated them about our differences in the type of client we accept, the different income guideline, and the type of service we provide, we began to see more referrals from them when they saw a client who did not fit their guidelines," she says. Finding a way to work together has benefited all agencies, she adds. "For example, one organization is limited to serving a small, very specific geographic area, but they are not limited to accepting only women who are less than 28 weeks into their pregnancy," she says. "We refer clients who are more than 28 weeks pregnant and living in the organization's service area to them, because we cannot serve them," she explains. At the same time, the organization refers clients who live outside their service area to Odnoha's program. "We make sure everyone finds the service they need."
References
1. Olds DL, Kitzman HJ, Cole RE, et al. Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending. Arch Pediatr Adolesc Med. 2010;164:419-424.
2. Kitzman HJ, Olds DL, Cole RE, et al. Enduring effects of prenatal and infancy home visiting by nurses on children. Arch Pediatr Adolesc Med. 2010;164(5):412-418.
Sources
Carol Odnoha RN, BSN, MPA, Director, Nurse-Family Partnership Program, Visiting Nurse Service of New York, 1250 Broadway 7th floor, New York, NY 10001. Telephone: (212) 609-6267. E-mail: [email protected].
Lisa A. Ritchey, RN, Director of Community Services and Nurse-Family Partnership, Home Nursing Agency, 154 Lakemont Park Blvd., Altoona, PA 16602. Telephone: (814) 942-1903. E-mail: [email protected].
Prenatal and infancy home visitations to high-risk mothers do produce positive results that decrease government spending, improve the lives of the mothers, and improve academic achievement of children according to studies published in the Archives of Pediatrics and Adolescent Medicine.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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