Michigan and Nurse Family Partnership

1. Michigan and Nurse Family Partnership Implementing an Evidence-Based Preventive Intervention for Families

2. Why We Did It • To impact the health disparity of African American families in Michigan. • To replicate Nurse-Family Partnership, an evidence-based program with proven outcomes for families.

3. Nurse-Family Partnership Outcomes: • Improve health during pregnancy & improve birth outcomes • Improve child health and development • Improve families’ economic self-sufficiency

4. NFP Model Elements • Serve low-income, first time mothers • Early enrollment of pregnant women • Implement program with nurses, prefer BSN • Utilize visit guidelines that focus on personal health, caregiving skills and life course development • Duration of program is 2.5 years

5. Nurse-Family Partnership Provides • Professional Development for nurses • Web-Based Clinical Information System Program Evaluation • State Reports • Continued support to refine implementation • Prepare for NFP growth overtime

6. Michigan and Nurse-Family Partnership Department of Community Health and NFP partners together: • Community and organizational planning • Site Selection • Nurse training and consultation • Evaluation and reporting program data • Program advocacy, visibility and support

7. Creative Funding Partnerships • Three way partnership: • The Michigan Department of Community Health • Department of Education • Department of Human Services and Nurse-Family Partnership • Michigan Department of Community Health initially funds program • Graduated local contribution of • 10%, • 20% • 25% over the first 3-year cycle

8. State of Michigan Funding • State Nurse Consultant .5 FTE • State Infant Mental Health Specialist .5 FTE • Sites funded in 4 communities Detroit Benton Harbor Pontiac Grand Rapids .5 Supervisor .5 Data Entry 4 nurses serve 100 families

9. Community Support in DetroitNFP Steering Committee • Skillman Foundation • Wayne County Department of Human Services • Wayne State University College of Nursing • Infant Morality Project • Detroit Public Schools • Southwest Counseling and Development Services • Several health plans • County Commissioner • Community resident • Office of School Social Work Services

10. What We Found Gestational age at program enrollment: n = 572 Michigan clients 47% enrolled before 16 weeks 53% enrolled between 17 – 28 weeks 4% enrolled at 29 weeks or later

11. Mothers’ Health Problems Identified at entry into the program: • Asthma = 17% NFP National Data Asthma = 14% • Urinary Tract Infections = 7% • Underweight before pregnancy = 6% • High Blood Pressure = 6% • Heart Problem = 5% • Mental Disorder = 5%

12. History of Domestic and/or Family Violence Self report at intake: • History of physical or emotional abuse = 26% • Physical abuse in past year = 16% • Physical abuse during pregnancy = 8% • Forced sex in past year = 3% • Afraid or partner/someone else = 5%

13. Premature Infants All NFP Births 339 African American Infants: • NFP Michigan (222) = 10.4% • Michigan African American = 16.5% • Detroit African American = 15.6% Michigan & Detroit Residents 2001-2003

14. Low Birth Weight Infants African American Population: NFP Michigan (226) = 11.9% 29% of low birth weight infants were 5.0-5.5 lbs Michigan African American =14.2% Detroit African American = 14.5% Michigan & Detroit Residents 2001-2003

15. Successes • Early gestational age enrollment • Accessing care early • Utilizing community services • 6.1% decrease in preterm births • 2.3% decrease in low birth weight infants

16. Barriers & Challenges • Establishing a new program • Establishing referral system • Recruitment and retention of nurses suited for long-term and intensive services for vulnerable families • Adequate community support and advocacy • Sustainability of program

17. What We Think About What We Found • Improved pregnancy and child health outcomes • Early access to care and services • Increased clinical skills for nurses • Creative partnerships & funding • Improved local community collaboration and support

18. Take Home Message • Improve pregnancy and child health outcomes with evidence based NFP • Support sites to develop best practices • Renew community partnerships • Be creative with current funding sources

19. NFP Supervisor Quote • “It’s an evolution , the development comes over time. Once we got the word out to the community and nurses began to learn how to deliver the NFP the momentum has been enormous – and now its pure love for the program and the relationships with clients.”