Working Together to Ensure Healthier Families

1. Working Together to Ensure Healthier Families ASTDN January 2012

2. Overview To be covered in this webinar: • Why Nurse-Family Partnership (NFP) • Evidence Behind the Nurse-Family Partnership • Return on Investment and Cost Benefits • How to Implement NFP • Sources of Funding

3. "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-educated nurse." David Olds, PhD, Founder, Nurse-Family Partnership

4. Overview Why NFP? Nurse-Family Partnership is… • An evidence-based, community health program • Transforming lives of vulnerable first-time mothers living in poverty • Improving prenatal care, quality of parenting and life prospects for mothers by partnering them with a registered nurse Every dollar invested in Nurse-Family Partnership can yield up to five dollars in return.

5. Overview

6. Overview Key Program Components Why Nurses? Program Goals • Improve pregnancy outcomes • Improve child health and development • Improve parents’ economic self-sufficiency • First-time, at-risk mothers • Registered nurses • Intensive services (intensity, duration) • Focus on behavior • Program fidelity (Efforts to Outcomes, ETO) • Knowledge, judgment and skills • High level of trust, low stigma • Credibility and perceived authority • Nursing theory and practice at core of original model

7. Research Trials of the Program Dr. Olds’ research & development of NFP continues today… 1977 Elmira, NY Participants: 400 Population: Low-income whites Studied: Semi-rural area • 1988 • Memphis, TN • Participants: 1,139 • Population: Low-income blacks • Studied: Urban area • 1994 • Denver, CO • Participants: 735 • Population: Large portion of Hispanics • Studied: Nurse and paraprofessionals

8. Research

9. Research

10. Research

11. Nurse-Family Partnership is Cost-Effective The RAND Corporation estimates Nurse-Family Partnership can return up to $5.70 for each $1 spent on the program.* Savings accrue to government from decreased spending on: health care criminal justice child protection mental health education public assistance And increased taxes paid by employed parents Nurse-Family Partnership returns more than $18,000 over and above program costs for each family enrolled.** (Washington State Institute for Public Policy 2008) Monetary Benefits to Society 11 * RAND Corporation 1998, 2005; return for highest risk families ** Savings related to low birth weight, child injuries and immunizations not included

12. Monetary Benefits to Society Anticipated program effects per 100 participating families • 50% decrease in language delays at 21 months resulting in a savings of $133,000-$440,000* • 50% reduction in child abuse and neglect among children from birth to two years, resulting in a savings of $38,500* • 29% reduction in subsequent births within two years after the birth of the first child and a 14% increase in time between first and second births, reducing risk of premature delivery and saving $80,933 for every premature birth that was prevented* *Source: New York City Department of Health and Mental Hygiene 2004

13. How It Works Model Fidelity: What Implementation Looks like • Standard implementation: • 8 nurse home visitors, each serving a maximum of 25 families • 200 families total • Supported by 1 full time (1 FTE) nurse supervisor • In general: • Nurse: client ratio of no more than 1:25 for 1 FTE nurse home visitor • Supervisor: Nurse home visitor ratio of no more than 1:8 for 1 FTE supervisor • Implementing agencies have at least 0.5 FTE general admin support staff per 100 clients • Small team guidance for rural implementation is available with consultation from Program Developer and Nurse Consultant

14. IA Overview Characteristics of Nurse-Family Partnership Implementing Agencies • Strong reputation • Excellent working relationships • Committed • Flexible and supportive of nursing staff • Financially stable • Effective • Mission driven • Focused on success

15. Implementation Process Implementation Plan Overview • Official plan for first year start-up and implementation that must be deemed “Ready to Launch” by the National Service Office (NSO) • Your “roadmap” for the first year of implementation • Designed to ensure successful implementation of the program with fidelity to the model • We’re here to help you succeed!

16. Implementation Process Implementation Plan Overview Components Include: • Basic agency/organization information • Community need and population characteristics • Organization mission and culture • Information on organization’s capabilities in relation to implementing a program like NFP • Planning for nursing practice and support • Planning for community linkages • Sustainability planning • Financing and fiscal policy support information • Planning for research and evaluation of NFP

17. Implementation Process Implementation Plan: Review Process and Timeline • Step 1: Draft the Plan • Step 2: Ensure that funding is secured • Step 2(b): Revise Plan as needed • Step 3: Face-to-face meeting with your Program Developer and Nurse Consultant to talk about draft plan • Step 3(b): Revise the Plan as needed • Step 4: Submit finalized Plan to your Program Developer • Step 4(b): Revise Plan as needed for final submission • Step5: Program Developer initiates the Application Review Team (ART) Process • Step 6: ART team reviews the Plan, identifies questions • Step 7: Virtual meeting with your ART team to discuss strengths and possible challenges • Step 8: Official “Ready to Launch” letter from the National Service Office (NSO) • This means you can officially move forward with implementation! • Step 9: Proprietary Property Protection Letter (“pre-contract”) drafted and approved by NSO and agency

18. Implementation Process Next Steps: Moving Towards Implementation • Post positions and recruit staff • Interview and hire nurse home visitors (NHVs) and administrative support staff • Attend NFP Education in Denver, CO • Begin enrolling clients • Reach full caseloads in 9 to 12 months after NHVs attend education

19. Introduction to the NSO Insert photos from office not nurse and mom The National Service Office (NSO) • Prepares communities and agencies to implement Nurse-Family Partnership model with fidelity • Educates nurse home visitors, nurse supervisors and administrators • Provides ongoing clinical support • Provides ongoing agency management and operations support • Advocates for local political support and long-term resources • Provides resources/training for marketing and community outreach • Collects and evaluates data to ensure quality services and to guide quality improvement

20. Funding and Support Sources of Nurse-Family Partnership Funding • Tobacco Settlement • United Way • State, City and County General Funds • Private Philanthropy • School Readiness • Maternal, Infant and Early Childhood Home Visiting Program (MIECHV, federal) • Medicaid • TANF/Public Welfare • Title V/Maternal and Child Health Initiatives • Child Abuse Prevention • Juvenile Justice/Delinquency Prevention • Substance Abuse and Mental Health

21. Funding and Support Funding Identification and Support • Every Community is Different • Medicaid billing/Targeted Case Management (TCM) • NFP Medicaid Director • Advocacy • City, County and State • Family Foundations and Grants • Federal Funds

22. Funding and Support 22 Nurse-Family Partnership is Endorsed as a Model Program by World Health Organization Office of Juvenile Justice & Delinquency Prevention National Institute on Early Education Research

23. Questions? • Program Development: • Kristen Rogers Kristen.Rogers@nursefamilypartnership.org • Lauren Platt Lauren.Platt@nursefamilypartnership.org • State Specific Developers: http://www.nursefamilypartnership.org/assets/PDF/Policy/HV-Funding-Guidance/Contact_Program_Developer • Nursing: • Elly Yost Elly.Yost@nursefamilypartnership.org • For more information: www.nursefamilypartnership.org

24. THANK YOU for joining us today!Please join us for the NFP-Part Two webinar Thursday, Feb 2, 2012 12:00-1:30pm EST