mom holding newborn baby's hand

Strength Through Partnership: The Nurse-Family Partnership in Shawnee County

by Jason Probst

Even under the best of circumstances, parenting a newborn child can be a difficult and challenging job. While a baby opens up a world of unmatched joy and happiness for families, caring for a newborn also strains the limits of human endurance. As well as sleepless nights, immeasurable exhaustion, and a gnawing sense of worry and anxiety that there’s more that could be done to provide a child with the best care possible.

For many new mothers, the first year of a child’s life is one of uncertainty and doubt. Even families with financial means, and a strong support system can struggle amidst the chaos of caring for an infant. Mothers who are raising their children alone, with limited resources, the challenges are even more daunting and the risk to families greater.

The Shawnee County Health Department launched an effort in 2013 to provide support, help, and education to new mothers—particularly those facing unique challenges in the first two years of a child’s life. Using a mix of funds from the county government, the Children’s Initiative Fund, and a matching Medicaid grant, the department launched the Nurse-Family Partnership. In its official form, NFP establishes a partnership between a specially trained registered nurse and first-time mother before the child is born and up to two years post-natally. Yet the program is much more than a partnership—it’s a long-standing relationship that helps provide new mothers with the tools, and friendships, they need to thrive in motherhood.

“Many of the mothers say they don’t know what they would’ve done without their nurse,” said Bonnie Gonzales, coordinator of NFP. “Some say they wish their childhood could’ve been like this. They’re trying to break the cycle of generational stress.”

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In Kansas, the average age of NFP-enrolled mother is 21. Roughly 84 percent are unmarried, and 94 percent utilize Medicaid. The average annual household income is $14,000. Shawnee and Johnson County are the only two locations in Kansas that utilize NFP. To date, more than 270 families have been served by the program.

“This population suffers greatly from anxiety—90 percent aren’t married and half don’t have the father around,” Gonzales said. “They don’t know where life is headed. We see victims of domestic violence, and they may hide that violence in their life. We help teach them to advocate for themselves and their baby.”

The program, which has enrolled more than 300,000 mothers nationally, employs a two generation approach that focuses both on mothers and children to break cycles of generational poverty. The NFP program is an evidence-based program with more than 40 years of randomized, controlled trial research that has demonstrated improved prenatal health, reduced childhood injuries, fewer subsequent pregnancies, increased maternal employment, better fatherhood involvement, better school readiness, and reduction in crime.

Additionally, the program, headquartered in Denver, Colorado, reports significant savings to federal, state, and local governments. Every $1 invested in the program, the organization reports, creates future savings of $5.70. It is estimated that the $8,096 invested in each NFP family (for an average of 527 days) yields $23,026 in direct federal and state cost savings. Factoring in less tangible savings, such as potential gains in employment and wages, produces a broader social benefit of $48,155—a 6.1 to 1 benefit to cost ratio for every dollar invested.

In a letter to Governor Laura Kelly, NFP’s Cam Scott urged the state to expand the program beyond Shawnee and Johnson Counties.

“A state investment of $1 million annually would allow for an initial expansion,” she wrote. “Either through the startup of a new implementation site in another area of the state, or through expansion of one or both of the two current Kansas NFP sites…Looking to the future, NFP could be scaled state-wide for approximately $7-8 million annually.”

The NFP program focuses on three core areas, coupled with additional specific targets for new mothers. The first is to improve pregnancy outcomes through the employment of preventative health practices during pregnancy. The second is a focus on child health and development—accomplished by helping parents develop competency in responsible care. The third area focuses on economic self-sufficiency by helping parents develop and realize a vision and plan for the future.

Studies on the program show significant results, including a 25 percent reduction in smoking among pregnant mothers, 33 percent reduction in pregnancy related hypertension, a 48 percent reduction in infant mortality and a 12 percent increase in mothers who attempt breastfeeding.

“We get so much positive feedback from the families,” Gonzales said. “When we ask what they like about the program, it’s almost exclusively about the relationship. That they work as a team. The moms say they don’t know what they’d have done without their nurse. It’s all about the relationship. Sometimes it’s as simple as being available to hear their story in away that is comfortable to them, and reacting to them in a manner that demonstrates that we hear what they are saying and understand their feelings.”

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Gonzales said the NFP program is part of a broader effort to wrap comprehensive services around new mothers. The Shawnee County Health Department is one of a handful of counties in Kansas that supports an infant mortality review program that researches the causes of fetal and infant deaths and uses that information to deploy programs to improve outcomes in the community. Along with NFP, the department regularly hosts community baby showers to help connect new mothers with the resources that can help them, and their children, thrive.

“The research thesis this is founded on was done in the 1970s,” Gonzales said. “The idea was what would be the result if we wrapped around services to pregnant teenagers? We saw that we had good results short-term, but we wanted to see the results long-term.”

Over time, that early research revealed that children were more likely to complete high school, less likely to land in jail, more likely to attend college, have a lower rate of emergency department use, and overall better health outcomes. For mothers, the study found they had higher employment retention, higher educational outcomes, and fewer repeat pregnancies.

“Locally, as they continue through the two-year program, we track the outcomes,” Gonzales said. “We rarely have a woman who keeps smoking. Ninety percent initiate breastfeeding, and roughly 30 percent do until the child is 6 months old. Almost all the kids engage with doctors through well check ups.”

Additionally, the nurses work with mothers on emotional and social development, help ensure the children are ready for school, and develop a vision and future plan for both the mother and child.

“We try to help mom develop that vision, and ask what we can do to help take steps to meet that goal,” Gonzales said. “We help with working toward those goals, and problem solving, and track progress every quarter.”

Craig Barnes, public information officer for the Shawnee County Health Department, added that the department works to fold other services into the NFP program to augment the efforts and improve results.

By pairing families with a health department nurse, the program can serve as a conduit to other services that can help make the first few years of motherhood calmer, and more productive, as well as identifying solutions for when the two-year NFP program ends.

“By working together with other programs, we ensure we’re not duplicating services while also sharing additional resources,” Barnes said. “We can get them in WIC (Women, Infants, and Children),” he said. “Even if they’re out of the NFP service, we can still provide that continuum of care.”

Gonzales agreed, saying the NFP program works to build bridges between different levels of service. Before a mother graduates from the NFP program, staff assesses what the family needs in the 3 to 5 year range.

“It’s all about being equipped to provide service,” she said. “It’s about never leaving the mom alone – and there are thousands more women we could touch where we could make a difference.”