RN, regional nurse consultant for the NFP in Louisiana. “A part of the model is that only a small change is necessary. So if a client never quits smoking but she doesn’t smoke in the presence of her child, that’s a plus.”
In case-controlled, longitudinal trials conducted among racially and ethnically diverse populations—beginning in 1977 in Elmira, New York, and continuing in Memphis, Tennessee, and Denver, Colorado—the NFP has shown reductions in unintended second pregnancies and increases in mothers’ employment. Children of mothers visited by nurses are less likely to be abused and by age 15 to be arrested. (For links to these and other studies of the NFP, visit www.nursefamilypartnership.org/provenresults/published-research.) The per-child cost is $9,118; for the highest-risk children, a return of $5.70 per dollar spent is realized (Karoly et al., 2005).
Several models of home visitation are in use, but the NFP relies on trained RNs for its interventions. A 2002 study compared home visits by untrained “paraprofessionals” and nurses. On almost all measures, the nurses produced far stronger outcomes (Olds et al., 2002). “People trust nurses,” said Ruth A. O’Brien, PhD, RN, FAAN, professor of nursing at the University of Colorado in Denver and an author of the study. “Low-income, minority people who have not had a lot of trust in the health care system might be willing to let a nurse in the door.”
Barriers to implementation include the fact that states use various sources to fund the NFP, and in some the funding is limited. The Affordable Care Act mandates that $1.5 billion be spent over 5 years on home visitation programs for at-risk mothers and infants*—substantially less than the $8.5 billion over 10 years that President Obama requested in his 2010 budget (OMB, 2010). While the act establishes a federal agency to oversee such home visitation programs, it does not specify that nurses provide the care. Also, some municipalities increase the nurse’s caseload beyond the recommended 25, diminishing the intensity and effectiveness of the interventions.
For her part, Ms. Rodrigue is looking ahead. She had completed a certified nursing assistant program while pregnant and will soon start nursing school, in which she had enrolled but quit shortly after high school. “I wasn’t ready for it,” she said. “But now I have a child and I know what to expect. I feel like I’m ready. I want to better myself.”