Problem: Every year, about 600,000 babies are born to low-income first-time mothers in the United States who lack the resources to provide themselves and their children with optimal care. As a result, these women and their families are at high risk for problems associated with poor health, limited education and economic dependency.
Background: Harriet Kitzman, R.N., Ph.D., F.A.A.N., got her first taste of the power of public health decades ago as an obstetric and pediatric nurse in Rochester, New York. During visits with pregnant women and new mothers, she could see the faces of her patients light up as they began to envision better lives for themselves and their families. “They got a feeling of hopefulness as they began to imagine a better future,” she recalls.
Kitzman pursued her interest in helping low-income women and children as a graduate nursing student at the University of Rochester, where she studied maternal and child health. During her studies, she met David Olds, Ph.D., a developmental psychologist who shared her interest in finding ways to lift young families out of poverty.
After earning her doctorate in nursing, Kitzman joined the nursing faculty at the University of Rochester in 1984 and teamed up with Olds, now director of the Prevention Research Center for Family and Child Health at the University of Colorado in Denver. Together, Kitzman, Olds and their colleagues studied the effects of public health interventions on low-income first-time mothers in Elmira, N.Y., which is a small, economically depressed city in the state’s southern tier.
They learned a lesson that has since become an axiom of public health: Teaching low-income pregnant women about prenatal health and childhood development can lead to dramatic improvements in the health and well-being of participants and their families.
Now a nursing and pediatrics professor at the University of Rochester and director of the university’s Center for Research & Evidence-Based Practice, Kitzman is building on the nurse-visitation research she began three decades ago.
The research team is currently evaluating the effects of the intervention on the children from the original sample of respondents in Elmira. The results aren’t in yet, but Kitzman hypothesizes that the findings will echo earlier findings from research conducted when the same group of children were 2-, 4-, 15- and 19-years old: that the children whose mothers received the intervention are living happier, healthier lives.
“We have learned that families with few resources can make headway,” she says.
Solution: These lessons have become the founding principle behind the Nurse-Family Partnership, a national organization that partners registered nurses with low-income pregnant women around the country. Under the program, nurses visit low-income women during their pregnancies and through the first two years of their children’s lives. During these visits, nurses teach participants how to have healthy pregnancies, coach them in child development, and help them make decisions about work and family.
The program has been shown to have a profoundly positive effect on women and children. Women are more likely to have healthier pregnancies, more likely to wait longer before becoming pregnant again, and less likely to rely on government subsidies.
Infants and toddlers, meanwhile, experience less child abuse and neglect and make fewer trips to emergency rooms for accidents and poisonings. Older children have fewer behavioral and intellectual problems and are less likely to be arrested as teens.
“If you help women during their first pregnancies, it does increase the potential that women and children will live healthier lives,” Kitzman says.
Society also benefits. The program costs $4,500 per family per year but leads to long-term savings to society, studies show. That is why President Obama expressed support for the program as a presidential candidate in 2008—a pledge he has followed up with as president with requests to Congress for funding for nurse-visitation programs.
Kitzman hopes more funding will help the partnership reach more women in need. It currently serves more than 20,000 families in 29 states. “The goal is to make services available to all families having first children who are likely to benefit from them.”
RWJF Perspective: For her work, Kitzman has been named an Edge Runner by the American Academy of Nursing (AAN). The Edge Runner program is a part of Raise the Voice, an initiative funded by the Robert Wood Johnson Foundation (RWJF) and directed by AAN to recognize innovators in health care. Edge Runners have developed care models and interventions that have been proven to be effective.
The Foundation has also supported Kitzman’s work to narrow health disparities. And Kitzman has given back to RWJF, serving as a coordinator of the Foundation’s Clinical Nurse Scholar Program, which has been retired, and a mentor to a Nurse Faculty Scholar.