Mar 31 2014
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County Health Rankings — Nurse-Family Partnership: Q&A with Elly Yost

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Rockingham County, N.C., is one of several counties profiled in videos produced for the 2014 report of the County Health Rankings, a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and released yesterday. The Rankings shows how communities across the country are doing and how they can improve on their health.

Rockingham evolved from a wealthy county to a poor one very quickly after losing two major industries only a couple of decades ago. The community suffers from high general smoking rates, high obesity rates and high rates of smoking during pregnancy. When the 2010 County Health Rankings were released, Rockingham was ranked at 71 out of 100 counties on health measures. The community's poor standing served as a wake-up call.

One new program set to begin this spring is the Nurse-Family Partnership, a decades-old, evidence-based community health program that serves low-income women pregnant with their first child.

Nurse-Family Partnership is based on the work of David Olds, MD, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver. While working in an inner-city day care center in the early 1970s, Olds was struck by the risks and difficulties in the lives of low-income children and over the next decades tested nurse home visitation for low income families in randomized controlled trials in Elmira, New York, Memphis, Tennessee and Denver. Results have shown that the program improved pregnancy outcomes; improved the health and development of children; and helped parents create a positive life course for themselves. There are now Nurse-Family Partnership programs in 43 states, the U.S. Virgin Islands and six Indian tribal communities.

In the Nurse-Family Partnership programs, the mothers receive ongoing visits from the nurses in their homes from the first trimester until the baby is two years old. Program goals include:

  • Improve pregnancy outcomes by helping the new mothers engage in good preventive health practices, including comprehensive prenatal care from their healthcare providers, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
  • Improve child health and development by helping parents provide responsible and competent care.
  • Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.

According to Heather Adams, executive director of the Rockingham County Partnership for Children, there are about 5,000 children under the age of five in Rockingham County. Over half live in poverty and are born to mothers under the age of 20 and many of the children are in single parent households.

“The County Health Rankings really gave us some concrete data to show us what we knew anecdotally was really true,” said Adams. “Nurse-Family Partnership really rose to the top as a really strong program that could help meet some of our needs.”

As part of its County Health Rankings coverage, NewPublicHealth recently spoke with Elly Yost, MSN, PNP, director of nursing practice at the Nurse-Family Partnership national office in Denver, Co. Yost is a pediatric nurse practitioner who previously worked in hospitals and community practice settings.

NPH: Two of the outcomes that we know of Nurse-Family Partnership is better education and income for the mothers. What about the program is responsible for those outcomes?

Elly Yost: We look at the environment the mom is living in. We look at whether she has:

  • Adequate housing,
  • Access to health care,
  • Access to food,
  • Safety for the child and the client herself,
  • Plans for attending school,
  • Employment opportunities, and
  • Family support.

The nurses meet with the clients in their home or in a place that the client chooses approximately every other week and at a minimum of once a month. That frequency helps establish trust between the nurse and the client, and it also gives the nurse an opportunity to really assess the client’s environment.

Then we provide referrals to resources to help her get what she needs to sustain her life, the baby’s life, and then move in a more positive direction. The nurse really spends some time looking at the community that the client is living in and what is available to her and to her family. From there the nurse and the client work together to establish both short and long term goals that the client can be successful in. And a very key factor is celebrating every success, small and large.

NPH: What are examples of small and large successes

Yost: A small success may be a client who has talked for months about obtaining her GED and actually gets the paperwork. Or may drive by the building where you take the test because for clients that we see, school hasn’t always been particularly a positive experience and so even the thought of obtaining the paperwork, of beginning to study, of going into that building and taking the test is a challenge. And so a small success is just taking that step, and the large success is hopefully taking the test and getting her GED.

NPH: When it comes to the infants and the babies, how does a healthy start to life help contribute to life-long health, better education outcomes and better education outcomes for children in the program?

Yost: I’ll begin with developmental health. We really encourage the mothers to talk to the babies, to play with the babies, to read to the babies. And for some of our moms, that’s something new. So we encourage it and we explain why it’s important to the child’s development—so that when they get to school they are at, hopefully, a level with their peers where they can continue to learn. The nurses also help the moms to understand developmental milestones such as sitting, crawling, cruising and standing, so that they have appropriate developmental expectations for the babies and are always able to scaffold that development and move the baby forward.

They also work on social and emotional support of the baby in helping the moms to understand the importance of a secure attachment, and how that helps the baby then be able to explore the environment and learn more.

NPH: Are the Nurse-Family Partnership models in all communities identical or do they change in order to meet certain community needs?

Yost: The communities that are looking to implement NFP do a needs assessment to determine where they have the most needs based on social determinants for NFP and what they may want to be addressing specifically in their community. So, for example, a community may want to really focus on low-income teen moms in particular. The program offices don’t drastically alter the model, but they will emphasize different parts of the model within their context.

NPH: In communities do the programs work with other partners or other needs of the families?

Yost: A big part of the program is making sure that we are receiving adequate referrals. One of our major referral sources is from WIC—the Women, Infants and Children program—and we also make sure that we have the right relationships within each community to be able to refer our clients to the services that they need and want.

NPH: In what ways has the Nurse-Family Partnership benefitted from using County Health Rankings data for programming?

Yost: When programs conduct a community needs assessment to see whether the NFP program can make a difference they look at available data including the County Health Rankings to determine where the challenges are in the community and whether the NPF program would be able to effect change. And if the answer is yes, then they’ll move forward with some approaches to implementation, finding funding and looking at how many nurses are in the community, etc. Then once they're implementing the program, nurses love data, and so they will look at the data from many sources including the County Health Rankings and compare what they're doing in their practice with what the rest of the community looks like. They do this for a couple of reasons. To hopefully improve overall rankings in the community, but we want to be able to show that NFP is making a difference in this subset of women’s lives.

NPH: What do you see as the highest level goal of the relationships between the nurses and the young mothers?

Yost: For me, the most important thing and the most vital thing about NFP is that it’s a partnership between the nurse and her client. The number one thing the nurse is going to do is ask that client: What do you want to know about pregnancy and early childhood? Let’s talk about your goals, and let’s help you set the goals that you want to achieve.

It is so important that by the end the client has the self-efficacy to part from the nurse and move forward knowing that she’s on a very positive path with her life, her family’s life and her baby.

>>Bonus Links:

  • Watch a video on the impact of the County Health Rankings on health improvements, including the upcoming Nurse-Family Partnership program, in Rockingham County, N.C.
  • Read an article in a recent issue of Pediatrics on new research and innovations from the Nurse Family Partnership.

Tags: County Health Rankings, Nurses, Public-private partnerships, Q&A