Nurses join hands with families for improving community health care

Nov 8 2017

The University of Alabama at Birmingham School of Nursing has received more than $1.7 million in philanthropic grants from a number of community partners to bring a Nurse-Family Partnership® program to Jefferson County.

The Nurse-Family Partnership® is an evidenced-based national community health program that has specially trained registered nurses regularly visit low-income, first-time mothers-to-be at home -; ideally starting in the first trimester of pregnancy -; and continuing through the child's second birthday. This allows for critical behavioral changes needed to improve the health and welfare of the mother and child.

The program is designed so the nurse and mother develop a strong relationship over the course of up to 64 in-home visits during the more than two-year period that focuses on the first-time mother's personal health, quality of care-giving and life course development -; inspiring long-lasting change that benefits both the mother and child. It has been used around the country for nearly 40 years, including in Montgomery and Tuscaloosa, with great success.

"This program has the potential to significantly improve birth outcomes in Jefferson County," said Cynthia Selleck, Ph.D., associate dean for Clinical and Global Partnerships. "As it is the most populous county in the state, and has pockets of infant mortality rates greater than 15 per 1,000 live births, this will fill a tremendous need for maternal health and early childhood intervention in Jefferson County."

The school has focused for a number of years on improving the health and quality of life for all Alabamians by partnering with community organizations to create innovative, targeted clinical programs to increase access to quality health care for vulnerable patient groups. The school has worked with new and existing community partners over the past two years, including The Community Foundation of Greater Birmingham, Jefferson County Department of Health, the Mike and Gillian Goodrich Foundation, The Daniel Foundation, and Blue Cross Blue Shield to make the Nurse-Family Partnership® a reality.

"These partners are all interested in improving access to health care and optimizing birth outcomes, so coming together to bring NFP to Jefferson County made a lot of sense," Selleck said.

Mark E. Wilson, M.D., health officer and chief executive of the Jefferson County Department of Health, says the Nurse-Family Partnership® can have positive impacts on short-term outcomes and long-term trajectory for babies and their families.

"I am really excited that the Jefferson County Department of Health has been able to play a major role in bringing this program to our county, and this is a wonderful example of how we can accomplish more through partnerships," Wilson said. "Concern about the high infant mortality rate -; especially in certain parts of our county -; led us to make improving birth outcomes and fostering optimal infant development priorities in our new strategic plan."

According to the Alabama Department of Public Health, Alabama's infant mortality rate is the second-highest in the nation and almost 40 percent higher for Medicaid births. Alabama has the third-highest percentage of low-weight births among all 50 states, and nearly a quarter of Alabama mothers receive inadequate prenatal care. These statistics are highest for Alabama babies born to African-Americans, teen mothers, and those with only a high school education or less.

Specifically, Jefferson County's preterm birthrate is 11.4 percent. In 2014, Jefferson County births included 3,876 babies born to low-income mothers; 9.7 percent of those were born to girls between the ages of 10 and 19, and 12.4 percent of those were born preterm. According to the March of Dimes, in an average week in Jefferson County, 172 babies are born, 20 are born prematurely, 19 are low-birthweight, and two die before reaching their first birthday.

"The Nurse-Family Partnership® focuses on first-time mothers because it is during a first pregnancy that the best chance exists to promote and teach positive and enduring behaviors between a mother and her baby," said Candace Knight, Ph.D., assistant professor and Nurse-Family Partnership® nurse supervisor. "With the partnership, we hope to see positive impacts that range from healthy, full-term babies and children who excel in school, to families who thrive and are economically self-sufficient. All of this begins with a relationship forged between a new mom and her nurse."

Specific objectives of this partnership are to improve Jefferson County's birth outcomes by helping women engage in good preventive health practices -; including getting prenatal care from their health care providers, improving their diet, and reducing their use of cigarettes, alcohol and illegal substances. They also will look to improve child health and development by helping parents provide responsible and competent care, as well as 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 prepare to find work.

"I am confident the UAB School of Nursing will make this gold standard of home visitation programs successful in Jefferson County," said Carol Butler, executive director of the Mike & Gillian Goodrich Foundation. "I am also pleased with the support garnered from other community partners, particularly the Jefferson County Department of Health. I look forward to 2020 when we will be able to fully realize the life-changing impact that the Nurse-Family Partnership® will have on women and children in Birmingham."

The school's Nurse-Family Partnership® program kicked off in July 2017. Four BSN-prepared registered nurses, called nurse home visitors, will each serve a maximum of 25 families at a time. Knight will oversee their work and provide ongoing consultation and support. Program Administrator Becky Wakefield will work closely with the program to ensure its effectiveness, and a data analyst will collect data to measure outcomes. During the next three years, the program has the potential to impact approximately 750 mothers, babies and family/social network members.

"For the Nurse-Family Partnership® to succeed, there has to be a source providing a steady stream of clients who are eligible for the program," Selleck said. "The school has enlisted its on-campus clinical partner, UAB Medicine, to help establish a regular referral base.

"We are working closely with key staff at UAB's Women and Infants Center, where Jefferson County Medicaid patients receive care and deliver their babies, to make sure all staff are informed of the program and know how to make a referral," Wakefield said. "We also are creating a streamlined process so that referrals reach us in a timely manner."

Knight says that, with nearly 40 years of research showing Nurse-Family Partnership® programs improve health outcomes of mothers and their babies, the partnership has the potential to produce lasting benefits for families and save money.

"We anticipate positive outcomes, both immediate and long-term," Knight said. "If we can promote and teach positive and enduring behaviors between a mother and her baby; help these young women address concerns related to their health, environment, economic status, stability and stress; and help them find available services in our community that will fill these needs, and are accessible, affordable and supportive, then I firmly believe we will be successful. We will create marked improvements in prenatal health, birth outcomes, child development, school readiness, academic achievement and maternal employment, as well as reductions in child abuse and neglect, early childhood injuries, mental health problems, drug abuse, and crime for Jefferson County's most vulnerable citizens."