Program aims to change kids' lives before birth

Helping young women develop parenting skills

The nurse-family partnership program focuses on first-time mothers because the first pregnancy offers the best chance to promote healthy behaviors, to building a bond between mothers and babies, and to teach the families positive child-rearing techniques, says Nancy Kehiayan, MS, RN, APRN-BC, nursing director at the NFP national service office.

The nurse-family partnership works with community-based organizations, such as health centers, hospital systems, visiting nurse associations, and faith-based groups that are already working with low-income populations. The local organizations adapt the model to fit in with the needs in their individual community.

Currently, there are nurse-family partnerships in communities in more than 32 states.

The nurses in the nurse-family partnership programs receive training in the national service office education center in Denver and go back to their agencies for more online training before they start working with clients. The program offers continuing education on a regular basis for all of the nurses.

The program employs nurse consultants who work with the program's local supervisors and help with any challenges or issues.

"We reinforce the education and provide clarity whenever it is needed," she says.

Nurses in the program need to be good problem-solvers with expertise in child health and mental health. They need to be able to work independently and have a passion for working with first-time moms, Kehiayan says.

Jane McKinley, RN, BSN, a nurse-family partnership nurse supervisor in Boulder, CO, has an office but adds "most of the time, my car is my office. It's filled with packs of information from other programs, developmental toys, baby scales, formal assessments, and ages and stages questionnaires."

Her organization has a weekly team meeting in which the nurses share their problems with clients and collaborate to find solutions.

"To work effectively with our clients, we have to know the resources of the community, and they are constantly shifting. This makes it important for all the nurses to work as a team and share case management information back and forth. In public health, we really rely on each other and expect that things will change. We work together and share our expertise," she says.

The nurses often bring up difficult cases and ask their peers for help in solving them.

"We use reflective consultation, which allows us to look at our experience of working with families. There can be situations that are very provocative but they may not be what we think they are," she says

For instance, one nurse case manager was working with a family where the infant was not gaining weight.

"When she observed the feedings, she became concerned that the mother was limiting the amount of food the baby was getting. She wanted us to help her come up with a plan on how to address the issue with the mother and whether an outside agency needed to get involved. In this case, she needed to make a report to social services because there was no medical explanation for the lack of weight gain," McKinley says.

The nurse was concerned that the mother would run if she was told that she was being reported to social services and that the baby would suffer.

"She was not clear about what to do. We helped her think it through and make a decision based on what she knew about the client. She decided to tell the client that it was mandatory for her to call social services. This is an example of moving through your emotional reactions and doing what is best for the client and child," she says.

The organization takes great pains to ensure the safety of the nurses as they travel into disadvantaged communities, McKinley says.

The nurse-family partnership supervisor may advise that nurses avoid making home visits in certain neighborhoods after dark.

"We have a lot of basic safety rules, like not taking a purse into the house," McKinley says.

If nurses have any discomfort entering the home, they are prepared to tell clients that they can't see them today.

"Most of the time, the families are very protective of the nurse. If they are inviting me to the home, they are good about ensuring that it's safe. They may call and say it's not safe for me to come today or they may cancel the meeting or suggest that this time we meet at a different location," she says.