The Nurse-Family Partnership: Innovation Meets Results for First-Time Moms

Dysfunction.  Discouragement.  Discord. 

These words are in the headlines we read and reflected in the stories we are drawn to. They are part of our daily reality, making it all the more imperative that we continue to find and highlight stories of hope, bipartisanship, and compassion. Christians must cling to the holy calling of being people of hope in the public square. 

In a season of dysfunction and discord, Nurse-Family Partnership is a program that receives few headlines but is making a transformational impact in the lives of many Americans. Nurse-Family Partnership (NFP) is a nation-wide initiative that works for better outcomes for babies, mothers, and families. NFP pairs nurses with low-income first-time mothers. According to the program’s website,

Nurse-Family Partnership works by having specially trained nurses regularly visit young, first-time moms-to-be, starting early in the pregnancy, and continuing through the child’s second birthday. The expectant mothers benefit by getting the care and support they need to have a healthy pregnancy. At the same time, new mothers develop a close relationship with a nurse who becomes a trusted resource they can rely on for advice on everything from safely caring for their child to taking steps to provide a stable, secure future for them both. Through the partnership, the nurse provides new mothers with the confidence and the tools they need not only to assure a healthy start for their babies, but to envision a life of stability and opportunities for success for both mother and child.

Especially for young mothers, a pregnancy is not always just a time of excitement. It can derail school plans or create financial or medical pressures that stretch them to the point of breaking. This means that babies may not get the stable environment (in and out of the womb) that they need to thrive and mothers are often left without the support they desperately need. Nurses can provide answers to basic medical questions, educate parents on what to expect, and help with some of the logistical issues that arise naturally out of pregnancy. They can answer many different types of questions: How will I pay for that?  Can I still get my degree?  What about transportation? How can my baby and I be as healthy as possible?  What should I prepare for in birth or breast-feeding?

The strength of a family is not solely a private issue, but part of the common good. 

NFP began on a small scale several decades ago. It expanded its reach in 1996 after founder David Olds had tested it for many years in Elmira, New York, Memphis, Tennessee, and Denver, Colorado. The results convinced Olds that NFP was ready to be re-created in other places. Today, it operates in 42 states, has approximately 33,000 families enrolled at any given time and has served over 260,000 families. 

The program is a unique example of government and civil society partnering together to serve low-income first-time mothers. NFP receives federal, state, and local funds and serves in communities nationwide. According to NFP,

Funding sources include the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, Medicaid, the Maternal and Child Health Services Block Grant (Title V), Temporary Assistance for Needy Families (TANF), Child Care Development Block Grant, Healthy Start, juvenile justice prevention funds, child abuse prevention funds through the Administration for Children & Families, tobacco settlement funds and state and local general revenue funds.

However, it also receives private funding from a variety of foundations and investors. This coordination between health providers, government agencies, and private funders is remarkable. 

This broad institutional support makes the current political moment even more important to pay attention to. NFP’s federal support is bundled with the Children’s Health Insurance Program (CHIP) and funding for CHIP is set to expire on September 30, 2017. While it is likely to be reauthorized, "The proposed budget also would reduce federal funding under CHIP and cap the eligibility level for which states could receive federal funding for children’s coverage at 250% of the Federal Poverty Level." It is important for us to stay aware of these lesser-known programs that are part of the federal budget. And in particular, as Christians, this is a program that we should affirm.

Nurse-Family Partnership recognizes strong families as a basis for a flourishing society. It also affirms the dignity of both mother and child – in giving the infant the best possible start to life and in giving the mother the support she needs. NFP has tapped into a fundamental truth about public justice: the personal is often public. The strength of a family is not solely a private issue, but part of the common good. And so while the authority of parents to make decisions is critical for justice, we joyfully recognize family health as a communal good to pursue, both for the health of the individual and society at large.

NFP fits into this comprehensive picture of public justice – bringing diverse institutions together for the sake of healthier families. It successfully blends rigorous standards and compassion. It affirms the value of the social programs and asks for accountability.  It is a program committed to measurable outcomes, and it has consistently demonstrated positive outcomes. For example, it has witnessed a 79 perecent reduction in preterm delivery for women who smoke, a 68% increase in the father’s presence in the household, and statistically significant increase in children’s school readiness (language, behavior, etc.).

As an affirmation of this commitment to positive outcomes, South Carolina has tied the NFP to a "Pay for Success"  model. What does that mean? Upfront capital from private investors is used to start the program and sustain it in the short term. In South Carolina several foundations have given substantial amounts – The Duke Endowment, BlueCross BlueShield of South Carolina Foundation, and Boeing Co., among others. The program then works toward measurable outcomes that have been agreed upon between independent experts, the program, and the government. At a previously agreed upon date, an independent assessment is done to determine if the outcomes have been achieved. In South Carolina, this independent evaluation will be led by J-Pal North America, a research center at MIT. If NFP demonstrates appropriate progress, then the government will reimburse the program. According to an NPR article,

The federal Centers for Medicare & Medicaid Services approved a waiver that allows the project to be reimbursed by Medicaid. This will allow approximately $13 million in Medicaid reimbursement (jointly funded by the federal government and the state) to go to service providers over the course of the project. And after the first few years, the state will contribute as much as another $7.5 million (in total) in "success payments" to help keep the program going over years four and five — but only if the partnership achieves specified results.


This    infographic    from the Nonprofit Finance Fund helps us to visualize the Pay for Success Model.

This infographic from the Nonprofit Finance Fund helps us to visualize the Pay for Success Model.

A fact sheet from the South Carolina Department of Health and Human Services helps to further explain Pay for Success in the state,

In a Pay for Success project, funders provide upfront capital to expand social Services and government pays for all or part of a program only if it measurably improves the lives of participants. In some Pay for Success projects, investors earn a small return on their investment. In this case, the funders are recycling any returns back into Nurse-Family Partnership services in South Carolina.

Do you see the hope and excitement in this model?  Private investors, policy makers, government agencies, social workers, nurses and mothers are all working together to improve family outcomes with built-in accountability and agreed upon values and outcomes. Even more encouraging is that this pay-for-success model is something that has bipartisan support.

While it might seem dry, this little graphic is a small beacon of hope. This is a positive example of public justice. Creative, yet simple solutions can be implemented to increase the flourishing of society.  Small, but measurable improvements can be made through cooperation between various institutions.These institutions can work together to achieve results. It is not hard to imagine how these principles of public justice could be applied to reforms in the juvenile justice system or education or the protection of the environment. We have, in fact, imagined these very things here at Shared Justice. What an encouragement to see them enacted in such a positive way. In a sea of stormy headlines, it’s a little light to guide our way.

-Dan Carter is a husband, father, neighbor, reader, runner, and Senior Pastor of Calvary on 8th St. located in Holland, MI.