“Nurse coaching” is another name for the nurse-family community partnerships that began in 1996 with a vision from David Olds and funding from the U.S. Department of Justice and Office of Juvenile Justice and Delinquency Prevention.[i] What first began as 3 small case studies in New York, Tennessee, and Colorado has grown into a publicly and privately funded non-profit organization called Nurse-Family Partnerships (NFP). The free and voluntary program for low-income mothers, that now operates in 42 U.S. states and the U.S. Virgin Islands, is based on the idea that disadvantage starts in utero and in early childhood. In efforts to help low-income, first-time mothers prepare for and begin to raise children, each participating mother is partnered with a registered nurse and receives regular home visits throughout her pregnancy and until her child’s second birthday. With early case studies from the 1970s on home nurse visits, the NFP organization relies on over 40 years’ worth of data from randomly controlled trials to enhance interventions and further improve outcomes.[ii] Examples of topics covered during nurse home visits include foods a mother should eat or not eat during pregnancy, how to child-proof certain areas of a home, and how to provide a stable and secure future for her baby. The main goals of NFP are to improve pregnancy outcomes, improve child health and development, and improve the economic self-sufficiency of the family.[iii] The NFP interventions seek to improve these outcomes by encouraging preventative health practices, reducing the use of cigarettes and alcohol during pregnancy, and planning actively for the future.
Evidence-based Successful Outcomes
Since the beginning of NFP in 1996, over 309,000 families have experienced improvements in health and social outcomes in both mothers and children. By empowering mothers through close relationships with trusted resources, NFP reduces rates of pregnancy complications, child abuse, substance abuse, and violent crimes. Furthermore, it improves language development and long term educational outcomes for children, as well as improves family self-sufficiency and employment for mothers.[iv] Marriage and stable partner relationships improve with the nurse home visits, contributing to better child and family functioning. In the Tennessee trial, nurse-visited women were 60-70 percent more likely to be living with a partner or the child’s father when the child reached age five.[v] When compared to a similar population, mothers in NFP had 18 percent fewer pre-term births and 21 percent more mothers breastfeeding, and the number of up-to-date immunizations for infants in NFP was 19 percent higher than non-participants. [vi] As a result of the decreased percentage of pre-term births, and therefore fewer medical complications, NFP saves an average $50,000 for each baby that’s born healthy and full-term, compared to pre-term.[vii] Analysis of the NFP 1990s randomized clinical trial in Memphis, Tennessee proved that prenatal and infant home visitation by nurses can reduce mortality among mothers and reduce preventable deaths among children in low-income, disadvantaged settings.[viii]
Funding, Costs, and Savings
Nurse-Family Partnership is funded by a combination of public and private sources, including Medicaid and public welfare funds, federal grants, state and local funds, and private philanthropic organizations.[ix] The cost of the NFP program varies state by state, and even city by city, mainly driven by differences in the salaries of participating nurses. In South Carolina programs, it’s estimated to cost $6,000 per family, whereas in New York programs, that number is 1.6 times higher at around $9,600 per family.[x] In the U.S., the average cost to serve a family, with an average enrollment time of 527 days (around one and a half years), is $9,933 per family.[xi] According to a 2015 study from the Pacific Institute for Research and Evaluation, the federal government actually saves money in the long-term when Medicaid pays for NFP services.[xii] This same study also found that NFP services result in lower Medicaid and SNAP enrollment, with an 8.5 percent decrease in Medicaid costs from birth to age 18 and a 9.6 percent decrease in SNAP costs in the 12 years after the birth of the child.
Evidence-based policymaking is, these days, one of the only shared ideas between political parties in Congress. The Bipartisan Budget Act passed by Congress and signed by President Trump in 2018 included a five-year reauthorization for $400 million a year in funding for states to expand NFP and other evidence-based home visit programs.[xiii] Funding for the bipartisan-supported Maternal, Infant and Early Childhood Home Visiting (MIECHV) program was expanded through a provision in H.R. 3, which was passed by the House of Representatives in late 2019.[xiv] While, H.R. 3 is mainly pushed by Nancy Pelosi and Democratic representatives and is opposed by conservatives, the expansion of funding for Nurse-Family Partnership is a bipartisan matter. Increasing funding for MIECHV addresses liberal concerns about income inequality and addresses conservative concerns related to unequal access to opportunity. For fiscal conservatives especially, funding nursing home visit programs will reduce government spending on welfare programs in the long-run. It’s estimated that state and federal government cost savings average almost $27,000 per family served in NFP, or almost $3.00 for every dollar invested.[xv] Furthermore, total benefits to society are close to $60,000 per family, or just over $6.00 per dollar invested in NFP.[xvi] Although the costs and benefits are temporally disjoint, with short-term costs and mostly long-term benefits, the successful case studies from NFP provide evidence in favor of supporting the expansion of home visit programs. Nurse-Family Partnership is one example of how investing taxpayer dollars in evidenced-based programs can achieve successful outcomes overtime, as “nurse coaching” interventions improve the health of low-income mothers and children and reduce long-term reliance on welfare programs.