Nursing health care systems and practices

Winston Churchill once remarked that, "There is no finer investment for any community than putting milk into babies." In a similar vein, Karen Howard, the Director of Policy and Government Affairs, is a strong supporter of Nurse-Family Partnership and its programs. The Nurse-Family Partnership is a preventive effort to target first time at risk young mothers and to provide them with home visits by qualified nurses. This effort begins at early pregnancy and helps guides them rough this difficult period until their infant is two years old. Karen Howard is a strong believer that this program not only benefits mother and child but society as a whole as it reduces cost to the healthcare system and allows nurses to take direct efforts to help patients.

The concept of the Nurse-Family Partnership (NFP) emerged from the work of Professor David Olds and in particular three large randomized trials he conducted starting in Elmira, NY in 1977, Memphis, TN in 1988 and Denver, CO in 1994. This work suggested a spectrum of positives for children and their mothers both in the short- and long-term from having regular nurse visitations. Of all early childhood preventive efforts, the NFP has one of the strongest scientific foundation supporting it. The U.S. government recently conducted an analysis of all medical home visit programs and reported that the NFP has 64 positive effects across 7 different domains, many of which were long lasting.

The significant benefits put forth by Karen Howard consist of better prenatal health, less pediatric injuries, less subsequent pregnancies, expanded time between births, enhanced and higher earning employment for the mother and better school preparedness. When evaluating these findings it is vital to understand that for many of the studies conducted the greatest statistical benefit was found in the most high risk women coming from low socioeconomic or psychological profiles entering the program. These benefits were not exclusive to childhood however, in the Elmira trial, which is the only trial whose population has reached the teenage years, a decreased involvement in crime have been observed.

All of these benefits stem from Karen Howard's and the program's goal of educating mothers-to-be to make informed choices regarding their pregnancy and child. The Olds studies found that for these mothers the NFP resulted in less smoking during pregnancy, enhanced prenatal nutrition and a decrease in hypertension in pregnancy. In addition, the greater time periods between the birth of first and second child witnessed amongst NFP participants in all three trials was associated with superior outcomes for the second pregnancy and child.

The Nurse Family Partnership can be understood as one of the most effective programs for lowering rates of child abuse and decreasing childhood injury. Some of the strongest evidence of the Olds studies found that the NFP led to decreased verified child abuse and neglect, lower childhood injuries and more specifically: a 48% drop in verified cases of child abuse and neglect by the age of 15, a 56% decrease in emergency room visits for injuries during the child's second year of life (Elmira), a 28% decrease in all types of health care visits during child's first two years of life (Memphis) and a 79% change in the number of days that children were hospitalized with injuries in the child's first two years of life (Memphis). NFP has also been shown to be effective in other research as the most effective program for lowering rates of child abuse and neglect in a review by MacMillan published in The Lancet.

Looking towards adulthood, the literature suggests that NFP children exhibit better cognitive and language development and have higher grades on standardized exams than their control group counterparts with these effects limited to low-resource mothers. More specifically NFP children demonstrated: a 50% reduction in language delay at 21 months (Denver), enhanced academic achievement in the first six years of school (Memphis, low resource mothers) and better language and emotional development at age 4 (Denver, low resource mothers).

Another of FNP's objectives is to help high-risk mother's better their own life development, with an emphasis on economic self-reliance, which leads to better outcomes for their children. Research shows that NFP maternal status is improved by: less subsequent pregnancies and greater intervals between first and second births, less need for welfare and other state resources, greater father presence and stability, enhanced maternal employment and less arrests and convictions

The data also demonstrates that NFP participation leads to significant financial savings to the government and to the general society. These benefits accumulate with time as the children get older but the cost of the NFP is generally returned by the age of four for the highest risk families and certainly by the age of 12. U.S. studies suggest cost savings of between $17,000 to $34,000 per child, a $3-5 return for every $1 invested, depending on the risk stratification group. Karoly (2005) estimates a cost savings of $34,000 per child by the time they reach adulthood for high risk mothers, a saving of $5.70 per $1 invested. Likewise, Lee (2008) in a study of government programs aimed at keeping families off the child welfare system estimated net benefits of NFP to be $18,054 with a benefit to cost ratio of $3.02 for each dollar invested.