18-year evaluation of nurse-led early intervention program shows significant outcomes for participants

Improved math scores. Better emotional intelligence. Increased receptive language. Improved working memory. More high school honors graduates.

These are among the cognitive function and academic performance findings of an 18-year follow-up study of Nurse-Family Partnership (NFP) participants in Memphis, according to a recent report published in the journal Pediatrics. The study evaluated 18-year-old youth born to high-risk mothers with limited psychological resources to cope with poverty.

This new evidence signals that the national program, which pairs first-time moms with home-based, personal nursing care from pregnancy through the first two years of a child’s life, may positively influence a child into adulthood. An additional Pediatrics study, over the same 18-year period, found that NFP saved the government $17,310 per family in public-benefit costs, resulting in a net savings of $4,732 (in 2009 dollars) after accounting for the cost of NFP. This is a 9% reduction in public benefit expenditures over the 18-year period.

These studies represent the largest, with 742 women (228 nurse-visited; 514 control), and longest (18 years) evaluations of the program to measure youth cognitive development, academic performance and cost savings per family to the government.

On the heels of these two new studies, the Tennessee Department of Human Services announced in January an award of approximately $4.6 million in four years to the NFP program at Le Bonheur Children’s Hospital to expand its services.

“If a mother is supported in her pregnancy, the outcome of that investment will change a generation,” said Le Bonheur Community Outreach Maternal Child Director Sandra Madubuonwu, who is in charge of the hospital’s NFP program.

NFP Sandra

With the new $4.6-million investment, Madubuonwu’s team will double and expand to serve approximately 200 additional families. Since 2010, more than 900 mothers and babies have completed the program in Memphis.

Positive Outcomes

NFP changes the future for the most vulnerable babies born into poverty by giving a first-time mom trusted support through nurse home visitations from pregnancy through her child’s second birthday. The program is backed by over 40 years of scientifically-proven outcomes for mom and baby and currently serves over 38,000 moms in 41 states, the U.S. Virgin Islands and many Tribal communities.

The Memphis studies, which began in 1990, enrolled primarily African-American women living below the federal poverty level. Researchers found that nurse-visited youth were three times as likely to graduate with honors compared to the control group. Also, at age 18, the proportion of nurse-visited youth receiving supplemental security income (SSI) for disability was 64.2% lower than that of the control group. Moreover, girls born to mothers participating in NFP, as a trend, had fewer convictions at age 18 than girls in the control group.

Nurse-visited women, compared with women in the control group, had no increase in partnered relationships but had increased cohabitation (as a trend), marriage and confidence in the ability to manage challenges in their lives. Although the program had no effects on income, nurse-visited women earned more than women in the control group during years four and five after the first child’s birth.

Previous program studies have shown reductions in first-born disability and rates of low birth weight in second births. Of Le Bonheur program participants, 89% of babies are born full-term, 75% of mothers initiate breastfeeding and 97% of toddlers are current with immunizations.

This latest study notes that nurse-visited mothers had more limited psychological resources (the ability to manage challenges in their lives) than the control group, and yet, children in the program outperformed those in the control group on many important cognitive and academic measures.

The findings suggest that nurse-visited mothers, like current program participant Charol Hewitt, truly change the life course for their children.

“The only thing I don’t like about this program is that more mothers don’t have access to it,” said Hewitt.

A Beacon of Truth

When Hewitt was 24-weeks pregnant, she attended a community baby shower where she learned about the program and decided to enroll. A few weeks later, the expecting mom from Whitehaven met Nurse Stephanie Washburn.

“It’s so different when you to go to the OBGYN, as soon as I got there the questions I had would just fly out of my head,” she said. “But when Stephanie visited, in my most comfortable place, my home,I felt like I could ask her more. I had a lot of questions about childbirth.”

Hewitt said that as a Southern woman with a large family, her nurse served as a beacon of truth in a sea of superstition and old-wives tales.

“The greatest support I received from NFP was facts,” she said. “The readings and materials we received from the program I actually use when parenting,” she said.

Washburn’s first visits with Hewitt revealed blood pressure issues missed in previous office appointments. Washburn counseled Hewitt and her husband, Chris, through the pregnancy and helped them create a birth plan.

Stephanie gave me that support and knowledge that other moms go through this. It’s joyful, but it’s also demanding and takes so much from us.

Charol Hewitt, participant

Hewitt said that after watching several birthing videos with Stephanie and completing her hospital preparation checklist, by the time she went into labor on June 18, 2018, she felt calm and prepared to meet her son, Gavin.

Gavin Hewitt

“I remember when I first held him, I looked into his eyes, and I just saw all this personality,” she said. “Now that he has grown more and is more expressive, I think ‘Yep, I saw all this personality when you were just a little bitty baby.’ He’s this incredible person that I can’t believe I carried in my belly.”

Gavin, whom Hewitt calls her “sonshine,” is a thriving 18-month old who loves to laugh and practice on his kid-size drum set.

Frontline Care

Hewitt’s transition to motherhood wasn’t without its challenges. Hewitt said her 15 minutes with a lactation specialist at the hospital did little to help when she got home and experienced latching issues.

Washburn came over and provided “hands-on, frontline care” that made a difference in her decision to breastfeed, Hewitt said. And when Hewitt began crying “for no reason” after she came home with Gavin, she recognized the signs of post-partum depression she had discussed with Washburn beforehand.

“I was able to identify it, able to coach myself through it and express, ‘Hey – I need a break,’” she said. “Stephanie gave me that support and knowledge that other moms go through this and it doesn’t make me a bad mom. You feel so guilty for being depressed during a time when we are supposed to be so happy. It’s joyful, but it’s also demanding and takes so much from us.”

Hewitt’s health and coping skills have since transcended her own family. When her nail technician told her about a new mom who was exhibiting severe signs of post-partum depression, Hewitt gave Washburn a call. Together, they found resources to offer the new mom in Hewitt’s social circle.

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