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First-time moms focus of home-nursing pilot

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By Todd Cohen

RALEIGH, N.C. — In North Carolina, where the rate of infant mortality exceeds the national rate, the percentages of poor children and of infants born with low birth weight both are growing.

To help give vulnerable newborns a better start, a collaborative partnership is launching a pilot project teaming nurses with first-time mothers and their families in some of the state’s poorest counties.

With funding totaling roughly $2 million a year combined from The Duke Endowment in Charlotte and the Kate B. Reynolds Charitable Trust in Winston-Salem, the partnership will invite 30 counties to apply for funding.

After working with those counties to plan their proposals, the partnership next spring will select four to six counties or groups of counties that will be eligible to receive funds for up to seven years.

Prevent Child Abuse North Carolina and The North Carolina Partnership for Children have teamed up with the national Nurse-Family Partnership to offer the program, and plan to expand it throughout the state over the next decade if private and public funding can be secured.

With mothers volunteering to participate as early in their pregnancy as possible, registered nurses will make home visits every week or two, focusing on the mother’s personal health, quality of care-giving and overall development.

The nurses also will work to get family members and friends involved, and will assess the need for other health and human services.

“Part of what we need to do in this state is work on supporting families before child abuse and neglect ever occur,” says Anne Sayers, new parents program consultant for Prevent Child Abuse North Carolina. “This is a window of opportunity.”

Emmy Marshall, family support consultant for The North Carolina Partnership for Children, says many of the most vulnerable children do not receive the care they need.

A federal study found those children are less likely to be in licensed, regulated care, she says.

Having focused mainly on early-care for children and on professional development for their teachers, largely because of mandates by state lawmakers, she says, the statewide organization in the new family-nurse initiative now can expand to include more health or family support for a population that is particularly vulnerable.

“We recognize that our most vulnerable children may not be in early care,” Marshall says.

Rhett Mabry, director of child care for The Duke Endowment, says the 30 years of clinical trials of the national nurse-family model have reported lower rates of child abuse and neglect, fewer emergency-room visits, better access to medical care and better birth outcomes.

The Duke Endowment’s investment in the pilot program reflects the desire of its board that its health-care and child-care divisions continue to look for ways to work together more effectively and achieve greater impact, Mabry says.

The board also has decided that the foundation should aim to “pay out” 5.5 percent of its assets each year, compared to the 5 percent payout required by federal law, a decision that will increase by roughly $15 million a year the grants the foundation makes, Mabry says.

The foundation wants to target those additional dollars to “signature programs that have the opportunity to have an impact on the families targeted,” he says.

John Frank, director of the health care division at the Kate B. Reynolds Charitable Trust, says the initiative’s emphasis on prevention is critical and will include pre-natal care, parenting skills, and preparing children for school, as well as a focus on the entire family.

“It’s all encompassing,” he says.

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