April 2007 - Nationally, progress has been made in improving maternal and child health represented by reductions in infant mortality, teen pregnancy, and cases of child abuse and neglect. Overall, this advancement is also true for New York City as a whole; however, there are still communities where this progress has not yet been realized. In parts of Harlem, the percentage of babies born at a low birth weight is higher than the citywide rate. In areas of Brooklyn and Queens the infant mortality rate is almost twice as high as New York City as a whole. In Hunts Point, Brownsville, and East Harlem, there are twice as many reports of child abuse and neglect filed compared to New York City overall.

To address these pressing needs, the Nurse-Family Partnership (NFP) program was introduced into New York City in 2003 to improve the health and social opportunities for mothers and their babies. Piloted initially in Jamaica East, Queens and subsequently expanded to Brooklyn, Bronx, and Harlem, the program has been implemented in more than 270 communities in 22 states throughout the country. NFP is an evidence-based home visiting program that offers intensive clinical and social support for mothers and new babies over a two-year period. The program provides a foundation for health, well-being, and self-sufficiency for parents and their children.

NFP has demonstrated significant success in improving key indicators related to maternal and child health. Nationally, program outcomes indicate a 50% reduction in reported child abuse and neglect through the child's second birthday, a 35% reduction in emergency department visits overall and a 56% reduction in visits for accidents and poisonings, and a 50% reduction in language delays. The NFP model has also proven to be cost-effective; it is estimated that the cost-savings to society and government over the child's lifetime are at least four times greater than the cost of the program itself.

The New York City Department of Health and Mental Hygiene has overseen the expansion of NFP to more than one thousand families throughout the city and the Fund for Public Health in New York, Inc. has been a partner in that expansion. Mayor Bloomberg has endorsed NFP as a strategy to address child poverty and significant funding has been allocated to expand the program in targeted communities throughout the city over the next five years. The current wave of program expansion aims to reach 1,320 families by September 2007.

FPHNY spoke with NFP Nurse Susan Fisher, who is managing a caseload of 25 families in Brooklyn and reports that working with NFP is some of the most fulfilling work of her career.

Click here to read about the NFP program in NYC.

FPHNY: How did you develop an interest in the Nurse-Family Partnership program?

SF: "I have been a nurse for 32 years and have worked in a hospital for 23 years, mostly in obstetrics and pediatrics, and after my time in the hospital I did some private duty work. I then took some time and reflected on what I wanted to do with the rest of my career. After reading an article from a journal that advertised a program similar to the Nurse-Family Partnership (NFP) program, I became very interested in that line of work. I had been particularly interested in reducing child abuse and neglect while still being able to use my knowledge and training."

FPHNY: What would you say to a person who is considering a career in nursing?

SF: "If the person showed an interest, I would tell them that it's a great opportunity. There is a lot a person can do with a nursing degree, especially with a concentration in child and maternal health."

FPHNY: What do you feel is the best way to recruit mothers into the program and get them excited about the program?

SF: "Aside from word of mouth, I feel the best way to get mothers into the program would be to educate them ­ give people the opportunity to learn about the program and all it has to offer. Also, other healthcare providers have been and could continue to be very helpful in recruitment - social workers and nutritionists have given plenty of referrals so far."

FPHNY: What do you think is the most important element of the mother-child bond?

SF: "The mother's understanding of the importance of having a bond with her child and of how the bond occurs is most critical. For example, a mother should realize that breast feeding is not only about giving the child food, but also about bonding with the child, which in turn affects their physical and emotional development. Aspects such as these are what NFP nurses teach mothers."

FPHNY: What role do you see fathers playing and how can it be improved?

SF: "Currently, I see very few fathers involved and participating in the process. What roles the fathers have depends partially on what role models they have had in their lives, on how they were raised, and on what they are used to. Also, it partially depends on the client herself and if she insists on the father being a part of the pregnancy and baby's life, because many mothers too easily just accept the role of 'single parent'. This can be improved if the client insists on the father's participation - they would then have less of an excuse to be nonexistent in the child's life. NFP nurses encourage mothers to ask fathers to come and participate in the child's life."

FPHNY: What would you consider to be your greatest/most fulfilling moment thus far with an NFP client?

SF: "In general, seeing the mothers interacting with their babies - while they are both doing well mentally and physically - is most fulfilling to me."

FPHNY: What has been your biggest challenge thus far in doing your job?

SF: "My biggest challenge so far has been finding mothers housing and other needed resources. The main problem is that there are so many limitations including catchments, the mother's age, the mother's desire to be independent, and/or the mother's parents. Some parents, especially of young mothers, kick them out of the house and that causes a slew of others stresses and problems. Other parents, who allow the child to stay at home, often treat the mother harshly and that affects both the mother and child's physical and mental health."

FPHNY: Do you feel you make a real lasting difference in the lives of these women and their families?

SF: "It is hard for me to say one way or the other so early in the NYC process, but research has shown that the NFP program does in fact work and that NFP nurses leave a lasting impression on both the mothers and the children. However, I have been a witness to some progress - baby steps, but progress nonetheless. Some people that are currently in the program do say that the nurses make a difference."