Nurse Family Partnership upends pattern of abuse

By Matthew Hamilton

September 12, 2009 /  thenewsstar.com

Kalisha Carroll, a first-time mother at the age of 22, dreaded the thought of someone sticking a needle into her 6-week-old son Kaiden Gayfield.

“If you have ever seen a baby with whooping cough or measles, you’d regret not doing it,” Duhaney said.

Since Carroll was in her 28th week of pregnancy, Duhaney has been visiting her living room in Delhi, taking height and weight measurements of Kaiden Gayfield, telling Carroll about immunization shots, baby colic, nutrition, hygiene, sleep deprivation and the countless other trials of a young mother and her first child.

The visit is part of the Nurse Family Partnership, an ongoing effort where nurses work with first-time, low-income mothers to ensure their health and the health of their children. Child advocates in Louisiana say the program helps to rein in a pattern of abuse that threatens the state’s children, but the program itself has recently had to fend off funding shortages that threaten its existence.

The origins of the Nurse-Family Partnership date back more than 30 years ago when researchers began sending nurses into family’s homes in Elmira, N.Y. Memphis and Denver. While collecting data and using the same standards that the Food and Drug Administration uses for testing new drugs, the researchers found families who welcomed nurses into their homes were 48 percent less likely to suffer child abuse or neglect and 59 percent less likely to have children arrested 15 years after the last visit.

Christy Champman, supervisor of the NFP team at the Ouachita Parish Health Unit, said the program’s health education helps prevent mild illnesses turn into serious conditions, especially in rural areas like northeastern Louisiana where clinics and hospitals are far from home.

The initial success of the program prompted states to adopt similar efforts, and in some cases define the progam’s limits. South Carolina and Hawaii both replaced licensed nurses with social workers, only to watch the programs fail to meet NFP’s first success rate. Other attempts to rapidly expand the program appeared to water down its efficacy.

Louisiana’s version adopts the original plan of sending a licensed nurse to periodically visit a willing family from the 28th week of pregnancy to the second month after birth. Since the program’s inception in 1999, 876 families have participated in northeastern Louisiana. part of the 8,717 participating families in the entire state.

Linda Gavioli, the executive director of the Children’s Coalition of Northeast Louisiana, has mentioned NFP as one of the programs helping to stem a rising tide of child abuse in the state.

A report by the Louisiana Partnership for Children and Families, a child advocacy organization, claims the number of children in Louisiana under age 6 driven to foster care because of abuse has increased by 81 percent since 2001. In 2006 and 2007, the state saw the largest increase, with 1,841 removed from their home, an average of five children every day.

Jackie Perkins, who oversees Ouachita Parish’s Office of Community Services, part of the state’s Department of Social Services, said 201 children were removed from their homes in Ouachita Parish in 2007, compared to 107 in 2003. She also has said NFP holds promise in decreasing child abuse and cases of children in imminent danger.

The program itself was in danger during the last budget session, when the state Office of Administration was considering a cut of $2 million from the Nurse Family Partnership. In the end the program was able to retain its funding through the combination of a Title X block grant through the Office of Public Health’s Maternal and Child Health program, Temporary Assistance for Needy Families and funds through Medicaid. But the program may face future budget threats with both federal and state governments decreasing their Medicaid dollars to Louisiana.

For now the program remains in place, much to Carroll’s gratitude. Duhaney said the new mother was an avid reader who pores over every health pamphlet she gets.
“Without it I’d be lost,” Carroll said.

Since the age of 12, when her brother died, Carroll has suffered bouts of depression. Postpartum depression hit her hard.
“The first couple of weeks he cried, and then I cried,” Carroll said. “To know that that’s normal, and what to expect, it means so much.”
As the visits have helped Carroll navigate the first nervous years of motherhood, the visits also seem to have an effect on the nurses. Chapman and Duhaney said they find the living room more fulfilling than the emergency room.
“In the hospital, your job is to get them well and get them out,” Duhaney said. “This job is not for everyone, but it’s rewarding in that I get to be a part of another person’s life and had a hand in having them do what they want to do.”