June 1, 2004
Phone: (504) 865-5714
When a poor, teenage girl gets pregnant, it's depressingly easy to predict for her a future that includes underemployment and continued poverty, perhaps seasoned with domestic or child abuse or dependence on alcohol and drugs.
It's not so easy to figure out how to break that cycle or stop it before it starts. Paula Zeanah is the director of a Louisiana program that has had significant successes in helping poor, young, first-time mothers beat the odds.
Women who participate in Louisiana's Nurse-Family Partnership are 33 percent less likely than their peers to get pregnant again in the 14 months after their first delivery, 52 percent less likely to deliver prematurely, 44 percent less likely to have problems with drug and alcohol abuse, 50 percent less likely to take their child to an emergency room in the first 15 months and 46 percent less likely to be the victim of domestic abuse.
Nationally, participants have shown a 79 percent reduction in verified reports of child abuse and neglect over a 15-year period. Mothers are 83 percent more likely to be working by the child's fourth birthday and 69 percent less likely to be arrested over 15 years.
"We're having a positive effect on the things we want to have an effect on," said Zeanah, who is also an associate professor of psychiatry and neurology at Tulane. The Nurse-Family Partnership is an intensive, long-term program that sends nurses into the homes of poor, young, first-time mothers, usually for weekly or biweekly visits.
The visits began before the 28th week of pregnancy and continue until the child is 2 years old. "The program works because the nurses are able to develop trusting, collaborative relationships with their clients," said Zeanah.
The program has three major goals--to improve the mother's health and the outcome of the pregnancy, to teach parenting and child development skills, and to help mothers get their lives back on track by continuing their education or entering the workforce. It's open to women who qualify for Medicaid and are pregnant with their first child. Sixty percent of participants are under the age of 19 and almost all are unmarried. Participation is voluntary.
"Clients need to be self-motivated for this to work, but often it takes time for clients to even recognize what they want for themselves and their babies," Zeanah said.
Each nurse sees between 20 and 25 clients. Because the program is so labor intensive, it's expensive on the front end. But it's so successful that it pays for itself in four years and, according to an independent analysis conducted by the RAND Corp., eventually saves $4 for every dollar spent. Zeanah believes the effectiveness of the program is due to the right combination of elements.
One is the use of nurses instead of social workers--clients may be more interested in talking to nurses because nurses have knowledge that first-time mothers want. The program lasts long enough for real change to take place. The fact that visits take place in the home encourages the development of relationships.
The education and information offered addresses a wide range of needs and issues. And the program is tailored to each individual. Louisiana's Nurse-Family Partnership is 5 years old and is one of the largest. It's funded and run by the state Office of Public Health and currently serves 19 parishes in mostly rural and underserved areas around the state.
It is not yet in New Orleans, but Zeanah hopes to bring it here in the next two years. Eventually, the goal is to have the program available statewide. Tulane has been involved in Louisiana's program in several ways. The Department of Psychiatry's Institute for Infant and Early Childhood Mental Health has developed and conducted training in infant mental health for nurses and others involved. And Neil Boris, assistant professor of community health sciences, has conducted an evaluation of the program.
Tulane University, New Orleans, LA 70118 504-865-5000 firstname.lastname@example.org