By, Allie Semperger
Published April 2014: Michigan Nightlight
Vulnerable first-time mothers are raising healthy kids with the help of visiting nurses in Detroit.
Picking the perfect color for the baby’s nursery and registering at Babies “R” Us are unthinkable luxuries for some soon-to-be parents. In fact, many pregnant, first-time mothers in Detroit have much more urgent concerns: lack of money, an unstable family life, feelings of isolation, no car, and little education, just to name a few.
Nurse-Family Partnership reaches out to vulnerable first-time mothers and empowers them to succeed through a distinctive, evidence-based program that sustains the health and well-being of parents and children for years to come.
While many nursing outreach programs are driven by information or curriculum, Nurse-Family Partnership is unique because it focuses primarily on forming trusting, therapeutic relationships between registered nurse home visitors and first-time mothers. “It’s an empowerment-based model rather than enabling model,” NFP Nurse Supervisor Angie Chiodo says. The program aims to help mothers learn to help themselves and access the information and resources that they need.
NFP clients are paired with a specific nurse in order to develop a close and consistent relationship. Nurses can have up to 25 families in their caseload and see about three clients per day. The nurses visit their patients every week or every other week for the first two years of the children’s lives. According to Chiodo, NFP extensively prepares patients for this graduation and even continues contact as needed with their nurses, to connect the patients with any necessary support.
Each home visit involves careful preparation, planning customized to the client, and charting by the NFP nurses. In forming relationships with their clients, the nurses provide the mothers with important information and resources about health-related behaviors, child development, and economic self-sufficiency (including continuing education and finding employment).
The visits have an intentional structure, but can be as flexible as needed to address the major concerns in the client’s life. “Nurses have the freedom to scratch anything they’re supposed to do and just listen,” Chiodo says.
The flexibility, as well as the consistency and frequency of the visits, contribute to the success of the program. NFP recognizes that the mother is an expert on her own life; nurses use techniques such as motivational interviewing to show, not tell, the mothers that they already know the correct answers to caring for themselves and their children.
Father involvement varies, case by case; some fathers may be involved but are not necessarily in relationships with the mothers. Also, while some clients have very caring families (“Grandmas are big cheerleaders of our program,” Chiodo says), others face unstable home environments and inconsistent support.
Isolation is common in the community, and NFP nurse visitors are sometimes the only consistent supportive presence in the mother’s life. Although professional boundaries are maintained, the nurses become integrated in the lives of the families.
To further help combat the pervasive isolation, NFP holds events periodically, including community baby showers and a riverfront walking group. Although most mothers are eager to participate in events, many are unable to attend due to lack of transportation.
NFP nurses love their clients, and the feeling is mutual. During feedback visits, clients fill out forms about their experiences. Chiodo says that the reports from the families are positive.
Chiodo has a background in public health and also works as a certified nurse-midwife, the equivalent of a Nurse Practitioner, which adheres to the philosophy that childbirth is an inherently normal – not bad or pathological – process. She was working at a hospital as a nurse-midwife when her supervisor approached her about helping to start the program, which officially began in August of 2012 and is run out of the Detroit Wayne County Health Authority. The first graduation event of NFP clients will take place in December of 2014.
The program is funded by the W.K. Kellogg Foundation and the state of Michigan with significant support from healthcare providers that recognize the importance of the evidence-based program. Nurse-Family Partnership has two main referral partners: Wayne State University Physician Group Nurse-Midwives and Henry Ford New Center One.
The program has been a team effort that includes the funders, the nurses, and many community partners, such as the Black Mothers Breastfeeding Association and the Focus: HOPE HealthConnect One program.
Nurse-Family Partnership is more necessary than ever for the well-being of the Detroit community. A recent The Detroit News investigation found that the infant mortality rate in Detroit is the worst among big U.S. cities and worse than some Third-World countries.
“The biggest issue is Detroit has a lot more poverty and chronic stress, institutional racism, [and] all the social determinants of health care are impacting infant mortality,” Chiodo says. She acknowledges that other U.S. cities suffer from these circumstances as well, but the struggle in Detroit is especially challenging.