Whatcom County Health Department's Nurse-Family Partnership Program Gains Momentum

The Whatcom County Health Department Nurse-Family Partnership Program had cause for celebration last week, welcoming the first baby born since the program began enrolling families in December.

The Nurse-Family Partnership program is a community health program that provides support and resources to low-income mothers in their first pregnancies with the goal of providing children the best start possible. Nurses begin providing home visits to mothers beginning around 28 weeks into the pregnancy and continuing through the child’s second birthday. The program aims to improve pregnancy health and outcomes, child health and development and help families become economically self-sufficient.

Whatcom County Health Department received a $175,000 grant last July from the state’s Home Visiting Services Account. Fueled by public and private dollars, the account funds evidence-based home visiting programs and is administered by the Department for Early Learning and Thrive By Five, a non-profit organization for early learning. Today, two nurses serve the 12 Whatcom County families enrolled.

“The nurse will provide information about potential healthy outcomes – what you would want to be working for – and really talk with family about what sparks their desire. ‘What do you want to grow in? What do you want to know more about? What is it that you want to do in order to provide the healthiest environment you can for your child?’” said Judy Ziels, a public health nursing supervisor at Whatcom County Health Department.

In addition to giving physical health assessments, nurses help families develop goals in areas ranging from physical and social environment to physical health, work and education plans or parenting skills. But parents run the show.

“A primary principle of Nurse-Family Partnership is we follow the client’s heart’s desire,” Ziels said. “Change always needs to be motivated from within, and yet there are parameters that the nurses come in with particular information or areas of interest within that, it’s always focusing on what the family wants to know about and what they want to achieve.”

Established in 1970, the Nurse-Family Partnership model has been adopted in 42 states and become renowned for its success in improving early education and health outcomes.

“If you look at the national studies about Nurse-Family Partnership, children are much less likely to need special education, they have much better health and education outcomes, they’re less likely to have childhood abuse and neglect in their family, they’re more likely to graduate from high school, they’re less likely to enter the juvenile justice system,” Ziels said. “It’s just working with the family to get things in place in order to help that child to the best that they can do in life.”

In an analysis of 20 early childhood programs by the RAND Corporation, a non-profit research organization, Nurse-Family Partnership was found to have returns of $5 for every dollar invested.

Working closely with Skagit County’s already well-established program, Whatcom County Health Department hopes to replicate those results. Skagit County’s nursing supervisor acts as a resource for Whatcom County’s two nurses, helping them reflect on cases and problem solve.

“If this is successful and we grow then we might one day become independent,” Ziels said. “But this has been a beautiful way to start up. It’s been much less expensive, we’re learning from their expertise.”

Thirteen Washington counties have Nurse-Family Partnership programs. State data collected between 2010 and 2011 shows that 91 percent of babies born to the program were born full-term with 93 percent at a healthy weight. It also shows a 21 percent reduction in smoking during pregnancy and 94 percent of mothers began breastfeeding.

“We know that we are generally a really healthy community, but there are pockets of vulnerability,” Ziels said. “Looking at the data, we know that one of those pockets is poverty across the board, but there’s some specific issues in Whatcom County.”

In 2010, 15 percent of Whatcom County’s population was living under the poverty line, roughly 3 percent higher than the state poverty rate. Of single mothers with children under 5 years old, 62.6 percent live below the poverty line.

“All of these are pockets that we know in Whatcom County are more likely to have poor health and education outcomes,” Ziels said.

Whatcom County has a higher rate of adult substance abuse treatment at 18 per 1,000 individuals than the state at 13 per 1,000. High rates of maternal depression are another concern. The health department reported that more than 25 percent of Maternity Support Services clients exhibit depressive symptoms.

Most clients currently enrolled in the program were referred through WIC or health care providers, Ziels said. “But the women that are probably most at risk are a little bit harder to reach. We want to be serving the families that most need it and not just the families that walk through our doors,” she said.  

Low-income Latina women are another priority population, Ziels said.

“Statistically speaking, those of Hispanic descent or immigrant populations have a higher risk of poor birth outcomes and pregnancy outcomes as well as less access to medical care,” said Erin Schuldt, a nurse with the program. “Hispanic and immigrant populations are also more prone to be living in poverty, which means poorer health and poorer access to medical care during pregnancy. So, it is an at risk population that we want to make sure we are serving.”

Reaching families can be the real challenge. By partnering with local organizations the health department hopes to do just that.

Community to Community Development, a non-profit Latino farmworker community organization, is one such partner. Working to empower under-represented people, C2C provides resources and education surrounding food justice and civil rights while building a sense of community.  

“We just started talking with some folks at the county health department about how we can start working together,” said Tara Villalba, an AmeriCorps volunteer and promotora, or community health educator, with C2C. “We’re still in the beginning stages.”

“We’re trying to figure out what [the program] can offer the folks that we work with and how we can use it in a culturally appropriate way,” Villalba said. “The members that we see, if they are coming in about health issues, they usually run into some sort of barrier whether they can’t communicate with health practitioners, don’t have access to services or the people offering the services are unfamiliar with the lives and backgrounds of Latino farmworkers. They might say or do things that are very insensitive or alienate the folks that come in here.”

Establishing trust between program employees and community members must come first.

“Folks take advantage of information coming from folks that they trust,” said Villalba. “That’s something C2C has developed over a long period of time. We also want to make sure that if we partner with somebody, that folks in the farmworker community can trust that we are not going to be part of law enforcement, unless they themselves want law enforcement to be involved. That they’re going to be able to advocate for themselves. That it’s not going to be a process that is going to run away from their control.”

Additionally, providing information in Spanish is necessary to serve many families.

“We primarily communicate with folks in Spanish. So whatever information there is has to available in Spanish,” Villalba said.

“All materials in the Nurse-Family Partnership program are bilingual, available in both English and Spanish,” said Schuldt who speaks Spanish. “The program is set up to be able to serve Spanish speaking clients.”

Whatcom’s program has the ability to serve 45 families. Ziels said the health department expects to reach that number sometime in early spring. If the program meets its goals, outlined in quarterly reports to the Home Visiting Services Account, funding will continue for the duration of the five-year grant.

“We’re starting up by seeing what the community need is, seeing our ability to support this program and definitely our long-term goal is to become independent, but we also want to make sure that the need is there and it makes sense and we’re able to sustain that,” Ziels said.