NYC Nurse-Family Partnership

Westchester Children’s Association 2009 Advocacy Breakfast

March 27, 2009

Deborah L. Kaplan, PA, MPHAssistant Commissioner

Bureau of Maternal, Infant and Reproductive HealthNYC Department of Health and Mental Hygiene

NYC DOHMH Program Implementation

Strategy• Implement programs that are:

–Evidence-based/proven to work –Highly structured , program evaluation–Scalable –Sustainable

• Nurse-Family Partnership “fits the bill”– DOHMH implemented NFP as key public health strategy to improve maternal and child health outcomes in NYC–From the start, a vision of citywide scale-up

NYC Nurse-Family Partnership

Expansion 2003-Present• July 2003 – DOHMH launched demonstration site

in Jamaica East, Queens to serve 100 families

• 2004-2007 - Contracted with outside agencies to serve families in Harlem, Central Brooklyn and South Bronx

• 2006 – Developed special team of DOHMH nurses – Targeted Citywide Initiative - to serve mothers in foster care, shelters & Riker’s Island

• January 2008 – Expanded NFP services to all 5 boroughs to serve 1,500 more families

• Special team of 8 DOHMH nurses

• Serves vulnerable, first-time mothers in:

– Foster care (teens)

– Homeless shelters

– Riker’s Island

• Lower caseload (15 clients/nurse) as nurses follow clients as they move from borough to borough

• Works closely with Administration for Children’s Services, Dept. of the Homeless and Riker’s

NYC Nurse-Family PartnershipTargeted Citywide Initiative

(TCI)

NYC NFP is a partnership between the DOHMH & other Implementing

Agencies throughout NYC

Harlem HospitalPublic Health Solutions

Richmond Home Need ServicesSCO Family of Services

The Brooklyn Hospital CenterVisiting Nurse Service of New York

NYC NFP Expansion:Nurses Serving Clients 2006-2008

33

58

97.4

0

20

40

60

80

100

120

Dec 06 Dec 07 Dec 08

# N

urs

es

Serv

ing

Clients

NYC NFP Expansion:Active Clients 2006-2008

415

891

1,717

0

200400

600

800

10001200

1400

16001800

2000

Dec 06 Dec 07 Dec 08

# Act

ive

Clien

ts

NYC Nurse-Family Partnership

February 2009• 1,844 clients

citywide• 97.4 nurse home

visitors• 9 sites across NYC• 13 teams of nurses

- soon to be 19 teams

NYC NFP: the largest urban NFP site in the

country!

BMIRH Role: NYC NFP Implementation, Program Fidelity,

Expansion and Sustainability

• Direct Program Provision • Partnership with National NFP to Assure Program

Fidelity• Site Selection• Staff Training/Professional Development• Technical Assistance & Staff Support• Program Monitoring – assure consistency and quality• Citywide Program Coordination• Link to Public Health System• Evaluation• Secure Public and Private Funding

NYC NFP Client Demographics at Intake

NYC NFP Implementation Report Data through 12/31/08

• Median age: 20• Primary language - 69.3% English, 22.6% Spanish• Race/ethnicity

– 42.5% - Hispanic/Latina– 41.7% - Black/African American– 6.7% - Multiracial/Other– 4.3% - Asian/Pacific Islander– 3.9% - White Non-Hispanic

• 85.48% - Unmarried• 54.1% - With HS Diploma or GED• 34.4% - Enrolled in school• 73.4% - Unemployed• $13,500 - Median household income

Positive Program Outcomes in NYC NFP

Preliminary Outcomes:• Subsequent Pregnancy• Breastfeeding• Workforce Participation• Immunizations

Cumulative Percent of Women with Subsequent Pregnancy

6 Months & 18 Months PostpartumNew York City NFP vs. US

3

19

13

27

0

10

20

30

40

50

6 Months 18 Months

Cu

mu

lati

ve

Pe

rce

nt

NYC NFP

US

Source: US: CDC 2006 Pregnancy Nutrition Surveillance System (PNSS); NYC: Nurse-Family Partnership (NFP) Data through 12/30/2008

PRELIMINARY DATA RESULTS

8986

74

HP 2010 75%

0

10

20

30

40

50

60

70

80

90

100

NYC NFP NYC US

Pe

rce

nt

Breastfeeding Initiation Rate, NYC NFP, NYC and US

Source: NYC NFP: Nurse-Family Partnership Data through 12/30/2008; NYC: First time births on Medicaid from PRAMS, 2006; US: National Immunization Service (NIS), 2004

PRELIMINARY DATA RESULTS

At 24 months, percent of NFP clients in workforce is 32% higher than at intake

3844 41

54

41

0

20

40

60

80

Intake 6 Months 12 Months 18 Months 24 Months

Pe

rce

nt

Source: Nurse-Family Partnership (NFP) Data through 12/30/2008

Percent Workforce Participation:

PRELIMINARY DATA RESULTS

At 24 Months Percent of NYC NFP Infants Up-to-Date with Immunizations

Compared to Citywide

76

92

0

25

50

75

100

24 Months: NYC NFP 24 Months: NYC Estimate from CDC

Pe

rce

nt

Source: NYC: National Immunization Survey (NIS) 2007; http://www.cdc.gov/vaccines/stats-surv/nis/tables/07/tab09_24mo_iap.xls

NYC NFP: Nurse-Family Partnership Data through 12/30/08

PRELIMINARY DATA RESULTS

NYC NFP Public Funding Update

Medicaid

• State Plan Amendment to feds – April 09

• LHCSA application approved for DOHMH Jan 09

• Time Study completed in Dec 08

COPS

• Lobby Day

• Email blast

• Site Advocacy

– Client thank you letters

– Postcard drive

Private Funding:Key Program

Enhancements• Nurse recruitment/retention activities

• Key NFP staff lines

• DVD libraries to all new teams

• Certified Lactation Counselor Training

• Client retention projects: milestone markers

• Heart’s Desire Scholarship Fund

• Waiting Room DVD – English version completed 1/09 - now available on DOHMH website.

• NFP Advocacy Day in Albany – 2/09

• Comic Book – Estimated print date 4/09

• Citywide NFP Advisory Board – Planning 1st meeting for 4/09

• Client Success Stories Newsletter – Estimated print date 5/09

• Public-Private Ventures publication of client stories

Outreach Efforts are Key

NFP Expansion Challenges

• Recruiting and retaining nurses

• Building city-wide awareness of NFP for client enrollment/retention

• Developing effective avenues for automatic referrals

• Ensuring fidelity to NFP model in context of rapid scale-up

• Coordination with other community-based programs

Lessons Learned

• Public-private partnership

• Use data to inform program and advocacy

• Recruit pregnant women as early as possible

• Develop and maintain strong relationships with referral sources

• Use media opportunities to build awareness about your program

• Build strong relationships at all levels – community, city and state

• Target interests of targeted agency/group - child abuse, criminal justice, etc

Lessons Learned

• Use creativity and a personal approach to nurse recruitment

• Recognize and show appreciation for nurses’ work; provide ongoing staff development

• Expect expansion challenges to happen. Plan extra time for each step

• Provide a thorough introduction to all partners & agree on expectations early on

• Be focused and relentless!!

A Quote from an NYC NFP Mom

“I foresee a better future for me and my daughter from the NFP program because they have helped me see the importance of staying in school and focusing on the future. First I will go finish school. I should get my high school diploma by June this year and then go for my RN.”