Maternal Support Program Pays Off for Moms, Kids, Hospital

A nurse CEO describes the "good investment" her hospital has made in a 20-year-old program that sends specially trained nurses into the homes of low-income women during pregnancy and early childhood.

The nurse CEO at Le Bonheur Children's Hospital in Memphis knows firsthand the power of nurses working in the community.

"There's a great deal of need with young mothers and their children suffering from lack of prenatal care," says Meri Armour, MSN/MBA, Le Bonheur Children's Hospital's president and CEO. "Every family should have a nurse in it, just to be the interpreter."

In the late 1980s, Memphis was one of the first cities to pilot the Nurse-Family Partnership, a program that sends specially trained nurses to visit low-income women in their homes during their first pregnancy and throughout the first two years of their children's lives.

When Armour stepped in as CEO in 2007, she wanted to bring the program to Le Bonheur Children's Hospital. It's been in place there since 2010.

"We think that is a good investment," Armour says. "If there are good moms, there will be good kids eventually. There will be a trickle-down effect."

The Nurse-Family Partnership at Le Bonheur is free to participants, who must be first-time, low-income, pre-natal mothers who reside in Memphis/Shelby County. It's funded by Le Bonheur and by a grant from the Tennessee Department of Health.

Here's how the program works: BSN-prepared nurses are sent to expecting and new moms' homes to fill in gaps in care and provide advice.

Whereas other moms might get this kind of information and support from their own families, friends, or extended support systems, the moms in the Nurse-Family Partnership program usually don't have this kind of network and support system. Many of them are teenagers.

The nurses, who each have a caseload of 25 families, are available 24/7 by phone to answer any questions and to provide council. The nurses also visit once a week, often going into rough neighborhoods, in order to connect with the mothers and families and provide regular guidance and education.

They teach the moms about everything from how to deal with a colicky baby to the importance of regular well-child visits. They're not homecare nurses, however. If a child is ill, the nurses will advise mothers to call the pediatrician or visit the ED.

Instead, they provide intimate advice, support, and mentoring until the child is two years old.

"These are children who would not get the best of care or the best parenting without this intense support," Armour says. "We are… the grandmother, mother, and support system" that these new and expecting moms don't have.

There have been numerous studies showing the success of the Nurse-Family Partnership, which, according to its website, is now in 43 states, the U.S. Virgin Islands and six tribal communities.

The latest study, which was published online July 7 in JAMA Pediatrics, looked at 20 years of the program in Memphis. It found that the Nurse-Family Partnership produced a reduction in preventable child death from birth until age 20.

Children in the control group who didn't receive nurse-home visits had a mortality rate of 1.6% for preventable causes, such as sudden infant death syndrome, unintentional injuries, and homicide, whereas there were zero preventable deaths among nurse-visited children.

The program reduced maternal deaths, too: Mothers who didn't receive nurse-home visits were eight times more likely to die of external causes, such as unintentional injuries, suicide, drug overdose, and homicide, than nurse-visited mothers.

Armour says that since she, herself, is a nurse, she understands the importance of having nurses in the community. They're trusted and knowledgeable and often easier and less intimidating to talk with than even a pediatrician. It's a perspective that she's brought with her in her role as CEO.

"I think when you have a nurse at the helm… I think I see things differently sometimes," she says. "I'm a huge believer that we need to help every child every time."

Although the job is tough—and, Armour admits, doesn't pay all that well—Le Bonheur's Nurse-Family Partnership nurses are extremely dedicated to their families. They receive training and support; know that their own safety comes first (security or police are available to help them in unsafe situations); and love what they do. They get satisfaction when they see the difference they're making in lives every day.

"That's why they like their jobs so much, and why they do it for less money, and are willing to drive into bad neighborhoods," Armour says. "Every month that a child passes their well child visit is good."