Building Maternal Strength in Deep-Poverty Neighborhoods

What if the once-in-a-lifetime experience of becoming a new mother opened up a world of opportunity for women and their babies?

Photo of Katherine Kinsey
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

The Philadelphia Nurse-Family Partnership and the Mabel Morris Family Home Visit Program serve families in some of the most distressed neighborhoods in the United States. Research has shown that pregnant women and new mothers are uniquely open to receiving advice and making positive changes during this transformative period of their lives. Public health nurses, using an evidence-based approach, work with mothers to set goals and establish positive patterns that resonate for decades beyond the initial visit.

Our team of public health nurses encourages women to see their own strengths and become the best mothers they can be. In our experience working with thousands of vulnerable women (especially teen mothers), we have found that many lack confidence in their abilities because they have been told repeatedly – by family members, boyfriends, teachers, social service providers and others – that they are unworthy. Working with their nurse, many young mothers break multi-generational patterns of abuse and set goals for themselves for the first time.

Over the past decade, we have seen mothers enter our programs with increasingly acute needs. The vast majority of our clients live in neighborhoods with decaying housing, widespread crime, and high school dropout rates as high as 50%. More and more pregnant women come to us in crisis. Our nurses knew that we needed to find a way to address the root causes of family instability, insecurity and stress in our community.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Website

http://www.facebook.com/Philadelphia-Nurse-Family-Partnership-320983022000
http://www.nncc.us/program-center/improving-health-through-early-action

Location: Where is your organization headquartered? [State]

  • Pennsylvania

Location: Where is your organization headquartered? [City]

Philadelphia

Location: Where is your project primarily creating impact? [State]

  • Pennsylvania

Location: Where is your project primarily creating impact? [City]

Philadelphia

Problem: What problem is this project trying to address?

It is hard to overstate the challenges faced by the families we serve. Our clients’ average annual income is under $6,000. Two of the top zip codes served by our program have child poverty rates higher than 60%.

Over 90% – nearly all – of the mothers we serve have experienced three or more Adverse Childhood Experiences (ACEs). ACEs are strongly associated with physical and mental health disorders throughout a person’s life. Nearly half of the mothers we serve show symptoms of perinatal depression. The infant mortality rate for Philadelphia far surpasses that of comparable cities like Chicago, Los Angeles and New York.

Families in deep-poverty communities face a multitude of personal, social, and systemic challenges. What resources, we wondered, would be most likely to enhance our public health nursing approach and make a real difference in the lives of mothers and babies?

Evidence-based nurse home visiting services – including the Nurse-Family Partnership and Parents As Teachers programs – are at the heart of our work to promote children's well-being. And why not? They are among the most well-researched and compelling anti-poverty programs in the United States. Each client receives between 30-50 visits from their nurse over the course of the program. Nurses educate and coach new mothers on a healthy pregnancy and delivery; the baby's good health and development; and the mother’s vision and goals for the future. Over time, a unique and trusting relationship evolves between mother and nurse.

What’s unique about our approach is that in addition to home visits, we also provide integrated services that enable families to live healthier lives. We have developed new approaches that go beyond the core home visiting curriculum to better meet the complex needs of families living in deep poverty.

Our solution holistically addresses the conditions of poverty that interfere with parent-child bonds and stunt child development.

Beginning in 2014, the following innovations have been embedded in our public health nursing team’s daily work:

  • The interdisciplinary Nursing-Legal Partnership ensures that pregnant women and new mothers have the opportunity to raise their children in safe, healthy homes, with uninterrupted access to health insurance coverage and other benefits. Two legal aid attorneys – located on-site, 5 days a week – now collaborate with public health nurses to identify and address unmet legal needs that harm maternal-child health and well-being. Nurses and lawyers also work together to pursue policy issues impacting the health of families living in poverty.
  • Our clients have significant unmet mental health needs but often fail to follow through with referrals. Our Mental Health Assessment and Counseling pilot initiative brings a certified therapist to meet with new mothers in the privacy of their homes, and build bridges to more intensive services in the community. Having earned their trust over time, home visiting nurses are able to link new mothers to mental health services and reiterate the importance of seeking professional counseling in the weeks and months surrounding childbirth.
  • Our Breastfeeding Project has dramatically increased the availability of professional and peer lactation support services, resulting in improved breastfeeding initiation and duration rates. It also built our team’s long-term capacity to meet mothers' breastfeeding needs going forward by preparing 14 staff nurses to become IBCLC-certified lactation consultants. Nurses and lactation consultants also work with on-site Nursing-Legal Partnership lawyers to ensure that high schools, colleges and workplaces in our community support the needs of breastfeeding mothers.


When our team works together across professional boundarieswe can more effectively address the negative impacts of poverty on children and families.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Low-income communities

Does your model work within any of the following sectors?

  • Child and Family Services
  • Education
  • Mental Health
  • Other

If you chose "other," please share the sector you work within here:

Public Interest Law (Civil Legal Aid)

Year Founded

2001

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

A first-time mother had a significant history of trauma and mental health issues. Over time, she developed a trusting relationship with her home visiting nurse. Although her nurse repeatedly referred her to therapists, she never followed through. Over the course of multiple conversations with her nurse, it became clear that prior bad experiences had made her skeptical of mental health care. As her nurse put it, “Therapy didn’t feel very therapeutic to her.” Our licensed therapist visited the mother at home to assess her needs, find an appropriate provider, and accompany her to the first visit. She now receives therapy through a program for trauma survivors. The overall result is a healthier family and stronger maternal-child bonds.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

In 2015, our public health nurses educated and supported more than 700 mothers. Our team has also guided nearly 50 moms with perinatal depression and other mental health issues to therapy. We have provided over 3,000 one-on-one breastfeeding support sessions and nearly 90% of our clients breastfed their babies immediately after birth.

In the next three years, our interdisciplinary team of nurses, lawyers, therapists and lactation consultants will:
• Provide evidence-based parental education and support to more than 2,000 mothers
• Provide free legal services to at least 300 mothers
• Link at least 200 mothers to professional mental health therapy services
• Provide breastfeeding support services to at least 500 new mothers
• Advocate for policy changes to support maternal-child health, safe housing, family stability and economic well-being for low-income women and babies

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $1mil - $5mil

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

In addition to providing direct services, we are also working to develop a sustainable financial model for integrated parenting support and holistic wraparound services for very young children. With this goal in mind, we work with professional evaluators to measure our impact on family health and well-being in a variety of domains, as well as return on investment. We also advocate for sustainable payment streams to scale our solution.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

We have envisioned a nurse-driven way to link and coordinate a variety of health, social and support services to meet the diverse needs of the families we serve. Because of nursing’s emphasis on holistic, preventative care, nurses naturally operate at the intersection of health and social services. No other maternal-child home visiting program site in the country has taken such a proactive approach to bringing complementary mental health, legal aid, and other services on-site to meet the needs of mothers and babies living in deep poverty.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

I always share the reflection that public health nursing is "part of my DNA." Public health nurses have always been leaders on issues of health equity, beginning with Lillian Wald in the 1800s. I’m heartened to find that others are beginning to share a vision for a more holistic health and social services system. When we break down the walls between health care, education, and social services, we can change the entire trajectory of both mothers’ and babies’ lives. The truth is that prevention and public health should be in everyone’s DNA! What we do today is our legacy for tomorrow’s families.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Twitter
  • Email
  • Word of mouth

Program Design Clarity

The evidence-based Nurse-Family Partnership and Parents As Teachers curricula frame our core services. We serve low-income mothers and young children in Philadelphia. What's special about our approach is that we also partner with lawyers, therapists, lactation consultants and others to offer integrated services to better address the root causes of poor health and family instability. While health centers and hospitals have made recent strides to integrate mental health and legal services, it is unprecedented to bring these services into families’ homes through nurse home visiting programs.

Community Leadership

We hear and value family voices. Our Nursing-Legal Partnership was a catalyst for our recent #MyCommunityMyVoice event. Nurses, lawyers, public health staff and volunteers created a venue for parents to share goals and describe the changes they wish to see in their communities. All families received a professional portrait session, which served as an incentive and celebrated parent-child bonds. Client interviews will be shared with policymakers.

Age of Children Impacted

  • Pregnancy - 0
  • 0-1.5
  • 1.5 -3
  • 3 - 5

Spread Strategies

Nurse-Family Partnership and Parents As Teachers have nationwide reach via hundreds of local implementation sites. Our strategy capitalizes on this existing network. We will provide trainings and technical assistance that are uniquely relevant to a home visiting context. We also collect data to build an evidence-base for our holistic approach and pursue policy reforms (including sustainable financing) to enable the spread of integrated services.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

Every day, our team sees evidence that low-income women are capable and engaged parents, defying all-too-common stereotypes. By educating and coaching women to set goals for themselves and their children, we enable powerful maternal-child bonds that set children on a path to success. The child knows that he or she is loved unconditionally, parents are empowered to become their child’s first and best teacher, and families are more resilient.

Leadership Story

As public health nurses, we are always learning and growing. We also have the ability to see the power of practical interventions -- both "the forest" and "the trees"! Although our work focuses on changing lives one-by-one, we always trust that it will have a major impact on the future. Recently, we took on the challenge of consolidating nursing staff scattered throughout the city into one office. It was a practical effort to bring our team to one site in North Philadelphia, but it has paid real dividends in quality improvement and staff engagement, which means better outcomes for children.

What awards or honors has the project received? (Optional)

We are the largest countywide maternal-child home visiting program in Pennsylvania. We have received "exemplary status" recognition by the Commonwealth of Pennsylvania's performance review team every year since the review program was launched, indicating excellent outcomes and model fidelity.

Organization's Twitter Handle

@NFPPhilly

Organization’s Facebook Page (URL)

https://www.facebook.com/Philadelphia-Nurse-Family-Partnership-320983022000

Leader's LinkedIn Profile (URL)

https://www.linkedin.com/in/kay-kinsey-a5793310

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Team

We need more programs like this! Great job for the work you do! Keep it up.

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