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Spokane, Washington  Est. May 19, 1883

Opinion

Jamie Tobias Neely: Nurse program worth imitating

Jamie Tobias Neely Staff writer

If there’s such a thing as “program envy,” I saw it flash in the eyes of the public health experts I interviewed last spring.

Last week the Spokane Regional Health District announced it will head up a $2.3 million program to help prevent child abuse and strengthen a core group of families at highest risk for poverty, school failure and crime. It will center on Spokane’s own version of a nationally recognized program, the Nurse-Family Partnership.

This struck me as amazing news because only a few months ago, while researching columns and editorials during the community’s “Our Kids: Our Business” child abuse prevention campaign, I heard public health officials and local social service leaders talk wistfully of this very program. The moment someone would mention the approach of University of Colorado pediatrics professor David Olds, her eyes would light up. And then quickly a flicker of discouragement would cloud her gaze.

Olds’ Nurse-Family Partnership was considered “the gold standard” for intervention programs, based on randomized controlled research trials which had demonstrated its effectiveness. Yet it was simply too expensive for Spokane’s tight budget.

Olds developed the program after he realized that interventions aimed at toddlers enrolled in inner-city day-care programs were already too late.

He began in 1977 in Elmira, N.Y., sending registered nurses into the homes of first-time, low-income moms until the child turned 2.

Olds followed the progress of these children over time. He discovered that by the age of 15, these children were 48 percent less likely than a control group to experience child abuse and neglect, 59 percent less likely to be arrested and 90 percent less likely to be found in need of court supervision for incorrigible behavior.

The mothers themselves experienced 61 percent fewer arrests, 72 percent fewer convictions and 98 percent fewer days in jail.

The results were astonishing, but Olds was a careful researcher and gradually expanded his research to make sure the program could be replicated and would be similarly effective in other communities. In 1996 the Nurse-Family Partnership was expanded to six sites throughout the country, and it’s now offered in more than 150 sites in 20 states.

That’s why the front page news last week of this new program struck me as such a victory. Much of the $2.3 million will pay for starting Spokane’s own Nurse-Family Partnership, named “Summer’s Project” for Summer Phelps, the 4-year-old whose tragic child abuse death last March helped drive this spring’s campaign.

Last spring, I talked with one of the country’s experts on the needs of young children, Dr. Jack Shonkoff, director of the Center on the Developing Child at Harvard University.

If he were designing Washington state’s programs for intervening with high-risk families, I asked, what one thing would he prescribe first?

Immediately, he described launching a program like the Nurse-Family Partnership.

“I would start at the youngest possible age in those very high-risk circumstances, because those are the kids in the most trouble and that’s where the greatest savings will be in the long run,” he said.

By the end of January or February, that’s exactly what the Spokane Regional Health District plans to do. Four nurses will be matched with poor women expecting their first baby. By the time the women are 26 weeks pregnant, the nurses will begin visiting their homes, following Olds’ highly structured curriculum until the child turns 2.

Olds told CBS’s Katie Couric recently that he believes the program works for two main reasons: It capitalizes on the human instinct to protect oneself and one’s children. It also employs nurses, the kind of role model mothers have been turning to since the beginning of time.

Here in Spokane, Washington State University researchers have watched the safety net for poor families erode in recent years as state and federal funds have been cut.

Finally, says WSU’s Chris Blodgett, this program provides solid promise for Spokane’s most vulnerable children and puts a new light in the eyes of its beleaguered service providers. Blodgett also believes it will be the catalyst for other efforts to come.

That couldn’t be any better news for a city where so many single mothers live in poverty. Its public health and social service workers deserve a chance to transform their pangs of program envy into the rewards of evidence-based action.