Shawn Vestal: A bigger Nurse-Family Partnership would be a Christmas miracle for Spokane

If we had a wish for one big gift for Spokane this morning – something that would be a true gift to the health of the community long into the future – it would be for an expansion of the health district’s Nurse-Family Partnership.

That program pairs nurses with expectant moms facing poverty and other risk factors to help them have healthy kids and learn parenting skills. Decades of research indicate that among all the programs aimed at helping thwart the lifelong negative effects of poverty, this is among the most effective.

Across Washington state alone since 1999, nearly 11,000 families have been served by NFP programs. On key measures of well-being, the numbers are truly excellent: 91% of babies born at healthy weight; 95% of moms began breastfeeding; 92% received all immunizations by age 2; and, crucially, 57% of adult moms were employed when their child reached age 2.

The last figure is important because the NFP focuses on mothers as well as their children. As important as the program is for helping children get off to a healthy start in early life – those months and years that are so irrevocably important to human development – it gives skills to moms to live healthy lives themselves.

“We’re seeing healthy children being born, and we’re seeing these parents being able to successfully parent these children, which is exciting,” said Susan Schultz, program manager. “We have these young moms, many of them having had significant trauma in their lives, many of them never were parented effectively, and what they tell us is they want to learn to parent more effectively.”

A variety of research shows the program produces a range of long-lasting positive effects: One 2010 study showed that girls who were born in the program in Elmira, New York, were much less likely to have been arrested or convicted. A 2014 study covering two decades found significant drops in mortality for both children and mothers.

Researchers in 2015 projected the long-term effects of nurse-family partnership programs nationwide between 1996 and 2013, and they foresaw truly remarkable effects. In their article in the journal Prevention Science, they projected that by 2031 the program would prevent 500 infant deaths, 10,000 preterm births, 4,700 abortions and 42,000 “child maltreatment incidents.”

They forecast the program would prevent hundreds of thousands of crimes by youth, and spur dramatic reductions in drug use and smoking. The savings in social services spending were dramatic: $3 billion in reduced estimated spending on Medicaid, food stamps and cash assistance, at a cost for the NFP of $1.6 billion.

“Thus,” the authors conclude, “NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.”

Spokane’s program recently received a boost in state funding, allowing it to grow from six nurses to the equivalent of eight full-time nurses. That’s good news. It means 50 more families will get help, raising the total in the program to 200. The program is evolving, adopting a focus on opioid abuse and marijuana use, and expanding eligibility to include some families beyond strictly first-time mothers.

But the need in Spokane is great, and intergenerational poverty and its effects here are acute. Schultz says just 4% of the families who would qualify under the income guidelines receive help through the program. A statewide evaluation of risk factors showed Spokane County had more than 10,400 low-income births from 2013 to 2016.

When they ranked the accumulation of risk factors by school district, the Spokane area had six of the top 10.

So the recent expansion is good news. If there were some way to fund an even further expansion, though, it might be a Christmas miracle.

The program has struggled for stable funding since it was started at the health district in 2008. Initially, there were eight nurses serving 200 families; then state funding became more scarce and the program dropped to six nurses.

The recent boost returns it to the original eight nurses.

The district funds two positions with its county resources; state and federal dollars, and grant funding, cover the rest. The Affordable Care Act expanded federal money available for the program.

“Over the years we’ve had to explore different options to maintain the program,” Schultz said. “We apply for just about everything that comes down the pike. … We don’t always know from year to year how many positions we’ll have funding for.”

It’s good the program has grown again, and it’d be wonderful if it could grow more. It’s a gift to the people of the city.