Boise area now has a program where low-income new moms ‘take a nurse home with you’

Eliza Shabire is 26 years old. She is a Rwandan refugee who settled in Boise in 2020, with much of her family also settled in Boise. She is a college student and works a retail job. Her husband is awaiting legal approval to join Eliza in the U.S.

His immigration process took on a new sense of urgency when, last year, Eliza learned she was pregnant.

On top of work and school, Eliza entered 2023 with a growing belly and the unique side effects of pregnancy. As she approached her third trimester, Eliza had family support — from her father and stepmom and her sisters with whom she shares an apartment in southwest Boise.

But she needed more help. So, her physician referred her to the local Nurse-Family Partnership program. Eliza became one of the first clients of the program, run by the Central District Health regional public health department.

The program draws from decades of similar partnerships across the U.S. It is meant to help new mothers for up to 1,000 days — through the pregnancy and the child’s first two years.

“They were there for me when I needed them, and I didn’t have someone to answer a lot of questions that I had,” Eliza said. “And you know, the doctor’s appointment is only 15, 20 minutes and they’re checking on you, but they don’t get that time to go in deep with each and every question.”

Twenty-two clients were enrolled in the program as of last week, according to Liann Somerville, program manager of the CDH Nurse-Family Partnership. That was up from 15 clients just a few weeks ago. The program has two visiting nurses, but Somerville is working on a third nurse position to expand the program’s reach to Elmore County.

The program can accommodate up to 25 families per nurse.

Eliza made it in just under the wire — one day before she would’ve been too far along in her pregnancy to qualify.

Heather Poetoehena is the nurse home visitor assigned to Eliza’s case.

Heather spent time at Eliza’s apartment every week or two during the pregnancy and in those life-changing first months after the birth of her baby.

One nurse, matched to several families, yields $6 on every $1 invested

“Home visiting” programs have evidence to back up their value. As Idaho Voices for Children Director Christine Tiddens told the Child Protection Legislative Oversight Committee in 2019, parents who receive home-visiting services tend to have healthier children with better outcomes.

The programs lower the risk of a child ending up in foster care, and the families tend to fare better — needing less public assistance over time, and experiencing less domestic violence and crime.

Studies that compared families who did, or didn’t, receive nurse-family partnership home visits found the following, according to the national Nurse-Family Partnership National Service Office:

• 48% less child abuse and neglect
• 56% fewer ER visits for accidents and poisonings
• 50% reduction in language delays by toddler age
• 67% reduction in behavioral and intellectual difficulties by age 6
• 82% increase in months of parental employment
• 61% fewer arrests of the mother
• 59% fewer arrests of the child at age 15

There’s also some evidence that families in the program have lower rates of obesity, higher rates of breastfeeding and immunizations, fewer premature babies and healthier pregnancies.

According to a 2005 study by national think tank RAND Corp., the partnerships delivered about $5.70 in economic benefit for every dollar spent. (That is now higher, according to a 2015 study that pegged the economic impact at about $6.70 for each $1 spent.)

The most striking benefit was among high-risk families, where about $7,300 to support a nurse-family partnership was found to save nearly $33,000 in government spending that would have occurred without the partnership there to set up families for better health, social and educational outcomes. But even among families at low risk of poor outcomes, the programs delivered about $1.26 for every $1 invested, the RAND study found.

Nurse-family partnerships have been around for decades.

Idaho first gave them a try in North Idaho, where the Panhandle Health District launched its nurse-family partnership in 2012.

Southwest District Health, serving the western Treasure Valley, opened its program in 2015.

Central District Health was the latest to create a nurse-family partnership, last year.

But limited funding means only a small fraction of Idaho families receive the services.

About 4.7% of eligible children are served by Early Head Start, and about 540 families in Idaho receive home visiting through other federal grant-funded programs, according to a 2021 report by the First Five Years Fund, an early childhood advocacy organization.

The Central District Health department’s board last year approved an $18 million budget for this fiscal year that included $413,700 to launch the Nurse-Family Partnership.

With nurse-family partnership, ‘you can take a nurse home with you’

Somerville, who leads the program for the health department, spent much of her career in postpartum hospital care, at the bedside of new parents.

She learned of the nurse-family partnership concept while she was in nursing school, almost a decade ago — while doing an assignment for a community and public health class, she said.

“I watched a video of a nurse, ‘a day in the life’ or something. I honestly was glued to my screen, thinking this is the coolest job I have ever heard of, and I want to do this,” she said in an interview with the Idaho Capital Sun.

It was always in the back of her mind as a dream job, she said.

“Having worked in postpartum, sending home these parents that … (you have a feeling) they are going to need so much more help, and you’re sending them home after that 24- or 48-hour stay,” Somerville said. “You’d even get parents joking, ‘Can I just take you home?’ Literally, with this program, you can. You can take a nurse home with you.”

Somerville is a mother of three. When she graduated from nursing school, she had two young children.

“It’s really important to me to help these moms and show them what they can accomplish — even as single mothers, young mothers, experiencing whatever adversity” has come their way, she said. “I can’t even imagine how different my life would look if I hadn’t been able to go back to school and graduate with a degree in nursing. But, I had a village, you know? I had family that was able to help support me.”

Many of the expecting parents in the program do not have a solid support network.

Some are young, single soon-to-be mothers with few financial resources.

They might have substance use disorders, mental health challenges, unstable housing or relationships. Some of them have “pretty complex other medical issues that make their pregnancies more difficult,” Somerville said.

Getting ready for baby to arrive

Heather spent up to an hour a week in the family room of Eliza’s apartment, watching and listening, asking questions and giving Eliza the time to ask all those questions that seem to vanish from memory the moment you walk into the doctor’s office.

Heather noticed that Eliza seemed nervous about emotions after the birth; so, the nurse gave Eliza some information on “baby blues” and postpartum depression — and advice on how her sisters could help protect Eliza’s mental health, too.

Heather shifted gears to the practical stuff: what Eliza might still need as she entered parenthood. Was she already signed up for Medicaid? Had she chosen a pediatrician? Did she still need to enroll in the WIC program that helps ensure nutrition for Women, Infants and Children?

Heather answered an even longer list of questions from Eliza, who knew her life was about to change in ways she couldn’t predict.

Eliza gave birth to her daughter, Mina, in mid-February at a local hospital.

Her husband was still in immigration limbo, so he couldn’t be there for the birth.

Eliza was in labor for almost two days, she said.

“It was really hard, and I was scared, and I almost (gave) up. I was mad,” she said. The hospital nurses would tell her not to give up. “You’re almost there!” they would say.

“And when they told me it’s time to push, I was like, ‘I am going to push you,’” she said, laughing.

‘I just didn’t know where to go, or who to ask’

One of the first people to meet the baby was Heather.

The nurse showed up at Eliza’s apartment with suitcases of medical equipment and activities in tow — a kind of Nurse-Family Partnership welcome wagon.

As a first-time parent, Eliza had common questions:

• Was she producing enough milk for Mina?
• Was the baby’s poop the right color?
• Are patches of thin hair normal?
• How to keep Mina from spitting up in her crib after eating? (The answer: cradle the baby upright for a while after she eats, instead of laying her down right away.)
• Was there cash assistance available to get them through until she could return to work?
• How do you know when to switch to a larger diaper size?
• How can you tell if a baby is too hot or too cold?

And Heather had questions for Eliza:

• Did she have pain anywhere?
• Any bleeding? Fevers?
• How much sleep were she and Mina getting?
• Did the baby’s Medicaid card arrive?
• Did Eliza need help with paying hospital bills?
• Did she feel safe in her relationships?
• Had she begun reading to the baby?
• What was her plan for child care?

Eliza had a hard time asserting herself — when strangers asked to touch her baby, for example, she felt timid about saying no.

Heather gave her a confidence boost — pointing out that, even when Eliza was in the hospital right after delivery, she asserted her desire to be the sole source of food for her baby, telling the nurses there to bring Mina to her to eat, instead of giving the baby donated breastmilk or formula.

Eliza mentioned a pain in one of her calves. Heather jumped into nurse mode, asking questions and looking to assess whether Eliza might have a blood clot — a dangerous complication of pregnancy and postpartum. (She didn’t. But Heather recommended bringing it up with her doctor.)

The program exemplifies one of the challenges Eliza hadn’t expected as a new mom.

She prides herself on independence. But as a pregnant person and, now, as the mother of a newborn, Eliza had a new challenge: to get comfortable with asking for help.

“It’s a good program. Especially for moms, new mamas, and for those who are new in America — because when, maybe for you guys, you will have a lot of friends and know a lot of organizations and know where to go to ask for help,” Eliza said as she held Mina on a March afternoon.

“But for me, I just didn’t know where to go, or who to ask,” Eliza said. “But now I can say (to Heather), ‘Oh, do you know someone with food assistance?’ and then she will send me like 15” people to contact.