Tennessee Nurse Family Partnership Program Patti Vanhook, PhD, - PowerPoint PPT Presentation

Rural poverty-stricken first-time moms and BSN partnerships. The story of NE Tennessee Nurse Family Partnership Program Patti Vanhook, PhD, FNP-BC, FAAN Julie Hubbard, MSN, RN Annual Rural Health Association of Tennessee Meeting November 15, 2018 Music Road Convention Center Sevierville, TN

Disclosures • Dr. Vanhook, FNP-BC-nothing to disclose • Julie Hubbard, MSN, RN-nothing to disclose

Julie Hubbard, MSN, RN Patti Vanhook, PhD, FNP-BC, FAAN

Goal First-time moms living in poverty are at risk for staying in poverty. The Northeast Tennessee ETSU Nurse Family Partnership Program connects these moms with BSN prepared nurses who guide them through support and education to have better birth outcomes. How this is accomplished in NE Tennessee will be shared.

Objectives 1. Participants will compare the differences between urban and rural Nurse Family Partnership Programs 2. Participants will influence policy- makers to support NFP programs both urban and rural

Funding Information • • ETSU College of ETSU Community Outreach- Nursing-Nurse-Led Families First Clinics • 2-generation • Success in program approach development • Partnership • Partnership

Where are we? 8 Counties NE Tennessee 2897 sq. miles population 507,244 Hancock Co 30 residents/sq mi Johnson Co 60/sq mi

National Crisis? Teen Pregnancy?

Decline in teen pregnancy for US rural counties https://www.cdc.gov/teenpregnancy/about/index.htm

Teen Pregnancy NE Tennessee Per 1,000 70 60 50 42 40 30 20 20 19 20 17 10 0 2014 2015 2016 2017 Johnson Co Hancock Co. Hawkins Co. Hawkins Co Carter Co. Unicoi Co Greene Co. Washington Co. Sullivan Co STATE US Robert Woods Johnson County Health Rankings www.county healthrankings.org

Northeast Tennessee NFP Demographics • < 15 years old-5.3% • 15-17-year olds-21.1% • 18-19-year olds-21.1% • 20-24-year olds 36.8% • 25-29-year olds- 15.8%

Teenage Pregnancy 47.5%

NFP Barriers Communication Engagement Geographic Location Other Family Members

What Happened to You-The Impact of Adverse Childhood Experiences ACES

Adverse Childhood Experiences (ACEs) • Stressful/traumatic experiences 1. Abuse 2. Neglect 3. Household dysfunction including: mental illness, incarcerated relatives, mother treated violently, substance use, divorce, poverty, racisim, and bullying

The Impact of Adverse Childhood Experiences (ACEs) • Disrupts the nurturing environment • Is more common for those living in poverty • Can overcome the child's undeveloped coping mechanisms

The Results of Toxic Stress • Impact on brain architecture, biology, and gene expression • May disrupt brain architecture and impair executive functioning

Longterm Effects of Toxic Stress • Can lead to longterm impairment and illness-obesity, heart disease, cancer, depression, suicide, drug and alcohol abuse, high risk behaviors, and violence • Epigentic mark-changes gene expression by turning the gene on or off

# Patients to Mental Health Providers Northeast Tennessee Counties 9000 8070 To a single 8000 mental health provider! 7000 6000 5000 4000 3000 2000 780 1000 360 0 Johnson Carter Unicoi Hancock Hawkins Greene Washington Sullivan STATE US 2015 2016 2017 Robert Woods Johnson County Health Rankings www.county healthrankings.org

Northeast TN NFP Statistics • Mothers using mental health services 1. Intake-8.82% 2. Infant birth-5.19% 3. At 6 months-5.66% 4. At 12, 18, 24 months-0%

NAS 1,068 infants were diagnosed with neonatal abstinence syndrome in 2016 — more than any year prior. Blue Cross Blue Shield Tennesseehttps://bettertennessee.com/health-brief-neonatal-abstinence-syndrome/

Why is all this important? Blue Cross Blue Shield Tennesseehttps://bettertennessee.com/health-brief-neonatal-abstinence-syndrome/

Opportunity?

Lofty Goals • Eight Counties-NE Tennessee • Nine Nurses • 200 first-time moms Reality • 7 nurses • >100 moms • Rural counties-culture & distance matters

NFP Team % Food Stamps % Medicaid % WIC Le Bonheur 22.9% 83.3% 47.9% NE TN NFP 33.3% 75% 66.7% TN Total 25% 81.7% 51.7% National Total 26.6% 78.7% 67%

Attrition Pregnancy Infancy NFP Team % Total % % Moved %Unable NFP Team % Total % % Moved %Unable Attrition Miscarria from to Locate Attrition Miscarria from to Locate ge/Fetal Area ge/Fetal Area Death Death Le Bon- 8.3% 1.5% 0.44% 1.9% Le Bon- 32.4% 0.2% 3.9% 11.2% heur heur NET 6.6% 0% 0% 0% NET 44.4% 0% 11.1% 22.2% NFP NFP TN 8.1% 1.3% 0.4% 1.7% TN 32.6% 0.2% 4% 11.3% Nat’l 15.2% 1.2% 3.8% 3.1% Nat’l 33.1% 0.3% 7.8% 8.1%

Breastfeeding 88.2% Initiated at birth!

Success In Northeast Tennessee 36 Births Infant Gestational Age Pre-Term: (<37weeks) 4.69% Full-Term:(>/=37 weeks) 95.31% Breastfeeding Initiated: 88.2% National: 84.5% At 6 Months Continuing: 41.2% National: 33.7% Ages and Stages Questionnaire Completed at 4 months: 69.2%; National-55.6% 10 months: 100%; National-55.5% In need of further evaluation at 10 months: 0%; National-12.8%

Not just about pregnancy Homeless – 2 Bedroom Apartment Full-term Birth Initiated and Continues to Breast Feed Non-Smoking Meeting Milestones

Success  91% of NFP clients receive prenatal care in first trimester of pregnancy  80% reduction in smoking among NFP clients during pregnancy  Only 2% of NFP babies had an ER visit within their first 6 months of life  Between July 2017 and June 2018 preterm births were only 6.8% of all births in the NFP program, well below the state and national rates

Two-Generation Impact

Contact Information Julie Hubard, MSN, RN Patti Vanhook, PhD, APRN NFP Director NFP Administrator Northeast Tennessee Nurse- Associate Professor Family Partnership Program Associate Dean East Tennessee State Practice & Community University Partnerships Center for Community Outreach o: 423-439-7184 o: 423-439-6062 c: 423-306-5818(c) c: 423-900-3160 vanhook@etsu.edu HUBBARDJD@ETSU.EDU

References • About us (2018). Retrieved from https://www.nursefamilypartnership.org/about • Blue Cross Blue Shield Health Brief (2017). Retrieved Blue Cross Blue Shield Tennesseehttps://bettertennessee.com/health-brief-neonatal-abstinence-syndrome/ • Nurse-Family Partnership Outcomes (2018). Retrieved from https://www.nursefamilypartnership.org/wp-content/uploads/2018/08/Nurses- Mothers.pdf • Reproductive health: Teen pregnancy. (2017). Retrieved from Centers for Disease Control and Prevention https://www.cdc.gov/teenpregnancy/about/index.htm • Robert Woods Johnson County Health Rankings www.county healthrankings.org