State Senator proposes $100 million for Nurse Family Partnership (Capital New York)

By Dan Goldberg 

Eridiana Diaz offers a lot of parenting advice to her peers. The 22-year old Bronx mother of a 2 1/2-year old girl tells her friends about the most nutritious, kid-friendly foods, the best ways to care for an infant and the most productive ways to handle those terrible twos.

"Every parent, I tell, 'Don't do this, don't do that,'" she said.

Diaz is passing on lessons she learned from the Nurse Family Partnership program, which has shown success across the country in improving health outcomes for mothers and their children.

On Tuesday, State Senator Daniel Squadron will call for $100 million in new spending to fund the program for all Medicaid-eligible, first-time mothers.

“This doesn't just change lives,” said Squadron, a Democrat who represents parts of Manhattan and Brooklyn. “It also saves money, saves Medicaid dollars.”

Squadron plans to discuss the program at a forum Tuesday morning with the N.Y.U. School of Nursing and the Wagner School, as he tries to drum up public support.

The program is simple: A nurse works with a first-time mother during her pregnancy—discussing nutrition, offering support and preparing her for birth—and then during the child's first two years. The nurse answers questions, offers advice on topics from changing diapers, to breastfeeding, to practicing safe sex.

A 2012 cost-benefit study from the Washington State Institute for Public Policy estimated long-term benefits of almost $23,000 per participant in Nurse Family Partnership.

New York has funding for 2,800 mothers in the program, but Squadron said 40,000 could be eligible each year. If half of the eligible mothers participated, the state could save hundreds of millions of dollars.

That's a drop in the bucket for New York's $52 billion Medicaid program, but the societal value could be exponentially higher, Squadron said.

A study funded by the Pew Charitable Trusts estimated that social savings, which would include gains in work, wage and quality of life, would reach more than $85,000 per family, and estimated a $9.56 return on every $1 invested in the program.

In 2012, the National Institute on Drug Abuse looked at what happened to children 10 years after their mothers had finished the program, compared with a control group. At 12 years old, 1.7 percent of N.F.P. children reported having used cigarettes, alcohol or marijuana during the past 30 days compared to 5.1 percent in the control group. The N.F.P. children also reported less clinical or near-clinical anxiety and depression. Reading and math scores were also higher. Studies in Pediatrics and JAMA found the program reduces the number of unwanted pregnancies and increases the interval between pregnancies.

Diaz signed up while pregnant and was soon being counseled on nutrition and offered emotional support.

"I didn't know anything at all," she said. "It's not impossible to get you through something that you thought was going to be the end of the world."

Some of the advice she was given for her child differed from the way she was brought up. The nurse advised against solid foods too early because it increases the risk for obesity and high cholesterol.

Diaz was also advised to give her daughter, Hailey S. Mendez, a sippy-cup instead of a bottle.

“If you give a bottle for too long, there is a higher risk of teeth infection and their teeth can get all messed up,” Diaz said. “I wouldn't want my daughter to go through cavities or crooked teeth or just all these other things because I wanted to be lazy or didn't want to give her a cup at the proper age.”

One of N.F.P.'s most important stats is that it cuts in half the number of state-verified reports of abuse and neglect by the time the child is 14, according to a 1997 study published in JAMA.

Denise Alba-Rosario, a nurse supplied by the Visiting Nurse Service of New York, helped Diaz cope with Hailey's misbehavior, offering strategies like putting her in 'Time Out,' or calmly explaining why certain behavior isn't acceptable.

"It was completely different when I was younger,” Diaz said. “I would get my butt kicked.”

New York State provided $5 million in funding for the program in 2009 but cut that to $2 million in 2013, and the program was zeroed out of the state budget in 2014.

During budget hearings in March, the Cuomo administration said it had allocated additional funding for the Healthy Family program, a different pre- and post-natal visiting care program.

Healthy Family is important but different in scope than N.F.P., Squadron said.

Squadron is looking to use a pay-for-success model, or social impact bond, to raise the $100 million it will cost.

This model allows private companies to invest in the upfront cost and receive a return if the project saves the government money over the long-term.

The model was first used in 2012 by Mayor Michael Bloomberg, who encouraged private investment in therapy programs for teenagers on Rikers Island with the goal of reducing recidivism 10 percent by 2016. (The program was helped along because Bloomberg Philanthropies guaranteed the investment.) In 2013, Governor Andrew Cuomo announced a similar program, which will run through 2017.

For this to work, however, Squadron will have to convince his legislative colleagues to allocate $100 million into the budget so investors are assured they will be paid back if the program is successful.

Squadron envisions a five- to seven-year time frame for the N.F.P. program.

“I want the budget officers setting up the contract to ensure we really are paying for savings along with social services experts to know we've really change lives,” he said. “If folks who participate in the program are having better outcomes … then you can, if you're careful, attribute the appropriate amount to the program.”

Tuesday's forum at N.Y.U. will include former lieutenant governor Richard Ravitch as well as representatives from Goldman Sachs and Social Finance Inc.