New Mexico Foundation Places Nurses in Family Service Agencies to Improve Immunization Rates, Reduce Parental Smoking and Screen Parents for Alcohol Abuse
In 2001, the New Mexico Community Foundation placed nurses in eight family service agencies to increase child immunization rates and refer families for tobacco and alcohol addiction treatment.
- Immunization rates improved among children aged 1935 months at seven of the eight agencies, with four exceeding the 90 percent target.
- Health screenings identified 70 parents as smokers who received services in the six agencies that participated for the full length of the project, and 20 percent of these reported a decrease in tobacco use during the project.
- The six agencies that participated for the full length of the project screened anywhere from 76 to 100 percent of parents for alcohol use, and referred 26 people (from 356 families) for help with drinking problems.
RWJF provided a grant in the amount of $460,000 to fund this project from August 2001 through July 2005.
New Mexico's rural families face challenges of poverty, violence, substance abuse and scarce services, according to the project director. The children of rural New Mexico are particularly vulnerable to the cumulative effects of these problems, putting them at risk for chronic physical and mental health problems.
According to a 1999 Kids Count report, more than 40 percent of the state's families with young children live in poverty and 22 percent are uninsured. These statistics worsen in the state's isolated rural areas, where Latino and Native American populations comprise 60 percent of the total population. Rural areas lack accessible preventive health care, such as immunizations for children and alcohol and tobacco abuse assessment and treatment services for their parents.
The Centers for Disease Control and Prevention (CDC) conducted a 1998 United States National Immunization Survey which found that New Mexico's overall immunization rate was 71.1 percent for children 1935 months of age, which was below the national rate of 79.2 percent. A 1995 statewide study of tobacco and alcohol use among women seeking pregnancy testing showed that 41.6 percent of the women had smoked tobacco and 39 percent had used alcohol in the last month.
To address some of these pressing needs of rural communities, the New Mexico Community Foundation and the McCune Charitable Foundation established the Strengthening New Mexico Families initiative. This statewide initiative funds programs that provide high-risk rural families with a wide range of early childhood development services.
Staff and board members from the Strengthening New Mexico Families programs met quarterly in "learning circles," a peer learning process, to share best practices and technical assistance. Discussions in the learning circles revealed that the initiative could not confront the challenges of child development in rural families without simultaneously addressing their health care needs.
In 1987, the RWJF Board of Trustees authorized $8 million to fund a two-year trial of a matching grants program to be called the Local Funding Partnerships.. Many matching grants programs set up by national foundations seek to replicate ideas formulated by the national institution itself.
Local Funding Partnerships was to be different. The local community would identify a pressing need, design the strategy for addressing it and put together a funding package that would provide at least one dollar of outside support for every one dollar of RWJF grant money. Each project would have one lead local funder, but additional supporters would be welcomed.
To be eligible, a project would have to fall within the general scope of RWJF's interest in health and health care. But a proposal would not have to meet the kind of specific criteria common to other RWJF programs. Instead of top-down, Local Funding Partnerships would be bottom-up with an emphasis on innovation. RWJF hoped this local "ownership" would ensure sufficient support to keep the project going long after the RWJF grant ended.
The Strengthening New Mexico Families Community Health Nursing Project sought to address child development and health care needs of New Mexico's rural families by placing nurses in eight family service agencies (see the Appendix for a list of the agencies) in predominantly Latino and Native American communities. The project's specific health objectives were to:
- Increase immunization rates in children 1935 months of age to at least 90 percent.
- Reduce harm caused by alcohol and tobacco through education, assessment and referral services. The project set as a specific benchmark that 20 percent of parents who smoke would reduce their tobacco use.
The nurses at each agency:
- Provided and tracked childhood immunizations.
- Referred families to medical and social services.
- Provided families with health education.
- Conducted assessments for alcohol and tobacco use and referred parents to appropriate cessation services.
- Developed relationships within the agencies and communities where they worked and with the families they served.
During the grant, the New Mexico Community Foundation replaced two agencies due to high staff turnover and lack of administrative support for the project within the agencies. See the Appendix for details.
The New Mexico Community Foundation hired Louise Kahn, R.N., M.S.N., M.A., a certified pediatric nurse practitioner and RWJ Executive Nurse Fellow as the program coordinator. Kahn supervised the nurses at the agencies and held quarterly learning circles, at which the nurse and one other staff member from each agency networked and learned about relevant topics.
The two-day learning circle sessions focused on a wide variety of family and women's health education topics, drawing from local experts in health care, child development, mental health and substance abuse issues. They allowed the nurses and agency staff to discuss concerns, provide mutual support and seek assistance and advice from the program coordinator.
Kahn also developed a health history form and an "action plan" form for the nurses to use in each agency.
The McCune Charitable Foundation ($250,000), the Daniels Fund ($250,000), the New Cycle Foundation ($70,000) and the New Mexico Community Foundation ($47,428) provided matching funds to support this project.
The New Mexico Community Foundation also granted $344,669 to the agencies participating in the Community Health Nursing Project to provide direct assistance to clients for emergency needs and hardships through its "Anonymous Fund," and $115,500 to the participating agencies to augment their programs and services through its "Donor Advised" fund.
The New Mexico Community Foundation subcontracted with an evaluator, Marah Cain Moore, M.C.R.P., of Community and Family Services in El Prado, N.M., to conduct an evaluation of the project. The evaluator worked with the project coordinator on data collection, analysis, interpretation and reporting. They examined:
- Nurse contact logs.
- Immunization data collected from the agencies.
- Client charts at each agency to assess the use of the health history forms, smoking and alcohol interventions and health education.
- Learning circle evaluations.
The evaluator conducted annual site visits to each agency, interviewing the nurse and other staff. She also conducted telephone interviews at the end of the project with nurses, agency heads and local health providers who worked with the agencies.
Community and Family Services produced a report for the New Mexico Community Foundation, Strengthening New Mexico Families Community Health Nursing Project: Final Evaluation Report. (See the Bibliography for details.) The report noted the following results for the project:
- Immunization rates improved among children aged 1935 months at seven of the eight agencies, with four exceeding the 90 percent target. The exception was an agency that had joined the project less than a year before it ended. All eight agencies showed an improvement in immunization rates when all children under than age 6 were counted.
- Health screenings identified 70 parents as smokers who received services in the six agencies that participated for the full length of the project; 20 percent of these reported a decrease in tobacco use during the project. One agency, Jardin de los Ninos, was responsible for most of the reduction in tobacco use, and the evaluators attributed that success to a nurse who excelled at working on smoking cessation.
- The six agencies that participated for the full length of the project screened anywhere from 76 to 100 percent of parents for alcohol use, and referred 26 people (from 356 families) for help with drinking problems. Most of the referrals came from a single agency, the Gathering Place.
The evaluator identified a series of systemic changes brought about by this project.
- The nursing project helped enhance the agencies' focus on families.
- The agencies that did not offer any health services prior to the grant reported that the nurse's work on meeting families' health needs allowed other agency staff to do their work more effectively.
- Because the nurse was able to "get the families talking," the entire staff could develop a deeper understanding of each child's environment and better meet each family's needs.
- The nurses helped to increase the visibility of the agencies within the community, making referrals easier and improving families' access to care.
- As the nurses became part of the team, the agencies were able to address health issues in an integrated and seamless manner.
- Because they saw the nurses as professionals with medical expertise, families, agency staff members and other providers of services accepted recommendations and information from the agencies more readily.
- All but one agency (the Child & Family Resource Department of San Juan College), which joined late in the project) have institutionalized the use of data collection tools such as a family health history and report that these forms have made their jobs easier.
- Align the vision of the project with that of each agency participating in the project. This project had to replace two agencies originally selected to participate because of such differences. Engaging each agency in formal conversations regarding its understanding and vision of the project can ensure that it shares the vision of the funded project. (Project Director)
- Target a broad range of staff in training efforts. The learning circles held during the grant included two people from each agency. The learning circles would have been more effective if additional agency staff could have attended. (Project Director)
AFTER THE GRANT
Most of the agencies sustained the nursing position by utilizing various funding sources. The New Mexico Community Foundation provided two agencies, Jardin de los Ninos and the Columbus Day Care Center, with grants to augment the Community Health Nursing project.
GRANT DETAILS & CONTACT INFORMATION
Community Health Nursing Program for Low-Income, Rural Children
New Mexico Community Foundation (Santa Fe, NM)
Dates: August 2001 to July 2005
The New Mexico Community Foundation originally selected eight agencies to participate in the project:
Las Cumbres Learning Services provides community-based services throughout Los Alamos, Rio Arriba and Santa Fe counties to adults and children with developmental disabilities or delays.
Little Feet Child Development Center is a preschool child-care program serving children 6 weeks to 5 years of age in the Sky Mesa and Bluff View Public Housing Projects on the Navajo Reservation in northwest New Mexico.
PB&J Family Services is a child development/home visiting team that serves rural Sandoval County, in Northern New Mexico's "Checkerboard Area," one of the most isolated and under-served areas of the Navajo Reservation. PB&J provides child development and family support services to teen mothers who are trying to graduate from high school.
Cuindando los Ninos provides child care and therapeutic services that meet the special needs of homeless children, and support services that assist homeless families in becoming re-housed and self-sufficient.
Community Services Center is a home visiting outreach program serving young and/or expectant parents among rural families of Roosevelt County in the Eastern plains of New Mexico.
Jardin de los Ninos provides family-centered child care for children ages 6 weeks to 10 years who are homeless or near homeless and provides assistance to their families in finding and using community resources to enable them to work, finish school or pursue training.
Ben Archer Health Center sponsors a community outreach project utilizing lay family service workers (promotoras) to serve young families with children in Luna County on the Mexican border in Southwestern New Mexico.
The community foundation later replaced two agencies, the Little Feet Child Development Center and the Ben Archer Health Center, with other agencies:
Columbus Child Development Center, a program of the Colonias Development Council, aims to provide quality early childhood education while also creating jobs and professional development opportunities for its employees within the small rural/border community of Columbus, N.M. The council comprises nine community organizations in the colonias (communities located within 150 miles of the U.S.-Mexico border that lack decent housing, potable water, wastewater/drainage systems and/or improved roads) in and adjacent to Dona Ana County in Southern New Mexico.
San Juan College Foundation received the grant for the Child & Family Resource Department of San Juan College, which supports families throughout San Juan County.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Strengthening New Mexico Families Community Health Nursing Project: Final Evaluation Report. New Mexico: Community and Family Services, Inc., 2005.
Report prepared by: Barbara Matacera Barr
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Jane Isaacs Lowe