Client story – Nely.
As Holly Poole scans the file of her newest client, Nely, she looks carefully for any red flags. Drug use? The report says no. Drinking? Another no. Holly feels some relief, but when she scans further, she sees it: red flag number one. Newly pregnant Nely is just 14 years old.
Driving through the outskirts of Philadelphia to Nely's home, Holly is concerned but optimistic. After seven years with Nurse-Family Partnership, she has a laser focus on goals for each young client: a healthy pregnancy and delivery, and development into a confident young woman with plans for her future.
Holly knows that guiding Nely through her pregnancy and the first two years of motherhood will be only part of her assignment. She must also acknowledge that Nely will deal with pressures about continuing her education, relationships with boys, self-image, and a host of other issues relevant to young teens. Holly wonders how Nely will handle these issues while also facing the stresses of pregnancy and motherhood.
At this first meeting, Nely sits quietly at the kitchen table. She is young and looks it, with her hair pulled back into a ponytail. It is clear from her downcast eyes and silence that she is shy. Terrified may be a better word.
During their 90-minute introductory meeting, Holly does most of the talking, asking questions to get a fix on Nely's health, family structure, relationships and interest in schoolwork.
Nely sits next to her mother, who works six days a week at a big-box store and had to request time off – no small thing – to attend this meeting. She was upset about the pregnancy at first, seeing it as another mouth to feed, but seems to have come around a bit. Nely has questions swirling in her head and Holly seems easy to talk to, so she decides she wants Holly to be her nurse home visitor. Nely promises to abide by the program's rules, such as "I will always call in advance to cancel any meetings I can't attend." Her relationship with Holly is now official.
Every other week, Holly and Nely meet for one hour, usually at the same kitchen table. In addition to discussing each stage of pregnancy, Holly focuses immediate attention on Nely's plans, especially for her education. "What do you want to do after you have the baby?" Holly asks.
"He wants me to drop out of school," Nely responds, talking about her boyfriend, the baby's father.
"Okay…" says Holly, "But what do you
want?" trying to help Nely's focus on her own desires and needs – her heart's desires. She knows that even a small step is significant. Her question prompts the discussion Holly frequently has with her young clients about careers and education options. She hopes Nely can envision a plan for her life beyond being a teenage mom. Holly asks gently, "If things don't work out with your boyfriend, how might you support the baby? What kind of job would you be able to get?"
Nely is hesitant, so Holly continues, "Sometimes we don't find out right away what we want to do. We just start someplace and get things going." Nely mentions that she likes playing with kids like her nephew. Bingo, thinks Holly, a place to start. Knowing that full-time school is of little interest to Nely, she introduces Nely to the possibility of vocational-technical school in a child development career. Nely decides to enroll after giving birth to her baby.
Although the father of the baby never attends Holly and Nely's meetings, his presence is felt. He is older than Nely and controlling. During one visit, he calls 20 times over the course of an hour. This is when Holly introduces Nely to the "cycle of abuse." She explains the concept of emotional abuse, prompting Nely to open up. "He says that no man will want me because I have a baby with him," Nely confides. "He wants me to drop out of school because I'm not that smart anyway." She even admits that he has hit her on occasion. "But I never thought of it as abuse," says Nely. "He always apologized afterwards." Holly focuses many subsequent sessions on strategies for building Nely's self-esteem while learning how to communicate with her baby's father even when his comments are negative and hurtful.
While Nely's self-confidence is building, she is simultaneously preparing for motherhood. As it turns out, Nely is something of a natural. She begins to come out of her shell and is eager to learn everything she can. She is so eager, in fact, that Holly begins to jokingly call the beginning of their meetings "the attack."
"I have so much to tell you!" Nely exclaims the moment Holly walks through the door for a meeting during her third trimester. "The baby is always moving! And I have a new pain. Is it a contraction?" Holly is thrilled that Nely has become the one asking the questions. The two discuss labor and delivery – Nely's biggest fear – frequently. "Is it as bad as it looks on TV?" Nely asks.
Their discussion moves from labor and delivery to nutrition and care for the baby after birth. As the hour comes to a close, Holly shares one more tidbit. "Did you know that the baby can hear you when you talk? When your baby is born it will recognize your voice." Nely stares at Holly with wide, amazed eyes. A spontaneous smile bursts onto her young face. Moments like this are the best part of Holly's job.
Almost a year later, Holly and Nely are still meeting regularly at Nely's mother's house. Now, when Nely greets Holly at the door, she is carrying Bryanna, her nine-month-old daughter. Bryanna is a healthy, happy baby. She is shy like her mom but possesses the same wide-eyed smile.
Holly is pleased with Bryanna's development and growth, but even more so with Nely's. She is now in the tenth grade at a vocational technical program in early childhood development. She has ended her relationship with the baby's father, although he still visits the baby occasionally. She's even stepped out of her shell to have some fun, attending a recent school dance with friends.
Holly's work is not done– the two will continue meeting until Bryanna is two years old. There are no guarantees that Nely will stay in school and maintain her growing self-esteem. But for now, it's clear that the red flags in Nely's life have transformed into green lights. With the help of Holly Poole and the Nurse-Family Partnership, Nely is on the path to becoming a successful mother, a high school graduate, and a strong, confident woman.
This Nurse-Family Partnership program is implemented through the Chester County Health Department in Pennsylvania.
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