Our actions support our intentions
and we are consistently listening,
learning, growing and evolving.
Annual Report 2021
A Letter to Our Community
I think we can all agree that 2020 was a year of immense change and bold adaptation. I am so proud of the families we serve for their resilience and in awe of our frontline providers and local partners for their bravery and service in such difficult times. As we reflect upon our response to the pandemic, we carry these lessons forward as we look to the future.
And looking to the future was exactly the theme of 2021. It has been a year of growth, development and innovation. We've expanded to best serve more families in need with a greater continuum of care as the National Service Office for Nurse-Family Partnership and Child First (NSO).
Throughout this Impact Report, you'll learn how we're doing this strategically, in deep partnership with many key stakeholders, with equity at the forefront, and always with the outcomes for children, families and communities at the heart of what we do.
We cannot wait to share more about:
- Bringing another evidence-based program Child First under our umbrella
- Expanding our impact to reach more families
- Learning, growing and thoughtfully meeting the needs of the families we serve
Rounding the corner from last year's pivots and stabilization into this year's growth and innovation took the support of each and every one of you. From our donors to our local partners and affiliates, to our bipartisan supporters helping shape policy, to every single nurse and clinician working with the resilient families we serve. Without you, our progress would be impossible.
This publication is dedicated to your unwavering commitment to address systemic inequities head-on, promote health and human support systems for families, help break intergenerational cycles of poverty and build a solid foundation to propel community change forward.
Thank you, and I am so excited to join the entire National Service Office team in sharing the story of a year of growth and forward momentum.
President and CEO
Impact at a Glance
NUMBER OF FAMILIES SERVED
NUMBER OF NURSE HOME VISITORS AND NURSE SUPERVISORS
TOTAL COMPLETED VISITS
PERCENT OF VISITS PROVIDED VIA TELEHEALTH
(TELEHEALTH INCLUDES VIDEO AND PHONE CONTACTS)
TOTAL NUMBER OF NETWORK PARTNERS AT THE END OF THE YEAR.
NEW NETWORK PARTNERS
NUMBER OF FAMILIES SERVED
NUMBER OF NEWLY ADMITTED FAMILIES
NUMBER OF CONTACTS WITH FAMILIES
PERCENT OF CONTACTS PROVIDED VIA TELEHEALTH
(TELEHEALTH INCLUDES VIDEO AND PHONE CONTACTS)
NUMBER OF CHILD FIRST STAFF
Our Commitment to Equity
Organization-Wide Work to Address Inclusivity, Diversity, Equity and Anti-Oppression
While serving families with dignity and equity is an NSO guiding value, this year we've taken an even closer look at how we can be more intentional about Inclusivity, Diversity, Equity and Anti-Oppression (IDEA) at every level of our organization. Our commitment to this work ensures that we listen intently to those we serve and continuously commit to honesty and vulnerability in addressing areas where we can improve.
In 2021, we:
- Dove deeply into understanding the role NFP can play in preventing maternal mortality, particularly for Black women and birthing parents.
- Invited feedback from families through a satisfaction survey, including questions on equity, racism and social isolation.
- Issued a national policy brief focused on addressing racial disparities in maternal and child health through home visiting.
- Adopted an organizational standard for the use of strength-based and inclusive language.
- Evaluated our data to remove any bias - in partnership with experts in the field We All Count.
- Hired the organization's first Chief Equity Officer - welcome Renea Banks.
Striving to Prevent Maternal Deaths and Improve Maternal Health Outcomes
Each year, roughly 700 women die from pregnancy-related conditions nationally. Maternal mortality disproportionately affects Black women, those with lower socioeconomic status and those living in communities where cyclical systemic racism and inequities persist.
The NSO formed a Maternal Mortality Task Force in 2019 to better understand this important matter and its root causes. The goal is to prevent maternal mortality and morbidity among NFP clients - a very rare occurrence - by offering health care providers case analysis, support and guidance to help all moms and babies not only survive but thrive during pregnancy and the postpartum period.
Learning from the Diverse Communities We Serve
The families we serve are the experts in their lives and their unique cultures. That is why the NSO is committed to listening to and learning directly from these communities.
One example is our close work with American Indian and Alaska Native (AIAN) leaders in tribally operated health care systems to promote equity and eliminate disparities for families served on tribal lands. This relationship has invited AIAN communities to guide how we embrace cultural knowledge in program delivery and care.
The insights gained from this partnership inspired our Expanded Eligibility Initiative, encouraging flexibility around program eligibility that respects traditions and norms while responding to emerging or pressing needs.
Child First: A Year of Growth
Growing Our Comprehensive Services and Expanding Our Continuum of Care
Child First is an evidence-based, two-generation model providing intensive, mental health home visiting services. It partners with families to help build stronger relationships between caregivers and children to protect and heal from trauma and stress.
Challenges often experienced by the families and where Child First has demonstrated impact include:
- High levels of stress, PTSD and depression among caregivers
- Deficits in social and communications skills and behavioral problems among children
Since coming under the NSO banner in 2020, Child First has seen growth in its reach including new markets and - most importantly - continued positive impact on families.
Together, we will continue to deliver tailored programming and work to scale Child First for the benefit of families.
Tauna, Child First Provider Story
"This is and will continue to grow as such a fierce partnership. To think that Child First and Nurse-Family Partnership can share knowledge and best practice across both nursing and trauma-informed social work and care - families will benefit and this entire ecosystem will be stronger."
― Tauna Baker, Senior Mental Health and Developmental Clinician, Child First Program
Tauna Baker is from the Center for Child Counseling in Palm Beach County, Florida. CFCC has been an implementer of the Child First model since its inception in PBC over seven years ago. Throughout her 20-year career in child and family services, she's seen a spectrum of interventions, including foster care, child welfare and the separation of family units.
"At times in child welfare, it was a challenge to feel that we were coming in once the barriers had already become too much for a family to manage - that we were intervening once things had progressed too far, rather than offering supports that lift a family up before challenges become insurmountable."
That's one reason why Child First resonates so deeply with Tauna. She has seen, both with her own eyes and through evidence, the power of supporting a family with the tools, resources and counseling needed to heal and retain the family unit before a more disruptive intervention is needed.
Like Nurse-Family Partnership, "the Child First approach truly taps into and believes in each family's innate resilience and strength. With Child First, the relationship between the family members and the clinician IS the intervention. Healing comes first. The trust and belief conveyed over time drive the treatment, and that drives the positive outcomes."
Since Child First joined the NSO alongside Nurse-Family Partnership in 2020, Tauna has seen the potential for the two programs to aggregate strengths, share learnings and support one another in distinct but complementary fields.
"As nurses and social workers, our domains are specialized and unique. But the thought that our partnership under the NSO will allow us to exchange knowledge, best practice, support and encouragement for one another - even if we aren't treating the same families or patients at the same time - is just incredible."
Working toward a future where multiple disciplines of support - nursing, social work, trauma-informed care and other practices - are integrated is the end goal in Tauna's mind.
"It feels so holistic to hold all of these lenses. It feels like together, we can do even more for the communities we serve. We're in for a really great journey together."
Expanded Eligibility Initiative
Expanded Eligibility Could Mean Serving Even More At-Risk Families and Children
In alignment with our commitment to health equity, economic mobility and working to eliminate disparities, we are seeking ways to expand our Nurse-Family Partnership programs - without compromising quality or outcomes - to serve more families and children in the communities of greatest need. To achieve this goal, we're excited to be launching a ten-year expanded eligibility initiative and clinical trial.
Currently, NFP eligibility criteria include:
- First-time parents
- Enrollment prior to the 28th week of pregnancy
Expanded Eligibility will include:
- Clients who have had a previous live birth (multiparous women/families)
- Enrollment beyond the 28th week of pregnancy or at least one visit by an NFP nurse before the birth of their baby
We believe that additional families could benefit greatly from Nurse-Family Partnership. We see it as an imperative to respond to needs when possible and test our ability to serve a broader population of families facing adversity and risk for healthcare disparities.
We are eager to take this next step forward with the Expanded Eligibility Initiative and are grateful for supporters and partners like you who have helped make this work possible.
― Melissa - NFP Graduate and now a practicing Registered Nurse
Impact that Spans a Lifetime
The Long-Term and Dual Generation Impact of Our Work
When Melissa learned of an unexpected pregnancy at a young age, she was first connected with NFP. She celebrated that baby's 18th birthday last year with some mixed emotions.
"There's a piece of me that's having such a hard time sending her off into more independence. But one of the great lessons Nurse Pat taught me was to celebrate every milestone and moment. It was about so much more than being my dedicated nurse; it was truly teaching me to be kind to myself and to see the confidence and natural parenting tendencies that I already had inside of me."
That's not all Nurse Pat imparted to Melissa. She also showed her what compassionate, caring, judgment-free and reflective nursing was all about. So much so that Melissa is now a practicing Registered Nurse herself.
"Sometimes she had to deliver a firm message, but she did it so gracefully without ever being critical. That guidance, that respect, is built into the practice of nursing. It completely colored my parenting style and my nursing approach."
Melissa's story isn't unique. Longitudinal research shows that the Nurse-Family Partnership program, and the NSO umbrella, help promote dual-generational outcomes for many of the families enrolled. Improvements include significantly improved outcomes for teens, improved family economic self-sufficiency and an estimated $4,732 net government cost savings per family.
Melissa's daughter is about to earn her GED and has a job she loves. Melissa is convinced that perhaps more than the tools and resources the program gave her, the lifelong lessons of patience, compassion and trust have resonated most.
"I learned to follow my instincts, to learn if there was another way that fit me better as a parent. And now I see my daughter doing the same, making her choices as a young adult. And I'm able to bring those qualities to my own nursing approach as well."
Even all these years later, Melissa and Pat are still in touch. "That's the power of this program, the effect it can have on a family's life forever."
Creating a Culture of Wellness, Community and Support for Our Teams
For 20 years running, nursing has been identified as the most trusted profession through the Gallup poll. There are myriad reasons why and many of them augment our work for and with families who benefit from our partnership and services every year.
We believe we must care for our nurses and clinicians as they dedicate themselves to supporting the families they serve. The NSO has remained deeply committed to supporting our nursing and clinical colleagues during the COVID-19 pandemic. We understand how fatigue, burn-out and stress are causing nurses and clinicians across the healthcare settings to leave their beloved profession - underscoring the imperative to ensure the wellness of those delivering our programs is a top organizational priority.
The NSO has undertaken strategies to help address some of the stress felt by the nursing workforce over the past year including:
- An NFP specific page on Health Journeys, providing mindfulness exercises and sessions on demand
- A six-session NFP Live! (a monthly webinar event) Culture of Wellness Series with topics that include Restoration, Moral Distress, Trauma and Violence Informed Care in the Workplace, Courage, Care and Compassion and Ongoing Application in Practice
- Nurstory - a way for NFP nurses to process trauma and stress through reflective storytelling
These times have called for unprecedented strength and teamwork and our NFP nurses and Child First clinicians have risen to the challenge of staying connected with their teams and families. The NSO is proud to support them and provide the care they need.
The Virtual Learning Environment
Innovating to Create Community, Connection and Education
So many of us experienced the fatigue and loss of connection that came when the pandemic took our world virtual. It was especially difficult for frontline healthcare workers, who rely on relationships and in-person interactions both for their practice and for connection and learning.
Yet in 2021 that was our reality. So we gathered the best possible learnings and insights on what would work and launched our own custom-designed Virtual Learning Environments (VLEs).
The program was designed with intention and an eye for the best outcomes. VLEs are dynamic seminars with a strong emphasis on peer-to-peer learning, rather than recorded seminars with a single speaker, to maximize the opportunity for connection and communication.
"One priority is certainly to strengthen knowledge and skills, but the point of these sessions is also to light up the network with peer-to-peer learning and sharing," said Jane Pray, Director, Regional Nursing Practice, and a founding architect of the VLE program. A mix of diverse contributors, highly interactive sessions and individualized, dialogue-driven breakout sessions have made VLEs a hit.
― Melissa - NFP Graduate and now a practicing Registered Nurse
Advocacy and Legislation
The Value of Bipartisan Support and Thought Leadership
The NSO stewards both public and private investment in programs that work to ensure consistent return on investment and implementation with accountability. We work as a thought leader in system-building to ensure our services are proactive, preventative and offer support as early as possible, rather than reactive or corrective - a reality we know doesn't work for many families or for society.
In 2022, the NSO will be focused on advocating for the following policy priorities:
- Improve, protect and sustain funding streams that support our programs, namely advocating for the renewal of the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program.
- Advance equity and economic mobility for families and communities.
- Enhance health care accessibility, care coordination and primary care prevention, particularly for maternal/child health and mental health services.
- Support innovation to build a dynamic public health infrastructure and stronger workforce.
South Carolina Pay for Success
The South Carolina Pay for Success (PFS) program led the way in innovation by being the first project of its kind to focus on maternal and child health. It was also the first PFS project for Nurse-Family Partnership. The goal of the project was to rapidly grow NFP implementation in South Carolina through philanthropic investment and demonstrate outcomes to enable payment that would support program sustainability going forward.
The results of the project are not a reflection on the NFP model, but rather a highlight on implementation challenges and offers us an opportunity to leverage learnings and scale them for continuous improvement and replication across our entire network.
Stories of Support
Philanthropic investors launch Nurse-Family Partnership in Washington, D.C.
"We are excited to be working with both Nurse-Family Partnership and Mary's Center to bring this evidence-based, proven home visiting model to our Nation's capital. This partnership aligns well with the Foundation's goal to help make maternal and child healthcare accessible to young families in Washington, D.C. We recognize that the District grapples with a maternal healthcare desert. Still, Mary's Center's new Nurse-Family Partnership program will provide families with the compassionate, culturally competent, pre and post-natal care they deserve."
― Nancie Lynch, Executive Director
Richard E. and Nancy P. Marriott Foundation
Starting in 2021, Nurse-Family Partnership now offers services to first-time families in Washington, D.C. This is a hard-won success after nearly two decades of the NSO, community partners and advocates fighting to address the maternal health desert in our Nation's capital. Key philanthropic partnerships with the Richard E. & Nancy P. Marriott Foundation and an anonymous individual donor based in Washington, D.C., along with the District's City Council, enabled us to overcome the financial hurdle to initially launch services in the District.
We are pleased to be partnering with Mary's Center, a well-known and respected community health center in D.C., to provide transformative care and support to families. Mary's Center's mission to offer integrated health care, education and social services align beautifully with the Nurse-Family Partnership model. Our shared commitment to close collaboration, comprehensive support and long-term partnership in the coming years is unique in the home-visiting field and is directly responsible for the high-quality outcomes for participating families.
Like Mary's Center, The Richard E. and Nancy P. Marriott Foundation is a longstanding and respected leader in the Washington, D.C. area. Their passion for creating access to affordable and equitable health care through transformative philanthropy was the driving force behind supporting Mary's Center's Nurse-Family Partnership program launch in D.C.
Philanthropic partnerships are the backbone of the National Service Office's ability to support a national network of local NFP and Child First programs. Contributions to the NSO are investments in the vital work of capacity building, implementation assessment and start-up and ensure accountability for both growth and performance-all of which yields empowering and positive long-term health, mental wellness and self-sufficiency outcomes for tens of thousands of families in communities across the country. We appreciate the support and commitment of these two critical partnerships to maternal health care in our Nation's capital. It is our hope this story inspires similar partnerships in the coming years.
Sujit CanagaRetna, Champion Supporter
"There is ample medical evidence that comprehensive pre - and post - natal care remain critical variables in ensuring that these babies grow into healthy, vibrant and productive adults with the potential to make a positive impact in their communities and society at large."
― Sujit CanagaRetna, Champion Supporter
Sujit CanagaRetna first learned about NFP a dozen years ago while reading a Nicholas Kristof column in the New York Times. Since that time, he and his wife Shanthini Abeyesundere have been contributing annually to support the transformative work of NFP.
After reading the Kristof article, Sujit did some research and found that NFP's mission to offer free, home-based nursing care to first-time families resonated deeply with him. NFP's mission sparked a childhood memory, one he'll never forget. Sujit's mother was a physician in Sri Lanka, where he was born. Her focus was public health and infectious diseases, but her passion was working on women's health issues. Sujit would regularly accompany her on visits to reproductive health clinics for rural women. His mother instilled in Sujit the idea that delivering maternal care and health information was extremely important to these rural communities, as this type of care helped families thrive through pre-and post-natal care.
Now, as a Georgia resident, Sujit has learned how critical services like NFP's are essential to rural communities in his home state. Sujit is painfully aware that Georgia carries the weight of an abysmal infant mortality rate and that 76 of Georgia's 159 counties do not have a single obstetrician/gynecologist (OB/GYN) providing maternal healthcare. Knowing that NFP's proven outcomes would lead to better circumstances for families of Georgia, he decided to carry his mother's legacy forward and offer his expertise in state legislatures as a volunteer to NSO employees to help advance NFP's work at the state level.
We are deeply grateful to Sujit and Shanthini for their stalwart support of NFP. Their first gift was given in 2010 and their annual giving is made even more meaningful with the addition of Sujit's time and expertise to help advocate for policies that support NFP families in Georgia. We are honored to count Sujit and Shanthini as members of our community of supporters devoted to a future where all children are healthy, families thrive, communities prosper and the cycle of poverty is broken.
(October 1, 2020 - September 30, 2021)
Philanthropic Contributions: $35.8
Investment Income and Other Revenues: $3.9
Fees for Services: $11.5
Total Revenue: $51.2 Million
Program Services: $30.3
General and Administrative: $4.0
Total Expenses: $37.3 Million
Change in Net Assets: $13.9 Million
The National Service Office recognizes philanthropic support for financial purposes in the year in which a commitment is made, regardless of when funds are received or when expenditures are incurred. Net assets, therefore, may increase in a year when commitments are recognized and decrease in later years when associated funds are spent. Adequate net assets also ensure the organization has sufficient operating reserves to weather any future financial unpredictability.