Megan Leypoldt was as prepared a new mother as you're likely to meet. By the time she gave birth to her daughter, Piper, Leypoldt and her husband had taken classes in Lamaze, baby care and infant CPR. She'd read books and watched videos about newborn care, subscribed to parenting magazines and signed up at a local Web site for moms. She had put her name on waiting lists for child-care services during her 10th week of pregnancy.
But once Piper was in her arms, the Duke graduate student says she didn't feel so prepared. "It was a little overwhelming, to be honest," she says. "I didn't know what I was doing."
A newborn's cry is a great equalizer. No matter how prepared a new parent may seem, the sound elicits universal feelings. A program called Durham Connects is responding to that cry by helping parents of all backgrounds and circumstances adjust to the arrival of a new baby. Under the program, nurses make free visits to the home of every baby born in Durham County, with follow-up visits in some cases.
Nurse Jane Schwarting visited Leypoldt's Trinity Park home when Piper was four weeks old. By that point, Leypoldt says, adrenaline had given way to fatigue as she tried to decipher the meaning of Piper's cries. Schwarting assessed both mother's and baby's health, answered questions about breastfeeding and sleeping and recorded data that the Durham Connects program will use to assess the effectiveness of its work.
Schwarting checks for safety issues and developmental cues, tunes into the interaction between mother and baby, and listens for questions about issues ranging from post-partum depression to dealing with the family dog. She's visited about 80 homes since the program began in June. She's changed a lot of batteries in smoke detectors and says one baby boy she was weighing peed directly into her clog. With a background in pediatrics and mental health, she finds the work fulfilling.
"I go in with a very non-judgmental approach," Schwarting says. "I think that's very important. Mothers are trying to do the best they can do, and I just want to support them."
Nurse home-visiting programs across the country have had a significant impact on the health and well-being of babies born to low-income parents. Studies show the most established such program, the Nurse-Family Partnership, has dramatically reduced abuse and neglect and emergency room visits for young children, and increased the education and earning power of their mothers.
The Nurse-Family Partnership pairs nurses with low-income, first-time mothers for a two-and-a-half year period that begins during pregnancy. It started in New York 30 years ago and has expanded nationwide, operating in Guilford County since 2000. This month, it expands to nine North Carolina counties, including Wake County, where four nurses are expected to serve up to 100 mothers this year.
Durham Connects has much in common with the Nurse-Family Partnership, particularly its emphasis on scientific evidence. Social services are widely considered to be essential and lifesaving, but there's little scientific research about what impact they actually have. Data has allowed independent researchers to analyze the program's effectiveness—and it's allowed the program's advocates to prove it works. Over 15 or 20 years, the investment can save society thousands of dollars in costs related to crime, health care and welfare. A RAND Corporation study in 2005 found a net benefit to society of more than $34,000 for every family the Nurse-Family Partnership served—$5.70 for every dollar spent on the program.
What's unique about Durham Connects is that it's universal. Instead of targeting poor women having their first babies, Durham Connects aims to cover every family in the county, which in 2007 had 4,300 births. In June 2008, the program began with 10 nurses covering about half of the county, and plans are in place to expand in January 2010 with another 10 nurses to cover all of Durham. By that point, the program expects to reach 4,000 families each year.
"The overall goal of this program is to improve child well-being and prevent problems in child development among all the children in Durham County, so we want to reach all the children," says the program's creator, Duke professor Kenneth Dodge, director of the university's Center for Child and Family Policy. There are many different services available to families, he says. "Durham Connects is an initial program designed to identify what a family might need" and then connect the family to what can specifically help them.
Why spend resources helping a middle-class mom like Leypoldt, who already has a lot of support?
By making the program available to everyone, Dodge says he hopes to remove some of the stigma some families feel about getting help. "It's a myth that middle-class families have no needs. No matter what your circumstances are, it's not easy. By making it universal and by recognizing that all families have needs, different kinds of needs, there should be no stigma."
Because the commitment to each family is shorter—on average, Durham Connects makes one visit to a home—the cost is about $300 to $400 per family, according to early estimates, much less than that of the Nurse-Family Partnership, which averages $4,500 per year per family. The Duke Endowment funds Durham Connects and provides some of the money for the Nurse-Family Partnership, which is funded through a mix of public and private money.
Seeing the mother in her own home often raises questions she may forget to ask in a doctor's office, and offers the nurse a broader sense of what the family may need and what stresses they may be under.
"There can be a lot of needs between when they come out of the hospital and their next post-partum visit," Schwarting says. Those needs have intensified this winter. More parents are asking for the donated cribs the program offers. "I do see right now a lot of women struggling, people losing jobs or going back to work sooner than they like to because of the economy."
Jonathan Kotch, a professor of maternal and child health at UNC, says Durham Connects is innovative. "From a public health point of view, it's closer in its model to a primary prevention program. That makes it more attractive from a social policy point of view because everybody is included. It looks less like welfare."
What excites Kotch, who serves on the program's advisory board, is the potential for learning more about how to prevent the mistreatment of children. "We really do not have a good tool for identifying children at birth who are likely to be maltreated." Children born to poor families may be at higher risk of abuse or neglect, he says, but "the majority of poor families don't abuse their kids," and in absolute numbers, more abused and neglected kids come from families that aren't poor.
"Situational stress can affect anybody," he says. "Years ago, I used to amuse my colleagues by saying we're all potential abusers under the right—or under the wrong—circumstances. With the kinds of pressures families are under today, there's a lot less time, less patience and less resilience on the part of families to absorb many of the challenges of parenting."
Expectant parents in Durham can find out if Durham Connects reaches them by calling 668-3279 or by visiting www.durhamconnects.org. For more information about the Nurse-Family Partnership, visit www.nursefamilypartnership.org.