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Nurses fight childhood poverty by supporting new parents

Published: Friday, Aug. 28 2015 9:05 p.m. MDT

Jamie Tuckett, a nurse from the Nurse Family Partnership, meets with Andrew and Kailey Newton about their young daughter Rhiley.   (Scott G Winterton, Deseret News) Jamie Tuckett, a nurse from the Nurse Family Partnership, meets with Andrew and Kailey Newton about their young daughter Rhiley. (Scott G Winterton, Deseret News)

It's a week before Christmas, and the last of the afternoon sun is streaming across west Salt Lake City. Andrew Newton, a tall and skinny 18-year-old, guides his beat-up black Chevy Beretta into its parking spot at the low-income apartment complex he calls home.

He just finished an eight-hour shift at Jiffy Lube. No matter how hard he tries, he can't get the grease from his fingernails. This didn't bother him much a few months ago, but now that he's got a 4-month-old daughter, there are a lot of things about himself and his situation he'd like to change.

For starters, his apartment on the west side of Salt Lake City is sandwiched between the Jordan River Parkway, a favorite haunt of the homeless, and a trailer park. Gas fumes from the nearby interstate blanket the sky above his home.

The Nurse Family Partnership, a federally funded program, provides RN home visits to low-income families during pregnancy and infancy. (Scott G Winterton, Deseret News) The Nurse Family Partnership, a federally funded program, provides RN home visits to low-income families during pregnancy and infancy. (Scott G Winterton, Deseret News)

Newton worries about how those things could affect his daughter's breathing and her well-being, but mostly he worries whether he'll have enough money to cover formula and diapers and the heating bill.

As he climbs the steps to his third-floor apartment, he can hear his daughter Rhiley crying. Once inside, he scoops up the baby, his oil smeared uniform rubbing up against the clean, pink blanket she is swaddled in. "What's wrong, little girl?" he whispers in her ear.

Across the small room, sitting on a tattered green sofa acquired from a friend, Kailey, Newton's wife of seven months, watches with relief. She's exhausted from being home alone all day with their fussy baby. A pretty girl with an easygoing disposition, she's just 19, a year removed from formal dances and late-night runs to Wendy's with her friends. Now, like her husband, her worries have changed.

Rhiley Newton is 4 months old. (Scott G Winterton, Deseret News) Rhiley Newton is 4 months old. (Scott G Winterton, Deseret News)

"It can be hard to stay patient with her when she cries all day," Kailey says. She spends her days in a process of trial and error to soothe her daughter. Feeding, changing, burping, walking and singing only bring temporary relief. "She'll be OK for a few minutes, and then she starts crying again."

A crying baby is stressful for anyone, but in some ways it is the least of the Newtons' problems. The young parents are barely scraping by. Andrew's take-home pay from Jiffy Lube amounts to about $350 per week, a salary that puts the family well below the national poverty line.

Basic living expenses eat up every cent of Andrew's paycheck. "There is no extra money for anything," Kailey says. They don't go to dollar movies with friends. They don't eat out. But that's not what Kailey worries about. Late at night when the lights are out, she worries that they don't have enough or the right kinds of toys for Rhiley's development, things with color and texture.

The Nurse Family Partnership, a federally funded program, provides RN home visits to low-income families during pregnancy and infancy. (Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News) The Nurse Family Partnership, a federally funded program, provides RN home visits to low-income families during pregnancy and infancy. (Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News, Scott G Winterton, Deseret News)

Although the Newtons qualify for food stamps, they've decided not to apply for the federal program. Fiercely committed to being independent, they canceled their Internet to free up money they need to pay for the extra expenses that come with a baby. Kailey took a job as a night hostess at Village Inn, a local diner, to help bring in a little extra.

Although they both would like to go to college, get higher paying jobs and provide a better life for their daughter, thinking about the future is hard when the present is overwhelming.

Stress and poverty

Every year, more than 500,000 babies like Rhiley are born into low-income homes, according to the U.S. Census Bureau. Studies by the Department of Health and Human Services show that low-income children are more likely to suffer from physical abuse and neglect, have parents in conflict with the law, be exposed to toxic chemicals and experience hunger. They are also more likely to struggle in school, to repeat grades and have behavioral problems.

Jamie Tuckett, from the  Nurse Family Partnership  meets with Andrew and Kailey Newton and their young daughter Rhiley Tuesday, Nov. 6, 2012. (Scott G Winterton, Deseret News) Jamie Tuckett, from the Nurse Family Partnership meets with Andrew and Kailey Newton and their young daughter Rhiley Tuesday, Nov. 6, 2012. (Scott G Winterton, Deseret News)

Research suggests the root of these problems is stress, and low-income families are particularly vulnerable. "Economic stress is a particularly potent catalyst for a variety of family problems that contribute to the emotional and behavioral maladjustment in children," said Rand Conger, a professor at UC Davis who specializes in researching families' resiliency to economic pressure.

Conger's research on low-income families in rural Iowa shows that poverty impacts parenting style. Parents with low socio-economic status are more likely to display punitive behaviors such as yelling and shouting and less likely to display love and warmth through cuddling and hugging.

It's not that low-income parents don't want to lovingly and productively interact with their kids, but stress actually changes the brain's ability to respond to difficult situations, said Martha Wadsworth, a psychology professor at Penn State University.

Jamie Tuckett, a registered nurse, meets with the Newton family.  (Scott G Winterton, Deseret News) Jamie Tuckett, a registered nurse, meets with the Newton family. (Scott G Winterton, Deseret News)

When a person experiences stress, his or her prefrontal cortex — the part of the brain that regulates reasoning and impulse control — basically turns off. To deal with the situation, the person has to take cues from parts of the brain that function in more reactive and automatic ways. This is why parents are more likely to respond negatively to their kids when they are stressed out, Wadsworth says.

Stress impacts children's brains in devastating ways too. In stressful situations, kids' "fight or flight" response system is activated, Nadine Burke Harris, a San Francisco-based pediatrician, said in an interview with National Public Radio. In some homes, the children are in a near-constant state of emergency, and when that happens, their prefrontal cortex doesn't develop properly. Without a fully functional prefrontal cortex, it is more difficult for these children to concentrate on schoolwork, control their tempers or think through the consequences of certain actions.

Andrew Newton and his daughter Rhiley consult with Jamie Tuckett. (Scott G Winterton, Deseret News) Andrew Newton and his daughter Rhiley consult with Jamie Tuckett. (Scott G Winterton, Deseret News)

The power of good parenting

To demonstrate the power of parenting and why it is so important particularly when children are small, consider a study done by researchers at McGill University in Montreal, Canada.

These researchers noticed that some mother rats licked and groomed their babies while others did not. The mothers who engaged in this ritual were more likely to do it after graduate students handled their babies (in other words, when their babies were stressed out). Researchers found that rats who were licked and soothed as babies were more confident, did better in mazes, were more healthy and less fearful as adults than the rats who were not groomed by their mothers.

The human equivalent of grooming — cuddling and hugging — produces similarly positive outcomes. Numerous studies suggest that with humans, like with rats, good parenting can mitigate the effects of growing up in a stressful environment. When a parent is responsive to a child's needs, the child forms a secure attachment, which essentially protects it from the negative effects of stress on its body, according to Wadsworth's research.

Perhaps most promising, research suggests that good parenting can be taught.

Helping parents succeed

Kailey and Andrew were still in high school when they found out they were going to have a child. Their guidance counselor recommended they participate in a program to help first-time parents with limited resources prepare to be parents. "I wanted a better life for my baby than I had," Kailey said, explaining why she and her husband signed up.

Although they didn't know it at the time, what the Newtons signed up for was the oldest and most respected parental coaching programs in the nation: the Nurse Family Partnership. The 40-year-old federally funded program serves low-income, first-time parents. Registered nurses make home visits to patients during pregnancy, continuing until the child is 2. Their goal is to empower and educate parents whose children, by virtue of their family's stressful economic situation, are more at risk of suffering from neglect, abuse and behavioral disruption.

Jamie Tuckett is the registered nurse assigned to visit the Newtons. Tuckett helps the young parents in all kinds of ways. When Kailey considered dropping out of high school because of the pregnancy, Tuckett reminded the expectant mother of her goal to be the first person in her family to go to college. As Kailey and Andrew planned their wedding, Tuckett coached them on dealing with conflict in marriage. And when Kailey had painful contractions during her seventh month of pregnancy, Tuckett gave her advice on what to do.

On a recent visit, Kailey told Tuckett about Rhiley's recent bout of fussiness. Tuckett responded lovingly with useful information. "Four months is around the time babies start teething," she said. Together they checked the baby's mouth for teeth. Although nothing was visible yet, it's just a matter of time before little white caps will appear on Rhiley's middle bottom gums.

Tuckett gave the couple suggestions to minimize teething discomfort. "Baby Tylenol and Orajel, which you can get at Walmart, work best," she said. She also recommended cold chew toys and teething tablets that dissolve in the baby's mouth.

Successful outcomes

NFP isn't the only parenting intervention for low income families, but it has the distinction of being the only program that produces results for children and their parents in a cost-effective way, said Greg Duncan, professor of education at UC Irvine. The program, which is funded by grants from federal and state governments, costs $8,000 per family. While that isn't an insignificant sum, the government ultimately saves money when families participate, according to a 2005 study by the RAND Corporation.

Families who participate in the program are less likely to need financial support in the form of welfare, food stamps and child-care credits, which is why, according to the RAND study, the government saves $9,000 on each low-risk family that participates in the program and almost $40,000 on each participant considered higher risk.

Participants report a 48 percent reduction in child abuse and neglect and a 56 percent reduction in emergency room visits for accidents and poisoning. NFP babies are also more likely to be born full-term, more likely to have healthy birth weights because their mothers are more likely to receive prenatal care and have a diet, and are less likely to smoke and drink.

Why it works

NFP succeeds where other programs fail for a few reasons, according to Duncan.

First, NFP parental coaches are registered nurses. That's a significant component because registered nurses are consistently rated the most honest and ethical professionals by Americans, according to Gallup research.

"Our patients trust us," Tuckett says. Kami Peterson, Tuckett's boss, suggests patient confidence is a function of nurses' training. "As nurses, we have a mix of medical and developmental knowledge," she said. "That helps patients feel reassured that we can help them." Nurses can answer questions about mothers' changing bodies, developing babies and temperamental emotions. Social workers, volunteers and teachers won't necessarily have that information.

A second reason the program works, according to Duncan, is that NFP nurses have lots of contact with their patients. NFP nurses visit their patients twice monthly throughout the pregnancy and up until the child is 2. Most other parental coaching programs are taught in classroom settings over a period of 12 to 14 weeks.

Related to the amount of time nurses spend with patients is the fact that the program is patient-directed. "We talk about the things they want to talk about," said Tuckett. NFP also stresses a non-judgmental culture. "My job isn't to tell my patients what to do," said Tuckett, "it is to support them in defining their own goals."

email: mwhite@desnews.com

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