The bleeding wouldn’t stop. Maria was 19, scared, weak, and eight months pregnant. All summer she’d tried to follow the doctor’s instructions after he’d diagnosed her with placenta previa and told her to get as much bed rest as possible. But one thing you need for bed rest is a bed. In the middle of Maria’s pregnancy, her mother, stricken with cancer, briefly moved the family from Bushwick to Puerto Rico before losing her own medical battle. Now Maria was back in Brooklyn, where a cousin was using Maria’s mother’s death as an opportunity to try to evict the pregnant teen from the family’s apartment.
The stress and the illness finally proved overwhelming, and not just medically. Maria was alone and hemorrhaging, but she was too panicked to dial 911 to ask for an ambulance. She did, however, possess one rare resource. Maria contacted Susanne Fischer, a nurse from a new program called the Nurse-Family Partnership who’d been guiding her through the pregnancy. Maria wanted to wait until Fischer could come over and accompany her to an emergency room. Fischer, who’d worked at Columbia-Presbyterian for 23 years, recognized the danger and enlisted one of Maria’s neighbors to call an ambulance. One hour later, Maria’s first child, a five-pound girl named Ayanna, was born.
Fischer is a nurse, but helping save the lives of Maria and Ayanna was actually a detour from her real work: teaching Maria how to build her own life. Soft-spoken but steel-willed, with bright eyes and graying hair, Fischer will work with Maria until Ayanna turns 2, and not just on health issues. As soon as mother and child were stabilized, Fischer got back to consulting tenant lawyers and wading through the housing-court bureaucracy. One month later, she succeeded in establishing Maria’s right to the Bushwick one-bedroom. “It’s tough to create better parents,” Fischer says, “until that parent actually has a place to live.”
Five child-abuse deaths in four months, and the overheated media coverage they provoked, forced the Bloomberg administration to act. Supervisors at the Administration for Children’s Services have been shuffled—particularly in the chronically dysfunctional Bedford-Stuyvesant field office, which mishandled three of the fatal cases—and money is being pumped into training for caseworkers. A more effective ACS is important, because poverty and evil will never be eliminated.
A more effective ACS is important—but the best way to protect kids is to keep them from ever needing ACS.
Yet the best way to protect kids is to keep them from ever needing ACS. Running through most of the grim cases was a common thread: a young mother with multiple children who is overwhelmed by poverty and parenthood. And away from the spotlight, Bloomberg’s Department of Health and Mental Hygiene has been experimenting with what could be a revolutionary approach to helping the city’s poor moms. The program is a classic bit of root-cause liberalism, and it’s another reminder that at heart, Mike Bloomberg is an old-school Democrat—and that, on social issues, he’s a vast improvement over Rudy Giuliani, whose primary cure for underclass woes was punishment.
The Nurse-Family Partnership began in 1977, in Elmira, as a way to test a psychologist’s theories about child development. David Olds’s ideas have been refined over the years, but the core genius of his method has remained the same: Pair nurses with impoverished first-time mothers when they’re pregnant—before any parenting habits need to be unlearned—and keep the nurses and moms together during the crucial first two years of a child’s life, when formative medical and emotional issues are in play (other key aspects are that the moms volunteer to be in the program and that it’s free). The nurses provide medical care and tutoring, but that includes everything from a proper diet to quitting smoking and drugs. The crucial work is teaching parenthood—breast-feeding, how to play with an infant to promote bonding and brain development, the importance of planning and spacing pregnancies—and encouraging the mother to get an education or a job. And then there are the subjects that aren’t on any nursing-school curriculum, like how to deal with a former boyfriend who’s become a stalker.
NFP has slowly expanded across the country and now operates in 300 communities in twenty states. Whether it’s implemented in South Central L.A. or Cajun Louisiana, though, the effects have been consistent, profound, and lasting. For the moms, that means dramatically higher rates of full-term deliveries and lower rates of public assistance. For the kids, it’s higher IQs and lower rates of child abuse—and, in the children who’ve been tracked for fifteen years, elevated school performance and fewer encounters with the criminal-justice system.
The program didn’t arrive in New York until Deborah Kaplan, an assistant commissioner in the Department of Health, sought it out and opened a site in Jamaica in July 2003; a Harlem office followed in February 2004. Each unit employs eight nurses, and each nurse manages 25 cases at a time; the program costs $5,500 per family annually, but a study of NFP in the state of Washington found that it saved taxpayers an equal amount in welfare, emergency-room, and foster-care costs.
The budget for the NFP site in Brooklyn comes from city and federal funds, plus money from the Robin Hood Foundation, and the site is managed by SCO, a social-service agency with a longtime presence in Bed-Stuy. Its office is two blocks from the Herkimer Street apartment where, in November, 16-month-old Dahquay Gillians died, drowning in the bathtub while his mother listened to CDs in an adjoining room. It was the first in what has become an awful series of child-abuse deaths this winter. If an NFP nurse had met Dahquay’s mother four years earlier, when she was pregnant for the first time, perhaps more than one life could have been saved.
So why isn’t NFP spreading farther and faster across the city? The chronic shortage of nurses, a problem afflicting plenty of places besides New York, is one major reason; since NFP hires only experienced nurses with advanced degrees and advanced empathic skills, its recruiting is even tougher. Another hazard is the entrenched social-service agencies that view NFP as a threat to their government stipends. The politics of Brooklyn’s social-service funding is “a viper’s nest,” says one city councilman. “There’s plenty of room at the table for many different programs, and it’s key that we support each other,” Kaplan says. “But the city can’t do everything, and we need to focus on those programs that have been proven to work.”
Bloomberg has increased spending on NFP from $1 million last year to $2.5 million in 2006, with some of the money going toward opening a new site in the Bronx in April. But that’s not nearly enough to attract the necessary number of nurses, who can make far more than the NFP salary of $60,000 a year working in private hospitals; the Bed-Stuy program, nearing its maximum of 100 clients, is searching for four additional nurses. NFP has enjoyed bipartisan support in other states, but it’s begging for a champion in New York’s congressional delegation, from either party. “Hillary Clinton spoke at our national symposium two years ago,” says Geri Summerville, who helps oversee NFP in New York. “Of course, she’s got a lot on her plate, but we’d love to see her get more behind the program in New York City.”
First Lady Clinton once attempted to reform the entire American health-care system and was caricatured as an extremist. Steering money to NFP would seem a much easier task. But we live in a country that would rather react to crises than prevent them, especially in health care. If Senator Clinton helped change that attitude, she’d be a real radical.
E-mail: Chris_Smith@nymag.com.