Barb Rowland stepped into Michaela Motschman’s Vancouver duplex on Monday, cheerfully greeting Michaela.
“Where’s that little peanut?” Rowland asked next, smiling as she spotted 10-month-old Lilian.
Lilian was at the couch, taking small steps as she used her hands on either the couch or a coffee table to steady herself.
Rowland was delighted at Lilian’s recent development.
“She was not walking when I was here the last time,” said Rowland, a nurse with Clark County Public Health who has been making regular visits to Motschman since she was five months pregnant.
Motschman, 19, was 18 when she became pregnant with Lilian. She heard about the county’s Nurse Family Partnership program through her doctor’s office and signed up; she was one of 111 low-income teenage first-time mothers to enroll in the program last year.
As far as government services go, the Nurse Family Partnership, modeled after a national program offered in 32 states, isn’t a mandate.
Clark County Public Health does have plenty of mandated duties, including issuing birth and death certificates, inspecting restaurants and controlling communicable disease outbreaks.
The Nurse Family Partnership, on the other hand, serves as an example of the department’s outreach work with the some of the community’s most vulnerable families, said John Wiesman, director of the health department.
While the county’s proposed 2011-12 budget includes $1,083,885 for the Nurse Family Partnership, the health department, which has been significantly hit by across-the-board cuts in state funding, still has a $750,000 shortfall.
If county commissioners don’t decide to fill that hole, Wiesman, who cut $2 million from his budget before asking commissioners for help, will have to cut somewhere. Non-mandated programs will have to be first on his list.
Wiesman will make a special presentation to commissioners Dec. 6 in the first of four budget hearings next week.
The public is invited to comment during sessions at 10 a.m. and 6 p.m. Tuesday, Dec. 7 and 10 a.m. Wednesday, Dec. 8.
Hearings will be at the Public Service Center, 1300 Franklin St.
Under the proposed budget, the number of participants in the Nurse Family Partnership will be reduced.
Rowland and three other county public health nurses are, as of January, going to have their hours cut from 40 hours a week to 32 hours.
Their caseloads will drop from 25 women to 20.
Eligibility runs out when a child turns 2.
Supporters of programs such as the Nurse Family Partnership argue that money invested in families now will be saved later.
All of the families in the program nationally are tracked; a 2005 analysis from the RAND Corporation found that every $1 invested in a Nurse Family Partnership participant equaled a savings of $5.70 of government services participants wouldn’t need because of the guidance they received while in the program, said Marni Storey, the county’s public health services manager.
A 2004 study by the Washington State Institute for Public Policy came up with a different number: $2.88 in savings for every $1 spent. It ranked the Nurse Family Partnership as getting the best return among all pre-K, child welfare, youth development, mentoring, youth substance prevention and teen pregnancy prevention programs.
Storey said 177 young mothers have been enrolled in the Nurse Family Partnership since Clark County launched the program in September 2007.
To boost the nurses’ hours back to full time, Storey said the county has applied for a grant from the Bill & Melinda Gates Foundation.
Wiesman said the county will also try for a share of $1.5 billion in federal funding that will be available through the 2010 Maternal, Infant and Early Childhood Home Visiting Program to implement, expand or maintain “evidence-based programs,” such as the Nurse Family Partnership.
Rowland has worked for Clark County Public Health for 10 years.
“It was always my goal to do public health,” she said.
When Motschman, who attended Fort Vancouver High School and Lewis & Clark High School before dropping out and earning her GED, signed up for the program, she had a lot of questions about her pregnancy that she couldn’t fit into her routine doctor’s visits.
As a teenage mother, she also lacked peer support.
“I felt pretty alone,” she said. “All of my friends were out partying and doing that teenage thing.”
Motschman lives her fiancé, Henry McCallum, 20, who works at Walmart.
She said when she discovered she was pregnant, she wasn’t sure what to do. She told her dad first, and then her mother, and said they were both supportive of her decision to keep the baby.
With Rowland, she found a teacher and confidante, someone she saw more frequently than her doctor. Rowland helped her connect with community resources, taught her how to eat for two in a healthy way and discussed other aspects of pregnancy.
Rowland was also the person Motschman called at 2 a.m. two weeks after Lilian was born, when Motschman was engorged and didn’t know what to do.
Breast-feeding, another thing Rowland has helped her with, has gone well and she plans to nurse Lilian until she’s 15 months old, unless Lilian loses interest.
Rowland said public health nurses offer a range of information, from necessary baby accessories and child-proofing tips to helping mothers set their own goals. Nurses can offer other advice as needed, she said, depending on the mother’s situation.
Motschman said once Lilian is eligible for Head Start she’d like to go back to school and study early childhood education to become a preschool teacher.
On Monday, Rowland talked to Motschman about incorporating music into her play with Lilian, such as singing an interactive version of “The Wheels on the Bus.”
Lilian likes listening to techno with her father, Motschman said.
“She starts bouncing,” Motschman said. “He’ll pick her up and swing her around, and she’ll just smile and bury her head in his chest.”
Motschman said she does sing to Lilian.
The music and rhythm is great, Rowland said, asking Motschman to recall her earliest songs and the feelings she associates with them.
“You can use it when she’s in a sad mood or fussing. It’s a great distractor,” Rowland said.
Rowland worked at Oregon Health & Science University for 14 years before coming to Clark County Public Health.
She said it was always her goal to work in public health.
The one-on-one time with clients is invaluable, she said.
“We teach our moms that we are the teachers of our kids,” Rowland said. “We build them and they bloom.”
Stephanie Rice: 360-735-4508 or stephanie.rice@columbian.com.
