Deb Avenido is a Minnesota pioneer helping to guide a visiting nurse program that President-elect Barack Obama pledges to bring to half a million new mothers and babies across the country. ¶ The Nurse-Family Partnership, a community health program already spreading across Minnesota and the nation, was inspired by research showing that intensive help for first-time, at-risk mothers can stem future problems such as child abuse, health risks and intellectual and behavioral problems for children.

Each day, Avenido hops into her car and drives to the homes of young pregnant women in Ramsey County who have agreed to let her be part of their lives until their babies' second birthdays. She unpacks blood pressure cuffs and dispenses information on goal-setting, employment, positive parenting, infant early learning and other supports for the entire family.

"It really helps to have someone to talk to," Cee Lor, a young mother-to-be, said as she sat in her St. Paul home with Avenido last week. "I feel like it keeps me prepared for the next steps [in my pregnancy]."

Case in point: Lor discovered she was four months pregnant -- not three months -- during that visit.

Avenido, a veteran Ramsey County public health nurse, values the chance to work with first-time mothers over the long haul.

"So many [of the women] are young, and we want them to look down the road," she said. "We want them to think about how life will be different with the child. Who will be their support system? Who will care for the baby?"

The Nurse-Family Partnership, launched in New York three decades ago, is one of the relatively rare social programs that has been tested by comparing mothers enrolled in the program to a control group of similar parents. As the program expanded nationally, studies showed that participating mothers not only had healthier babies, but also fewer emergency room visits, fewer subsequent pregnancies and stronger employment prospects than similar families not enrolled in the project.

About 14,000 families nationally now are enrolled in the program, including about 900 in Minnesota, where it already has been launched in several outstate counties, including Clay and St. Louis, said Mary Jo O'Brien, a former Minnesota health commissioner who is a regional representative for the national project. Ramsey County, which started the program last month, is the first urban location.

The Minnesota Department of Health recently received a federal grant expected to help the program grow further.

Participants must be first-time mothers, less than 28 weeks pregnant, with low incomes and relatively few resources. They are referred by health clinics, high schools and community agencies.

How it works

One day last week, Avenido knocked on the front door of Lor's home. Lor escorted Avenido to the kitchen, where the nurse checked Lor's blood pressure and weight, asked how she was feeling and whether she had quit smoking.

"Yes," said Lor with a proud smile.

Avenido then told Lor about some free prenatal classes and asked whether the baby's father might attend a parenting class for Hmong couples. The nurse gave Lor a Head Start application for her nephew and handed her a diary to record pregnancy milestones.

To begin instilling a mother-child bond, Avenido explained that Lor's baby now had eyes and eyelashes and that she'd soon feel it move. Next, she handed Lor a piece of paper.

"This is called a Dream Sheet," Avenido told Lor. "It will help you think about what dreams you have for yourself and the baby. [For example,] in three years, where will you be at? What kind of job or education will you have? Who will be the people important in your life?"

"I really like it [the program]," said Lor. "Sometimes things get confusing. I'm learning what I should be eating, what I should do if I don't feel good. ... It really helps to have someone to talk to."

Avenido enters data from each visit into a national databank that monitors visiting nurses to ensure they adhere to the highly acclaimed model on which the program is based.

The Ramsey County program will cost about $2.1 million for three years, mainly for staffing and training, said Ramsey County officials. The costs will be deferred by Medical Assistance reimbursement and some state and federal dollars, they said.

The program's success has caught the attention of the Federal Reserve Bank of Minneapolis, a staunch advocate for investments in early childhood education.

"The research behind the Nurse-Family Partnership is solid," said Rob Grunewald, associate economist at the reserve, noting that a $1 investment in the project has yielded at least $3 in savings in government and community costs.

"Early childhood education used to be age 3 to 6," added Rob Fulton, Ramsey County's public health director. "But if you don't get to some of these families before the children are 3, it's too late."

Jean Hopfensperger • 651-298-1553