Bonnie Arbittier / Rivard Report
Like true Millennials, Alaska and Jimmy Martinez met on Instagram. They were 19 years old and about to start college.
Not long after their real-life relationship began, on her first day of classes at Palo Alto College, Alaska found out she was pregnant.
“We were really scared because we were just starting our education, and I didn’t want to be a part of the statistics,” Alaska Martinez said. “We were nervous to tell our parents, and we got a lot of negative opinions, so we were worried we wouldn’t be enough for [our son].”
Two years later, their son Jimmy is a healthy 2-year-old and the Martinezes are a married couple on their way to earning college degrees. They credit nurse Angela Montez with helping them get prenatal care, teaching them parenting skills, showing them how to prepare healthy meals, and even finding scholarships that would allow them to continue their education.
Assigned to Martinez through the Nurse-Family Partnership (NFP), a state-funded community health program that works with Medicaid-eligible mothers pregnant with their first child, Montez was more than just a nurse to the Westside couple. Martinez described her as the couple’s “best friend” throughout her pregnancy; when Jimmy was born, Montez was at the hospital.
“There were a lot of moments when we were nervous or scared, and we just needed a little more support,” Martinez said. “[Montez] was there in a more neutral sense, and I was able to call her at any hour of the day if I had any questions regarding my son or myself.”
Each mother served by NFP is paired with a registered nurse early in her pregnancy and receives regular home visits that continue through her child’s second birthday. While primarily focused on mothers, the program also works to integrate the father and other family members into a strong unit based on individual needs and family structure.
The program’s goal is to foster the formation of healthy family units around new mothers. Some studies of abuse reveal that teenage mothers exhibit higher rates of child abuse than older mothers. Other factors such as lower economic status, lack of social support, and high stress levels contribute to the link between young parents and child abuse.
Children of teen mothers bear the greatest burden of teen pregnancy and childbearing and are at significantly increased risk for a number of economic, social, and health problems. The children of teen parents are more likely to live in poverty and suffer higher rates of abuse and neglect than would occur if their mothers delayed childbearing.
About 17% of mothers statewide experience postpartum depression before or after giving birth, according to a 2016 report from the Texas Department of State Health Services. Depression is a risk factor in the well-being of the mother and the well-being, safety, and development of the child.
Yvette Sanchez, chief program officer at NFP at the Children’s Shelter, told the Rivard Report that the program “works with first time moms to make sure that they are successful, to make sure their babies are healthy, and that they thrive.”
In Texas, 89% of babies whose mothers were involved with NFP were born at full term, and 90% were born at a healthy weight. Almost 90% of mothers started breastfeeding their infants, and 94% of their children received all recommended immunizations within 24 months. NFP has a 92% retention rate for mothers who enter the program.
Each nurse has a caseload of 25 clients, meeting with the family as often as needed – sometimes more than once a week.
“It is very tailored,” Sanchez said. “It’s primarily relationship-based – mom and nurse develop a close bond to where they can work on specific aspects of the mother’s life and what they can do for the family’s future.”
Montez worked with the Martinez couple for more than 18 months, until she became a nurse supervisor for the NFP program at the Children’s Shelter. They remain in touch.
After their son was born, the Martinezes struggled to gain confidence in their parenting skills. The couple said that while they received both emotional and financial support from their parents, it was Montez who helped them “find their groove” as parents.
“She didn’t tell us what to do, but she helped guide us on what we could do,” Martinez said. “She helped the three of us grow together and find ourselves and at the same time become a family – without all of our family telling us what to do.”
Montez taught them positive child discipline techniques, how to prepare nutritious meals and snacks, when to switch little Jimmy from a bottle to a cup, and how to be emotionally supportive of their child and of one another. She also encouraged them to plan and set goals for their future.
Both parents received associate degrees during their time in the program; Jimmy Martinez earned two. This fall, both will attend Texas A&M San Antonio, where Martinez will major in education and her husband will study business.
“We are raising the bar for our son,” she said. “We are the first college graduates in our families. We want to raise the bar for him and for other young parents to know that [education] doesn’t have to stop after high school.”
Martinez credits her son, and the relationship that Montez helped her establish with him, with providing the drive to pursue a teaching career.
“I would like to also be a professor, and after teaching for a time I would like to be a neurosurgeon, and I know I can do it,” Martinez said.
During their home visits, NFP nurses teach clients about parenting, health and wellness, and future-planning. At the end of each visit, the mother sets a goal to achieve, which is revisited at the next meeting. Topics are either chosen based on the mother’s personal interest, or the nurse will pick a learning topic based on her observations.
“Depending on their learning style, we may provide an activity, video, or handout,” Montez said. “All of the topics covered are relevant to where they are in their pregnancy at the time.”
Montez stressed that job of the NFP nurse is to empower women, regardless of socioeconomic circumstance, to be the best parents they can be.
Montez recalled working with a client who had a physical disability who wanted to learn to care for her child on her own, so Montez worked to adapt the NFP program to meet the woman’s specific needs. While there are numerous programs for disabled children, there were none for disabled parents trying to care for children.
“As a nurse I had to go outside of the box and start looking around for more information that would help,” Montez said. “I would go twice a week during pregnancy and infancy, and we learned to adapt her walker with a carseat to make it safe for her to transport her baby and created a safe space for her to do the bath herself.”
Nurse Cathy Lewis, who has been working with NFP for almost eight years, worked with a 14-year-old mother who regularly became involved in verbal and physical altercations at the alternative school she was attending. The girl told Lewis she wouldn’t continue to attend school.
“There is something about not having much that makes you more vulnerable to doing things that are socially questionable,” Lewis said. But seeing people take steps toward better decision-making is the reason she loves her job.
Lewis said that over the course of several meetings, she was able to nudge the girl back into school. She graduated from high school and successfully completed her two years with the NFP program. Lewis told her client: “You do have a choice in what your daughter thinks is normal, and if you teach her to fight there are consequences; choose to teach her that she wants to get through school.”
Providing new ways of thinking and alternative choices for mothers who may otherwise feel trapped by their circumstances is key to the program’s success.
In Texas, the NFP serves clients of all ages in 32 counties and receives $22 million in state funding. The three NFP programs in San Antonio are located within the Children’s Shelter, Catholic Charities, and University Health System. More than 37 years of research has shown it has achieved lasting and significant effects.
To ensure that the program continues to receive funding and support, the Martinezes made the 25-hour drive from San Antonio to Washington, D.C. to speak to the Texas congressional delegation about the difference Montez’s home visits made in their lives.
“Our nurses walk beside the client and help them reach the goals of the client – not the goals of the nurse,” Montez said.