It is hard to imagine anyone in human services having a wider breadth of experience than Roxane White, who this year became CEO of the Nurse-Family Partnership (NFP) at a critical time in the evolution of the program.
White has been a tireless advocate with a particular passion for fighting homelessness and supporting youth. A social worker by training, White oversaw San Francisco’s famous Larkin Street Youth Center for homeless youth. She then spent nearly a decade turning Denver’s Urban Peak into an equally successful program for homeless youth.
It was an effort not missed by a newly elected mayor named John Hickenlooper, who in 2003 tapped her to lead Denver’s Department of Human Services and then made her his chief-of-staff.
White followed Hickenlooper to the governor’s office, where she served as chief-of-staff from 2010 until last November.
She now leads the Nurse-Family Partnership National Service Office, the Denver-based nonprofit that trains organizations to administer the NFP model, which is one model for the delivery of what’s known as “home visitation.” In a nutshell, NFP pairs professional nurses with first-time, low-income moms to support them from pregnancy through the child’s second birthday.
The entire home visitation sector received a major boost in 2009 when the Affordable Care Act established a $1.5 billion investment called the Maternal Infant and Early Childhood Home Visiting (MIECHV) program. Before its inception, the Department of Health and Human Services spent about $14 million per year on home visitation. Last year, it spent $400 million.
For NFP, the onset of the federal program timed up with a $50 million investment in the national office. The combination of both has expanded NFP’s reach from six states to 43. The national office tightly controls which nonprofits can implement the model; there are currently 252 operators in the country.
The future of MIECHV is now in question, as Congress continues to delay a move to reauthorize the program. Youth Services Insider sat down with White to talk about her exit from politics, the impact of Nurse-Family Partnership, and the future of the home visitation field.
Youth Services Insider: The Chronicle just mentioned Urban Peak in a series about programs using positive youth development frameworks. How long ago does that job feel now that you’ve been so involved in big-picture policy for a city and a state?
Roxane White: I left in 2003. Last night, I was texting with Gavin, one of the kids from there. He is suddenly 30! I have one coming over tonight. He’s now 29, been on his own for awhile. He’s picking up a bed.
YSI: As you ascended with Mayor and then Governor Hickenlooper, how did you stay tied into the ground level of youth services? Any particular people or groups that helped you stay connected?
White: My role was to have a voice for those who don’t have a voice. I’m only being true to that if I remember that most don’t have the privilege to be at the table.
I guess for me, whether it’s a ‘Peaker’, or a homeless vet, I’ve always felt like having direct communication with people who are really struggling would keep me more grounded. [With NFP], the time I’m meeting mom and baby, or hearing from the nurses…If I don’t hear from them, I miss the passion that might help me communicate the message to others. I need that touch-point to feel authentic.
YSI: What did you know about Nurse-Family Partnership before you came on board?
White: I first came to NFP when I was at Peak. A lot of people won’t take homeless teens. They were willing to take in our kids, and I said, ‘Wow, they’re really amazing.’
At Denver Human Services, we used TANF dollars for NFP, trying to keep families out of the child welfare system.
When I was chief of staff [to Governor Hickenlooper]…we were doing every damn thing we could to cut Medicaid costs. So every new mom coming in [to Medicaid] got referred to NFP.
YSI: NFP has become a darling of the “evidence-based” camp. What is it, in your mind, that makes the model so successful?
White: One thing people ask all the time is, ‘Couldn’t you cut costs by not using nurses?’
Yes, but you can’t get the same outcomes. I struggled with that question at first too, because I’m a social worker by training.
I was out with a nurse once, she got a call from a mom that a toddler had grabbed a hot curling iron and burned his hand. The social worker in me is thinking, ‘Is the doctor’s office open? If not, I guess we go to the ER [emergency room].’
The nurse pulls over, and she tells the mom to take a picture of the hand and send it. Then she starts triaging with the mom on how to treat a burn. The nurse told her about blistering, and said, ‘Keep sending me pictures.’
And I’m thinking, ‘Oh, that’s why we have a 56 percent reduction in ER visits over the first two years.’
I was out with another nurse, she gets a call from a mom who thinks she is in preterm labor. Turns out, the mom had had a well-visit with the nurse the day before. And she got freaked out about delivery. So they’re talking it through, there’s no contractions, and she is actually a long way from preterm labor.
A social worker would have sent her to the ER to get checked. It’s a huge cost-saver for Medicaid, a huge cost-saver for hospitals.
YSI: Before MIECHV, about $14 million in federal funding went to home visitation programs. The program will end soon unless Congress reauthorizes it. What would it mean for NFP if there were no federal home visitation program in 2016?
White: We would lose at least half, if not two-thirds of NFP providers. Even though MIECHV is only 25 percent of our funding, those funds are huge for leveraging other resources.
I think sometimes the awareness that a federal program brings helps states do things. We have become an approved part of more Medicaid plans, and more states are directing tobacco taxes at [home visiting].
The leveraging is pretty unbelievable. It’s only 25 percent of dollars, but it has helped move us from serving six states to 43 states.
YSI: So what is the right level for MIECHV to continue at? Is $400 million in federal money the right amount?
White: I think it’s a great level to continue at. But if we think $400 million is going to create the kind of two-generation change we want, we’re fooling ourselves. [Home visiting programs] probably only serve about 3-5 percent of the moms who are at high risk in this country right now.
If we want to break this cycle of dependence on entitlements, and prepare kids for school success, we need a bigger investment to break that cycle of costs.
Norway and Denmark are funding about 60 percent of low-income moms to get home visits. They are moving the needle on child readiness and more importantly, they’re moving the needle on how kids perform long term.
Youth Services Insider is mostly written by Chronicle Editor John Kelly.