June 11, 2019

Michael Weller was changing his son Jaxon’s diaper when Nurse Jen Gould stopped by for her bi-monthly visit. Gould — who works with Multnomah County’s Nurse Family Partnership program — kicked off her shoes and greeted Weller and his partner, Alexis Elizando. Weller set his son onto the living room carpet, as the women settled down to chat.

The 7-month-old has just begun eating baby food.

Ramon Alexander Chino-Cortes has known his home-visiting nurse Jeanne Arnold since he was born.

“He ate a whole little baby jar of applesauce,” Elizando said, looking down at Jaxon, who pumped his chubby limbs, wiggling like a bug stuck on its back. He finally flipped to his stomach, pushed himself up on extended arms and tipped back his head to look at the faces above.

“I can’t keep him still,” Elizando said.

“There comes a certain point when all bets are off,” Gould said with a smile and a nod, as the family’s Chihuahua, Scotty, ran into the room, beelining for Jaxon and licking his nose. The family's other dog is older and grouchy, Elizando said, and Jaxon is just learning to pinch. Gould nods again.

“Yeah, we have to protect our kids from the dogs and our dogs from the kids,” Gould said.

They go on to discuss diaper rash, teething, sleeping safety tips, and the curiosities of babyhood.

Jaxson sucks his thumb. “But he gags himself sometimes,” Elizando said.

That’s normal, Gould said. “They don’t know their gag reflex yet.”

The parents and Gould talk about their son’s health and whatever else is going on in their lives. Gould supported Elizando and her partner through early sobriety and helped them navigate family dynamics when some relatives still actively used drugs or drank and offered to watch the baby. And she helped them find paternity resources to assure Weller will legally be recognized as Jaxon’s dad.

“It’s really comforting. Almost like having another mom in a way,” Elizando said. “She’s more than a medical resource. It’s health in the broad sense of the word.”

Elizando is one of more than 3,000 mothers who have been served through the Multnomah County Nurse-Family Partnership, which marks its 20-year anniversary this year. Nurses and clients will join elected officials June 13 to recognize the program during the regularly scheduled Board of Commissioners meeting.

The Nurse Family Partnership is a program of Multnomah County Public Health and housed in the County’s Northeast Health Center. The program connects a woman pregnant with her first child to a nurse who supports the woman until her child’s second birthday. The program emphasizes economic self-sufficiency, education and community.

“Nurse Family Partnership was started to work alongside expectant parents when they need it most,” said LaRisha Baker, director of Multnomah County’s Maternal Child and Family Health program. “We are proud of the success that Nurse-Family Partnership is having to strengthen families in the Multnomah County community and save taxpayers money.”

Nurse-Family Partnership is supported by the County General Fund, state contributions and Medicaid. Research shows every $1 invested in the Partnership can save up to $5.70 in service costs for families at greatest risk.

Researchers have found::

  • Children born into the program live in homes with fewer safety hazards and more intellectually stimulating toys, games, and reading materials. Those kids made nearly 90 percent fewer visits to the physician for injuries or stomach upset, and nearly 40 percent fewer visits to the emergency department.

  • Families in the program experienced fewer interactions with child protective services and required less federal assistance such as food stamps, social security, disability, and housing benefits.

  • Parents who participate in the program were less likely to mistreat that child, reported staying together longer, had fewer children and less impairment from drug and alcohol use.

  • In turn, the daughters born to mothers who were part of the program were less likely to become involved with the criminal justice system, and had fewer children on average, and relied less on government assistance.

“This is upstream public health,” said nursing supervisor Robin Nelson. “The data speaks for itself.”

Nelson spent more than a decade in primary care clinics before joining Nurse Family Partnership at the County.

“I always felt like there was something missing. A client was in and out in 15 minutes, and there’s so little we get to know in that context,” she said. “It was amazing how the picture became so much more clear though this program about how to support families when you understand their home environment, their neighborhoods, family dynamics.”

Nelson supervises a team of four registered nurses, who each make weekly or bi-monthly home visits to about 25 women and their children. They carry information packets and weight scales, gauge infant development and a mother’s mental health. But it’s not always medical expertise a mother needs. It might be brainstorming career paths, offering moral support, or helping a family connect to other services.

Mother Cindy Cortes-Rojas, left, with her son Ramon Alexander Chino-Cortes. She said her nurse Jeanne Arnold was like family. Here they visit with

Like many expectant mothers, Cindy Cortes-Rojas learned about the Nurse Family Partnership during a primary care visit. Her extended family was tight-knit and close-by. Her pregnancy was easy and her labor was short. Her son, Ramon Alexander Chino-Cortes, was healthy and happy. He sleeps through the night and takes naps.

But she had many questions about how to care for her son, especially when so many people offered advice. And she turns to her nurse, Jeanne Arnold.

“My family would tell me to eat this, or give him that, and I’d ask Jeanne,” Cortes-Rojas said with a smile. “I’d always listen to her.” When Ramon got a rash at 1 month old, her family told her not to worry, but Arnold suggested she ask her doctor. The pediatrician diagnosed an allergy.

Arnold was there when Cortes-Rojas struggled with breastfeeding. “I couldn’t hold him right, and I said, I’ll just get formula,” Cortes-Rojas recalled. “But my husband told me my milk was better.”

With help from nurse Arnold, Rojas-Cortes tried dozens of positions until she found one that worked for her son. “And after that it was easy,” she said. “It made me happy. I felt like he was happy.”

Rojas-Cortes had all the normal questions of first-time parents: Why is he putting everything in his mouth? When is he going to walk? At 14 months, Ramon should soon start to walk on his own. Arnold assured her he’s making progress. Last week Arnold suggested she let Ramon go barefoot to gain a more sure footing. Rojas-Cortes said she’s noticed a difference since then.

And while the family is healthy and happy, money has been a strain.

“We live well. We don’t drink. We don’t smoke. We like to stay home,” Rojas-Cortes said. “The only thing is finances.”

Her husband, Ramon Chino-Severiano, works in agriculture. And while strawberry season has brought longer hours, the winter months are tight. So Arnold connected the family with a program to offset their water and electricity bills. And that freed up money for diapers and other necessities.

Arnold has come to visit Rojas-Cortes and Chino-Severiano since they were pregnant with Ramon. Their son has known Arnold since he was born. But in nine months, when Ramon celebrates his second birthday, the family will graduate from the program and Arnold will move on.

“It’s sad. I don’t see Jeanne just as a nurse. She’s become part of the family,” Rojas-Cortes said. “She has always given me support. She reminds me to enjoy each moment.”

Moral support and encouragement was perhaps the most powerful medical intervention Jenna Brett received from nurse Thea Nealschneider after a terrifying birth and months of postnatal isolation.

Brett’s son, Augustus “Gus” Pennington, was born 11 weeks premature. Brett was a first-time mother, learning to parent a medically-fragile new life, while struggling in her relationship and questioning what to do with her life.

“When Thea came, I thought she would really help Gus, but Thea became my therapist, my helper, my friend,” Brett said. “She always told me I was doing good. She told me I was doing the right thing. That I’m doing the best I can.”

Jenna Brett, left with her son Augustus “Gus” Pennington and their home visiting nurse Thea Nealschneider.

On a recent morning, Nealschneider paid Brett a visit, two years after the family graduated from the Nurse Family Partnership. Brett’s son Gus, now a happy redhead of 4, played in the back yard with children who come for the daycare Brett operates out of the family home.

The women teared up when they talked about the intensive few months after Brett’s birth. She could only hold little Gus once a day, and her breast milk hadn’t come in yet. She used a pump every two hours, including nights, to coax her body to produce more milk. She tried for months. She even made lactation cookies to help the process along.

“It was supposed to be easy,” Brett said. “People have been doing this forever.”

Nealschneider would encourage her, saying, “There are so many moments when you have to adjust your expectations of what parenting is going to be. Your love isn’t in your breast milk.”

All families who take part in the Nurse Family Partnership struggle to make ends meet. But the program was designed specifically to help those that face obstacles such as homelessness, involvement with the criminal justice system or addiction.

Yet poverty, past criminality, or a history of substance abuse is little reflection of how well someone parents, said nurse Jen Gould.

“It’s a privilege to see people, to see who they are, and to see the strength that comes from their experience, rather than the deficit,” she said.

Hilary Milovich didn’t see that strength in herself; not until she realized she was pregnant. She thought she wasn’t worthy of becoming a parent, she said.

Milovich became a ward of the state at age 10, and repeatedly ran away from foster care placements before landing with a couple for four, short stable years. At 18, she flew to Guam, where she worked in strip clubs and began using drugs. She later worked as an escort.

Milovich earned a stretch of sobriety when she was 30, but lost it again. Her boyfriend, Joe, had lost custody of his two kids from addiction, and finally asked her to get clean with him. Ten weeks later they discovered they were pregnant.

“I was worried I wasn’t worthy of being a mom. It’s the biggest responsibility,” Milovich said. “But once I became pregnant, there was no question about my duty from here on out.”

Milo, center, plays with his mother Hilary Milovich, right, and their home visiting nurse Jen Gould.

Milovich joined the Women Infants and Children program, where she learned about the Nurse Family Partnership. Despite Joe’s fears of inviting a government worker into their home, Milovich signed on to have Gould come for regular visits.

Milovich and Gould sat together on a warm spring evening in Milovich’s Happy Valley condo to talk about the program. Milovich’s son Milo, now 2, watched Blimpy on her iPhone. Her cat Mason, now 13, spread out on the carpet.

“It was amazing with all the history that you let me in,” Gould told her.

“I needed help,” Milovich said. “Being a new mom I had no idea what I was doing, how to breastfeed, how to pump, how to freeze my milk. There’s a lot to it,” she said. “Jennifer taught me how to put a diaper on. I had questions about the poop itself. All the colors.”

Gould smiled, “We do a lot of reassuring for normal stuff.”

Milo fell off the bed when he was 6 months old, and Milovich, terrified, immediately phoned Gould. Gould gets a call like that every couple of months, and calmly walked Milovich through the warning signs — was Milo vomiting, crying inconsolably or suddenly sleepy? If not, he’s probably fine, Gould said. Then they problem-solved how to prevent another fall, prompting Milovich and Joe to move the mattress to the floor.

Milovich smoked throughout her pregnancy, and it made Joe angry.

“It was constantly a problem with us,” Milovich said. “But Jennifer just had this way of saying, ‘it’s better if you don’t.’” Gould and her often talked about smoking during their regular meetings. Finally, when Milo was 5 months old and without pressure from Gould, Milovich gave up cigarettes.

Gould and Milovich also talked about relationships and dreams, about her “heart’s desires.”

“That’s actually part of the curriculum,” Gould said.

Milovich had earned a few college credits. During their early visits, Milovich would sit on the couch chewing Red Vines and talk about earning a degree. She told Gould she was going to do it one day.

This month she graduates with an associate’s degree from Portland Community College. And she’s enrolled at Portland State University to pursue a bachelor’s in social work beginning this fall.

“It’s the most amazing thing, to shift focus from yourself to another human being, to be responsible for, to love and care for,” she said. “That’s something I wanted so badly and never had.”

Milo finished his children's show and looked up.

He grabbed his mother’s finger and led her to the kitchen for a frozen Go-Gurt. Then they walked back through the living room, stepping over a plastic Thomas the Tank Engine and Mason the cat, to a sunroom filled with toys.