Understanding Vulnerable Families in Multiple Service Systems Understanding Vulnerable Families.

We analyze Illinois families facing multiple barriers and their interactions with public-sector services. Using administrative data from five state agencies to identify families' receipt of child welfare, mental health, and substance abuse services as well as adult and juvenile incarcerations, we identify individuals across systems using probabilistic record-linkage techniques, defining family clusters based on networks of individuals who share child welfare and food stamp cases. We show that 23 percent receive services in two or more of these areas. This concentration accounts for 86 percent of the funding for these services used by the entire sample. They experience more and more severe problems. This population is otherwise heterogeneous, engaging with different types of services and clustered in certain parts of the state.

Status of Breastfeeding and Child Immunization Outcomes in Clients of the Nurse-Family Partnership.

Background The Nurse-Family Partnership (NFP) is a home visiting program serving first-time, low-income mothers, with an area of focus on healthy early childhood development. Previous foundational trials of program effect on breastfeeding and immunizations have shown a mix of neutral and positive results. The present evaluation investigates these effects following program scale-up, using a large contemporary cohort of clients. Methods Nurse-Family Partnership client breastfeeding and immunization status were compared to National Survey of Children's Health data and National Immunization Survey data, respectively. Sample differences in demographic covariates were adjusted using logistic regression. Results Nurse-Family Partnership clients were significantly more likely to have ever breastfed (adjusted prevalence ratio [aPR: 1.20 (1.17, 1.23)] and maintain breastfeeding at 6 [aPR: 1.17 (1.10, 1.24)] and 12 [aPR: 1.39 (1.25, 1.53)] months, but less likely to exclusively breastfeed at 6 months [aPR: 0.84 (0.70, 0.95)] NFP clients were significantly more likely to be up-to-date on immunizations at 6 [aPR: 1.23 (1.22, 1.25)], 18 [aPR: 1.33 (1.30,1.35)], and 24 [aPR: 1.15 (1.14, 1.16)] months of age than the reference cohort, with no significant difference at 12 months. Discussion Nurse-Family Partnership clients had more beneficial breastfeeding and immunization outcomes than children of mothers with demographically similar profiles. However, exclusive breastfeeding at 6 months lags behind the reference sample and represents a potential area for further improvement.