Some situations have looked grim, Amy Cross conceded, in her meetings with at-risk mothers.

Some had not received therapy for their tots with developmental delays, she said. Other mothers were homeless, unable to afford basic food and clothing.

"Sometimes I encounter mothers who are using substances, and not as available to their children, or they are also sometimes depressed," Cross said.

These might sound like situations where children should be removed.

But thanks to nurses like Cross, that doesn't have to be the case.

New mothers have found their footing as parents through the Nurse-Family Partnership program, long operated in the Spokane Regional Health District and now extending into North Idaho.

A national program, NFP assigns nurses to provide ongoing home visits to low-income, first-time mothers. Besides providing guidance on health matters, nurses also help mothers with adapting to a parenting lifestyle and becoming economically self-sufficient.

"It's a long-term relationship with a family that affects long-term results," said Cross, adding that in working for SRHD, she has helped mothers from pregnancy all the way up to the first two or three years of a child's life.

Now North Idaho mothers will have that long-term support.

The Panhandle Health District has partnered with the SRHD to expand the NFP into Shoshone and Kootenai counties.

Two nurses, Cross and Diana Bird, will each serve up to 25 clients in the two counties.

That's ideal, as a state needs assessment found a high number of at-risk mothers in both counties, said Cynthia Taggart, PHD spokeswoman.

"At risk can mean any number of things. It could be emotional, could be mental, it could be you're 14 years old and you're pregnant," Taggart said.

The 2010 assessment shows the rate of substantiated neglect in Kootenai County at 12 per 1,000 children, eclipsing the state average of 2 per 1,000.

Other high indicators in the county include intimate partner violence and high school dropouts.

Having constant NFP support can bolster the confidence of struggling mothers, Taggart said.

"Women who are pregnant the first time, they have no experience being a mom," she said, adding that many might not have a parental figure to turn to for help.

NFP's impacts can be far reaching, Cross said.

She has helped mothers find therapy for disabled children, she said. She has connected families with resources for housing, food and clothing.

She also offers motivational talks to mothers, she said, to pin down their goals.

"If we can find even a small strength to support that client, she can realize she can make great changes for the benefit of her family," said Cross, a Spokane Valley resident.

SRHD will supervise and support PHD's program. PHD will encourage client referrals from the medical community, mental health agencies, food banks, shelters and more.

NFP has been found to reduce child abuse and neglect, Cross said, as well as visits to the emergency room for accidents and poisonings.

"We've got mothers who have more confidence, they will possibly go back to school, go back to work, and raise healthier, happier children," Cross said. "They're less of society's responsibility and more of a family responsibility."

For more information about the program through PHD, contact Lisa Cramer, NFP coordinator, at 415-5298 or lcramer@phd1.idaho.gov.