Tanisha Reiff became sexually active at 14, had three partners, and was a mother by 15.

She is raising 6-month-old Kayla at her mother's house on Clifford Avenue in Rochester. Reiff remembers when she told her mother about the pregnancy.

"She was shocked and then she got kind of mad for awhile," she says. "But she went to the ultrasound with me. She's been a good support for me."

The family doesn't have a phone, so when Reiff gets callbacks on job applications, the message has to work its way from a cousin's house up the street. The system rarely works.

Reiff is on the younger side of parents in the Nurse-Family Partnership Program, where nurses do regular home visits with eligible mothers from pregnancy through the second year of their children's lives. Developed in large part in Rochester, the program helps low-income, first-time mothers learn how to care for their children and to also make healthier physical and behavioral choices for themselves. Advocates credit the Nurse-Family Partnership Program with everything from improved school readiness for children to fewer arrests and convictions for mothers.

Dr. Jeff Kaczorowski, a pediatrician and executive director of the Children's Agenda, says that the program is nationally respected as one of the most effective ever created for vulnerable children and families. The program is active in 25 states.

Today, Reiff and nurse home-visitor Cheryl Rodriguez will review developmental milestones to see how Kayla measures up. Rodriguez also offers Reiff guidance on playing with her child in a way that is both fun and educational - using several words to describe a favorite toy, for example.

"When Cheryl came in, I asked her a lot of questions like, why did the baby gag when she was breastfeeding," Reiff says. "It helps me a lot."

Reiff plans to go back to school and to enroll Kayla in day care. Reiff attended the city school district's Young Mothers Program while pregnant and expects to rejoin her class at Jefferson High School, so her education has stayed on track. She wants to go to college and study to be a pediatrician or a speech therapist.

Life is much different, Reiff says, since she had the baby.

"I used to go out with my friends and stuff," she says. "It's harder now because I have to stay home with her or care about who watches her."

Reiff hasn't used birth control until recently. She says that she just didn't think about the possibility of getting pregnant.

"A lot of girls are not thinking about it," Rodriguez says. "They're walking around with this attitude that, 'It's not going to happen to me.' Or it's not a problem because it's happening to so many of their friends and their friends are getting by. Whereas, 20, 30 years ago it was devastating to be a teenager and be pregnant."

Reiff hasn't seen Kayla's father since she was two months pregnant.

"It makes me mad inside," she says, "because he's missing out on her life."

The origins of the NFPP go back 30 years when program founder David Olds, a psychologist, began a trial program in Elmira, New York. Contributing significantly to the program's development were researchers from the University of Rochester, including Dr. Harriet Kitzman, now associate dean of research at the university's School of Nursing.

"There was more and more literature, more and more understanding of the importance of pregnancy and the first few years of a child's life," Kitzman says. "It also became very well-recognized that some women and children and families who were economically disadvantaged were then at more risk for problem behaviors that affected the development of school behaviors, school problems, and life problems."

Rochester and Monroe County started a Nurse-Family Partnership Program in July 2006. Women are referred primarily through their OB providers no later than the 28th week of pregnancy.

"Ideally, the objective is to get them around the 16th week," says program coordinator Pam Scott. "The earlier you pick them up in the pregnancy, the more influence you have - not only on the pregnancy. You also develop a stronger relationship so that they will continue through the second year."

The program targets first-time mothers because they typically do not have preconceived ideas about parenting, and it is hoped that any subsequent children will also benefit - although that has not been studied.

The age range of mothers in the program is 15 to 19. The youngest is 13.

The Nurse-Family Partnership is run through the County Health Department. Each full-time nurse - there are 12 in the program - carries a caseload of no more than 25 families.

Nurses and mothers work together to develop goals based on the needs and wants of the individual clients. But there are some basics. Nurses can help a mother learn to read a baby's "cues" and advise her on what to expect with labor, feeding, diapering, and basic infant care. Nurses also track the baby's development and can alert health-care providers when there's a problem. They can act as a life coach - helping mothers evaluate the health of their relationships, for example, or teaching them to use community resources to obtain housing; all the while keeping in mind that mothers are on their own when the program ends.

"We're working to help them to be self-sufficient," says nurse home-visitor Jobene Robinson.

Some maniac is honking compulsively on East Main Street, underneath Secilya Rivera and William Wilkinson's window. An infrequent breeze gently rolls the sheer drapes in a living room so cramped that the five adults standing in it could simultaneously touch by stretching out their arms.

"We're going to get out of here as soon as possible," Wilkinson says.

Wilkinson, 21, is a rarity - a father actively participating in the Nurse-Family Partnership Program. The program is mostly made up of single mothers. Rivera and Wilkinson have a 5-week-old daughter, Kiyana.

"I want her to have both of her parents. I grew up only with my mom," Wilkinson says. "My dad left me on my first birthday, and I didn't want that to happen for my daughter. My daughter is my world."

Many of the mothers in the program got pregnant by accident, but Rivera, 26, wanted to conceive. She tried with other partners before becoming pregnant with Wilkinson's child. She had worked as a nanny, she says, and was comfortable around children.

But there are issues.

Rivera has a mild mental disability, anxiety, and depression, Rodriguez says. It's immediately clear to even a casual observer that Rivera has difficulty coping when Kiyana is upset. She tends to overcompensate by patting the baby too hard, feeding her too much, or not putting her down when she should.

"I feel like there must be something wrong with me," Rivera says. "Sometimes she'll cry and she'll yell and yell and yell. It's aggravating, because you don't know what's wrong with her."

If the stress is too much, Rivera says, she'll give the baby to Wilkinson, go into another room, and try to calm herself down before interacting with Kiyana again.

Kiyana, with a mess of dark hair and those opaque baby eyes, spits her lunch out all over her mother. Her fussing gathers strength while Rodriguez, in a calm and instructive voice, tries to help Rivera find the source of Kiyana's discomfort.

"What do you think is going on?" Rodriguez says, leading Rivera. "She's 5 weeks old - newborns sleep a lot. She's been fed. She's dry."

Rivera surmises that the baby needs to sleep. Rodriguez helps Rivera swaddle Kiyana - Rivera sings nonsense lyrics while commencing the work - and then holds the baby in the air, on her side - parallel to the floor. It's like magic; Kiyana quiets almost instantly.

"You see?" Rodriguez says. "You did it. I just talked you through it. You did it."

The evidence is that the impact of the Nurse-Family Partnershipistransformational and long lasting, as demonstrated through evaluations of trials done in Elmira, Memphis, and Denver. Improvements in prenatal health, birth outcomes, child development, academic achievement, and maternal employment were reported, as well as reductions in child abuse and neglect, early childhood injuries, and mental-health problems.

An October 2007 follow-up on the 1988 Memphis trial showed that mothers had fewer babies, more time between pregnancies, and increased stability in their relationships. The children - age 9 at the time of the follow-up - had better grade-point averages and test scores in math and reading than their counterparts who were not in the program.

"It has been very, very rewarding to see the possibility and potential for really improving the lives of children and families," Kitzman says.

Rochester doesn't have that kind of data yet, because the program is so new - the first "graduating class" is January 2009. But the anecdotal evidence reported by nurses is encouraging in terms of the percentage of mothers who breastfeed, who go to work or school, and even who can make a doctor's appointment on their own, Scott says.

"I had a visit today and the young lady, just her being able to play with the baby, being silly, was huge," Robinson says. "She was able to get on the floor - she didn't worry what people around her thought - and using noises or clapping really excited and using facial gestures. That was huge."

Rodriguez has noticed changes, too. Reiff's priorities are less self-centered these days, for example, she says.

"When we first started, she was focused more primarily on socialization, and she's become a lot more focused on the needs of her baby and her future," Rodriguez says. "She's more mature than I expected, and I'm very proud of her. She's moving in all the right directions."

The nurse-mother relationship has also helped Rivera.

"Before, I was so depressed, I didn't even want to step outside," she says. "Now I take her everywhere and go outside. And I never used to do that."

Building trust with the mothers, who've often experienced upheaval in their lives, is a critical component of the program, Scott says. And once a trusting relationship is established between nurse and client, it is hoped that the mother will want to share that experience with her child.

"It's very surprising for them when you keep coming back," Scott says. "Y'know, they may blow you off for three or four visits. And the nurse keeps coming back. I think, sometimes, it's quite amazing to them."

The nurse home-visitors are sometimes the only consistent presence in these young mothers' lives.

"You do develop a different kind of relationship with the young ladies, because you are in their home," Robinson says. "They are inviting you into their home. You may be the first person who asks them, 'Well, what do you think? What do you want to do?'"

 After Rodriguez is finished with the baby, it's Rivera's turn. She checks Rivera's weight and then asks about her smoking habit. Rivera says that she still smokes cigarettes, but hasn't done anything more serious in awhile. Rivera smoked marijuana while she was pregnant with Kiyana. Rodriguez says that she tried to get Rivera to quit, and Rivera did stop eventually.

"I don't need it right now," Rivera says. "I have bigger plans: taking care of her and being a better example for her so she don't do any of that stuff."

Rivera's difficulty coping worries Rodriguez. On a previous visit, Rodriguez canceled a later appointment with another client so that she could stay longer with Rivera. She says that she wanted to make sure that the couple had a safe plan for when the baby wakes up crying in the middle of the night.

Wilkinson appears to be very supportive of Rivera - sitting close and rubbing her back when the questions drill a little too deep. Their commitment to their daughter is what's important, Rodriguez says, even if their relationship isn't built for the long haul.

Wilkinson says that he's determined to give Kiyana a better upbringing than the one he had - a better environment, a better school, and a better future.

Wilkinson's pronouncements are bold and declarative, but Rivera voices her hopes like a wish put on a penny.

"I hope she stays beautiful," she says.

Rodriguez momentarily lets her professional demeanor slip and assumes a tone of passion and urgency.

"Remember, beauty comes from the inside," she says. "You start teaching her that now, while she's still in that crib, and she will always believe that. You have to teach her what beauty is now, before she gets out there and other people in the streets start talking to her. Because you two are her first teachers."

Descending the narrow staircase to her car, Rodriguez concedes that Rivera and Wilkinson have a ways to go before they're able to give Kiyana that kind of confidence.

"We're going to do that between now and the day she graduates from our program at 2 years old," she says, pausing to let a hint of drama fill the space between words. "See? This is why I love my job."