Bringing Up Baby: Instructions Now Included
For parents who need extra help, family support and coaching are now stronger than ever.
Maia Cortissoz was still in pain from her cesarean section and emergency follow-up surgery when a stranger walked into her hospital room and handed her a packet.
“She said, ‘If you want to sign up for this program, we will come to your house every week,’ ” Cortissoz recalls.
The new mother of twin girls Thalía and Raquel had no idea at the time how much she would come to rely on the regular visits by nurses from the United Way of Santa Fe County in New Mexico. But in the ensuing months and years, as she struggled to care for her daughters while recovering from surgery that initially left her unable to nurse, battling severe postpartum depression, and coping with a layoff from her job, Cortissoz viewed the visits as a lifeline.
“It was a rough start for us, with the birth, the inability to nurse, then losing my job. Some days I was great and some days I was a sobbing mess,” says Cortissoz, now 33. But when the nurse visited, “she always had some sort of idea to help me out.”
Cortissoz frequently talks about how much nurses from the United Way helped her and her partner, Jesse Sandin, survive their difficult first years as parents. At the United Way office, where she now works as a researcher and data analyst, she shares her story with other new parents who might benefit from home visits, and also with potential donors. “We used a picture of the twins and us in the United Way holiday card last year—as a success story,” she says proudly.
Cortissoz and Sandin are among thousands of parents around the country who have benefited from home visits provided by government-funded, locally implemented family support and coaching programs. Although the programs have been offered in some states for nearly three decades, they became more accessible when the Bush administration allocated federal money for them in 2008. They got another boost in 2010 when the Obama administration created the Maternal, Infant, and Early Childhood Home Visiting program.
This federal-state partnership establishes standards while allowing states and local communities to set their own goals and tailor the program to the needs of their residents. Some jurisdictions offer prenatal care, some focus on getting children ready for kindergarten, and others help vulnerable families become more resilient, better able to handle stress, and more self-sufficient. Altogether, the Department of Health and Human Services has approved 17 evidence-based programs to provide assistance for some period from the time a woman becomes pregnant until her child turns five. The models have a few things in common: They are based on scientific research, they are voluntary, and they aim to help vulnerable families during the first, often stressful years of a child’s life.
Family coaching teaches parents about their babies’ health, developmental milestones, nutrition, and breastfeeding, says Katherine Freeman, president and CEO of the United Way of Santa Fe County. “We’ve also seen very early identification of developmental delays,” she says. “If treated in the very first year of a child’s life, these delays can be easy to deal with. But if they’re not identified until later on, they could be heartbreaking.”
Freeman credits the state’s home visiting program, which receives significant philanthropic support, with helping to identify such serious problems as substance abuse, child abuse, and postpartum depression.
For seven years, The Pew Charitable Trusts has collaborated with state and federal officials, family advocates, and nonprofit organizations to raise awareness about the need for support and coaching programs. It has worked to increase the programs’ effectiveness and accountability and to help them attract government and private investment.
Pew also has assisted 11 states in enacting laws requiring that publicly funded home visiting programs have a proven record of effectiveness, clearly articulate the investment goals, and most importantly, measure results.
“We helped states develop and enact policy that enhances the overall quality of the home visiting network,” explains Karen Kavanaugh, director of Pew’s work on family support and coaching. “States didn’t always know who they were serving or what they hoped to achieve. We helped them set their goals so they knew if they were being successful.”
Once a state passes legislation, she says, Pew helps advocate to secure additional appropriations to finance the programs.
In April, Pew helped to persuade Congress to extend the Maternal, Infant, and Early Childhood Home Visiting program for two years at $400 million each year. The legislation drew strong bipartisan support in the Senate and the House.
“I’m absolutely convinced that for many, many parents, these programs are essential for strengthening families and making them resilient,” says Kavanaugh. “When I think about the isolation that many of these families experience, it really makes a difference to have someone who comes in in a trusting relationship, a consistent relationship, and helps parents.”
Jessica Apodaca of the United Way of Santa Fe County, right, meets with first-time mother Lucy, who had heard about home visiting help from a friend when pregnant with Elise. They will continue to get together once a week until Elise is 3, measuring her development to ensure she is growing cognitively, socially, and emotionally.
Research shows that quality family support and coaching programs—often called home visiting programs because they take place in the home—ultimately reduce health care costs, lessen the need for remedial education, and increase self-sufficiency within families. The programs also are a wise investment in the long run: For each dollar allocated to home visits, taxpayers save $2 in future government spending.
“The Pew campaign started after the analysis that home visiting programs were a very good investment, both in terms of achieving child and family outcomes and saving taxpayers money,” Kavanaugh says.
She says Pew’s work has received support from law enforcement officials, who view home visits as a way to reduce child abuse and neglect; from the business community, which sees them as a way to ensure that children receive the education they need to succeed in school and eventually the workforce; and from state officials, who look to the programs to offer needed support to families.
“I’m a real believer in getting involved with families early on,” says James Haveman, who recently retired as director of the Michigan Department of Community Health. Family support and coaching “used to be done by neighbors and other family members. So much of that’s missing these days, and many young women and men need help with parenting and education and decisions about [whether to have] a second child.” In Michigan, he says, “Home visitation does a lot from early on to 3 years old, where so many formative things happen.”
Michigan spent $11.7 million to provide home visits to 40,000 families in the fiscal year that ended Sept. 30 and has committed $14 million in the current fiscal year. “We’re so enamored of this program that the governor [Rick Snyder] started what he’s calling the Michigan Partners for Success” to attract foundation money and increase home visits further, Haveman says.
Michigan aims to reduce premature births, infant mortality, and child maltreatment and to improve school readiness and family self-sufficiency.
“There’s a lot we can do to have healthy families and healthy kids,” says Haveman, who earlier in his career was appointed by President George W. Bush to build a health care system in Iraq. “The home visitation program is a cornerstone for us.”
Pew also worked with the New Mexico Early Childhood Development Partnership, a division of the United Way of Santa Fe County, to advocate for the state’s Legislature passsage of the Home Visiting Accountability Act in 2013. The law sets quality standards for home visiting programs and measures how well those programs perform.
Although New Mexico offers home visits to all first-time parents, the services are especially essential to the high proportion of New Mexican families living in poverty, says Claire Dudley Chavez, director of the New Mexico Early Childhood Development Partnership. From 2011 to 2013, the largely rural state with a vibrant tribal community had the highest poverty rate in the nation: 21.4 percent, according to a 2014 U.S. Census Bureau analysis.
Lucy and her husband, Okwen, have come to rely on their weekly home visiting sessions to help them with Elise. "We did the birth preparation and even parenting preparation classes, but now that we're in the thick of it, we feel very grateful to have someone who checks in and brings back our big picture perspective," she says.
Now, in partnership with the Santa Fe-based Thornburg Foundation, Pew is working to strengthen the outreach of the programs, conducting interviews and focus groups to learn how to reach more families. (See Trust, Winter 2015.)
When Pew began to work on family support and coaching in 2008, it set out, as the institution often does, to be a catalyst for change by establishing specific goals that would have a lasting impact.
Those objectives included ensuring federal funding, increasing state funding, creating accountability measurement in at least 11 states, and directing revenue toward programs with a proven record of effectiveness.
Having achieved the federal and state funding and created more effective home visiting systems in the 11 states, Pew will transition out of the field this fall, but not before it completes work on its latest project, the Home Visiting Data for Performance Initiative, to help states track and measure outcomes. Pew is working with those states and Los Angeles County to create a concise list of indicators that would provide solid data to help those working in the field to improve the health, safety, and school-readiness of children.
“Creating a strong measurement of what works and what doesn’t in helping young parents will in many ways be our strongest legacy in this field,” says Kavanaugh. “Real, positive change for American families has resulted from these programs, and we want to ensure that lasts.”
Jodi Enda is a Washington-based journalist who has written extensively for Trust about Pew’s work in the states.