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Home Visiting: Tales, Triumphs and Trailblazing

Tiffany’s first child passed away only days after being born.  

Not long afterward, she discovered she was pregnant. Six months later her son, Deshaun, was born premature, fighting for his life in the Neonatal Intensive Care Unit.

“He was on life support and I thought he wasn’t going to pull through,” she recalled.

But this time, Tiffany had someone by her side at Long Beach Memorial Hospital to provide help: her Welcome Baby parent coach.

“We were still going through a lot with the loss of our first child,” Tiffany recalled. “Welcome Baby helped me get through it. They were a great support. They taught me what to do when I was stressed and gave me a book on premature babies. It really helped because I didn’t know what to do or what to expect having a preemie.”

“We were still going through a lot with the loss of our first child, Welcome Baby helped me get through it." -Tiffany

For two months, Tiffany sat next to the incubator, waiting to hold her baby. She brought with her a small baby book, “Happy Baby”, from a new mother kit provided by Welcome Baby. While she couldn’t reach Deshaun through the incubator’s plastic shell, Tiffany touched her baby with the love in her voice each time she read the book to him.

Thankfully, her bonding with Deshaun did not end there.

Through Welcome Baby, Tiffany learned to bond with Deshaun – now 4-1/2 years old and going strong – and two more healthy children she has given birth to since at a Welcome Baby hospital. Her youngest, 1-year-old Nevaeh, was born at Martin Luther King Jr. Hospital.

Throughout the pregnancy, birth and first nine months of growth of each child, Tiffany has benefited from the in-hospital and home visits through Welcome Baby and other First 5 LA-funded home visiting programs that provide bonding and attachment advice, resources, infant developmental information, parenting tips and so much more support than can be listed on the Welcome Baby web page.

“Sometimes with a child all you do is feed them and get them to sleep. With the Welcome Baby program, it teaches you to build a relationship with your child,” Tiffany said. And each time she enrolls in voluntary, free home visiting, she learns something new from her parent coach. “I understand baby talk now. When Nevaeh talks, I can figure out what she says by some of the words she is saying and where she is pointing.”

When it comes to home visiting, First 5 LA is pointing others in the right direction, as well. New developments in countywide home visiting efforts, a first-of-its-kind state home visiting initiative and recent research all reflect First 5 LA’s growing influence in programs, partnerships and policy and advocacy to enhance and expand home visiting in Los Angeles County, California and beyond.

A SHOWCASE OF FAMILY STRENGTHENING

Perhaps no better showcase of the impact of home visiting in L.A. County is the LA Best Babies Network (LABBN) Family Strengthening Network Summit, co-sponsored by First 5 LA and held each June. The 2018 event drew more than 500 participants from nearly 40 agencies, including home visitors, nurses, hospital liaisons, staff, supervisors, researchers and First 5 LA staff and leaders to celebrate the power of home visiting, share research and hear testimonials from parents and home visitors. 

“We’re here to celebrate you and the work you do with your families,” Sharlene A. Gozalians, assistant director of Programs at LABBN, told the audience. “Your work directly benefits and transforms the communities you serve. No amount of research or data will ever capture the value of your work.”

“Especially in this current environment with a lot of fear and intimidation in our immigrant communities, that trust is worth gold.” -Kim Belshé 

“We know that moms and dads enter parenthood with a lot of different sentiments,” First 5 LA Executive Director Kim Belshé told the participants. “Some are confident and composed, some are a little trepidatious and some are downright scared to death,” Belshé noted. “But notwithstanding how they approach parenthood, you are there.”

Citing an April First 5 LA-funded study by Social Quest researchers that interviewed moms participating in home visiting, Belshé pointed out three key takeaways: 1) home visitors create a meaningful and powerful interpersonal bond for moms during what might be a chaotic time in their lives; 2) moms feel supported and validated by the caring and nurturing of home visitors; and 3) home visitors win a deep trust with their clients.

“Especially in this current environment with a lot of fear and intimidation in our immigrant communities, that trust is worth gold,” Belshé said. “Because of that trust, we are able to lift up parents in really powerful ways and function as the gateway in many respects to the services those families need so much.”

The work is not easy. According to the Social Quest study, home visitors typically deal with a high caseload (up to 10 visits per week), may use their personal resources to help clients (buying them a phone), have limited office space to do their work, face frustrations with entering data into a database and encounter emotionally involving work when visiting clients in cramped, filthy or unsafe environments.

Georgina Alvarez, a home visitor/parent educator with Richstone Family Center in Los Angeles, described her home visit to a mother of 11 children living in “deplorable conditions” including “a sticky carpet, stained couches, broken chairs, overflowing trashcans and roaches roaming around everywhere and a great need for food.”

“Due to her medical conditions, the client was unable to tend to the needs of her children,” Alvarez recalled. “If the older children made food, it would only be served in one plate so the children would fight over it. Due to the chaotic nature of so many people in the home, our program assistant went to the visits with me – she would bring books and activities that touched upon important topics like safety and hygiene for the children of ages 3-7 while I worked with mom and the two youngest children.”

Alvarez was only able to see the family for about two months. The mom became unresponsive after Alvarez made a report to the Los Angeles County Department of Children and Family Services.

“Although I saw this family for such a short period of time, I feel like we still made a big impact for the family,” Alvarez said. “We were able to provide donations of clothes, blankets, towels, a water filter, and other essentials, but most importantly we discussed how to make an area child-proofed and the importance of teamwork to help them move forward.”

“Although I saw this family for such a short period of time, I feel like we still made a big impact for the family.” -Georgina Alvarez

Click here for “Confessions of a Home Visitor” for a powerful profile of a L.A. County home visitor.

Indeed, study after study reinforces the positive impact of home visiting, with news on research, programs and developments appearing in articles across the nation regularly (see related article).  At the Summit, Cheryl Wold of Wold and Associates shared  A Portrait of Los Angeles County, which recommended investment in home visiting as one way to address gaps in well-being and opportunity among county residents. And Dr. Gloria Castro of the University of California, San Francisco, spoke to the positive influence of home visiting on new mothers who have experienced trauma in their lives.

First 5 LA is currently the largest funder for home visiting in L.A. County, representing 45 percent of the total funding. In addition to other Home Visiting programs (which may be referred to as Select Home Visiting or SHV), First 5 LA’s largest home visiting investment is Welcome Baby, a free, voluntary program begun in 2009 that provides L.A. County pregnant women and new moms with information, support and a trusted partner to help them through the journey of pregnancy and the first nine months after their child’s birth. Welcome Baby is available through 14 hospitals in L.A. County within the 14 Best Start Community Partnerships.

Overall, nearly 15,000 new moms and babies in L.A. County in 2018 were enrolled in a First 5 LA-funded home visiting program. Data from another study unveiled at the Family Strengthening Summit revealed that Welcome Baby enrollment rose from 8,756 participants in fiscal year 2014-15 to 12,711 through May 31, 2018. Among the study’s other highlights:

  • 43 percent of Welcome Baby participants exclusively breastfed for three months after birth which, for baby, helps prevent disease, eliminate health disparities and promote quality of life
  • Graduation rates for mothers completing the Welcome Baby program rose from 1,850 in FY 2014-15 to 5,059 in FY 2017-18
  • In a client satisfaction survey, Welcome Baby participants gave the program 4.88 out of 5 stars

This satisfaction was seen in the faces of home visiting clients who appeared on a panel at the Family Strengthening Summit, including Tiffany. She and her current home visitor Georgina Alvarez of Richstone Family Center in Los Angeles were among those parents and home visitors featured in this short video provided by LABBN Communications Specialist Steve Nish:

PROGRESS THROUGH PARTNERSHIP

Testimonials like these from parents and home visitors — along with data and research — are bolstering First 5 LA’s efforts to enhance and expand home visiting in the county, state and beyond through its communication, policy and advocacy work.  

These efforts are crucial. Sustainability is one of the most pressing challenges facing the network of home visiting programs in L.A. County. In addition to the challenge of unmet community need, current funds cannot be sustained, particularly as First 5 LA funding continues to decline with the loss of tobacco tax revenue. Home visiting is First 5 LA’s most significant and long-standing investment, at approximately $41 million annually.

“I see this in many ways as a prevention program.” -Sheila Kuehl

Recognizing that it cannot do it all alone, First 5 LA placed an emphasis on partnerships with other funders, government agencies and early childhood advocates as part of its 2015-2020 Strategic Plan. And it is beginning to pay off.

On the county level, First 5 LA has been involved in a number of significant developments since 2016, when the L.A. County Board of Supervisors, led by Supervisors Sheila Kuehl and Janice Hahn, passed a motion directing the Department of Public Health as the lead, along with First 5 LA, the LA County Early Childhood Perinatal Home Visiting Consortium, Children’s Data Network, and every child and family-serving county department to come together to develop “a plan to coordinate, enhance, expand, and advocate for high quality home visiting programs to serve more expectant and parenting families so that children are healthy, safe and ready to learn.”  The group has been meeting every two weeks since the motion passed to develop a countywide plan to be submitted to the Board of Supervisors.

John highlighted the latest progress as a result of the Board of Supervisors’ motion: “This is a significant time for home visiting in L.A. County,” said First 5 LA Senior Program Officer Reena John, who oversees the agency’s Home Visiting sustainability efforts.

  • $50 Million in Mental Health Services Act/Prevention and Early Intervention funds through the Department of Mental Health have been re-directed into home visiting in L.A. County over the next two years
  • Pilot effort with the L.A. County Department of Public Social Services (DPSS) to offer home visiting services to clients in the DPSS system. First 5 LA is supporting 50 home visiting slots through this effort
  • Pilot effort to leverage Medicaid Targeted Case Management (TCM) funding, in partnership with the L.A. County Department of Public Health. Recent changes in policy in L.A. County have enabled non-county agencies, such as First 5 LA to participate in the program, opening the door for First 5 LA-funded select home visiting (SHV) grantees to participate in TCM. First 5 LA implemented a TCM pilot in early 2018 with 5 SHV grantees, which was successful and demonstrated strong alignment between home visiting and TCM. First 5 LA plans to expand TCM to the remaining 14 SHV grantees in fiscal year 2018-19

Kuehl, who also serves as the chair of the First 5 LA Board of Commissioners, has touted the power of home visiting – and First 5 LA’s Welcome Baby program — in a number of her own blogs.

“I see this in many ways as a prevention program,” Kuehl has said, pointing to potential savings that can be made in reduction of child welfare, mental and public health services for children through home visiting.

On the state level, Governor Jerry Brown proposed and state legislators in June passed a $158 million Home Visiting Initiative (HVI) allocation in the 2018-19 state budget: “CalWORKs: Baby Wellness and Family Support Home Visiting Program,” which allows counties to utilize their CalWORKS dollars to support home visiting. The pilot initiative will be funded through 2021, with the intent to expand the program to serve more families pending the pilot’s success. This is the first time the state is directing funds toward home visiting programs, a major victory for First 5s and young children alike.

First 5 LA Policy and Programs staff was directly involved in informing/educating policy decision makers at the state level regarding how best to shape the HVI allocation to best meet intended outcomes and family needs. Learnings from the L.A. County pilot effort, a partnership between DPSS and First 5 LA (mentioned in the above bullet), helped inform the advocacy efforts.

“We participated in stakeholder groups, met with legislators and administration staff to advocate for state investment in home visiting,” said First 5 LA Senior Policy Strategist Charna Martin. “We were able to share the L.A. County pilot program design, implementation progress, initial data points, and shared learnings from the development as well as work with our county partners and advocates to rapidly respond to questions and offer resources to support program design and timelines.

“The Home Visiting Initiative is a huge win for California families.” -Charna Martin

“The Home Visiting Initiative is a huge win for California families,” Martin said, adding: “We are eager to partner on implementation and will continue to seek opportunities to expand supports for families.”

Finally, on a federal level, First 5 LA successfully advocated alongside other early childhood advocates throughout the nation in Washington, D.C. for the reauthorization of the Maternal, Infant & Early Childhood Home Visitation (MIECHV) Program.

Begun during the Bush administration, MIECHV expanded under the Affordable Care Act, and was funded at $400 million until it expired in September 2017. In February, Congress passed the Bipartisan Budget Act of 2018, which reauthorized MIECHV funding for five years through fiscal year 2022 at a funding level of $400 million annually.

“As members of the National Home Visiting Coalition, we partnered with advocacy organizations, national home visiting providers and stakeholders to advocate for the reauthorization of MIECHV,” Martin said. “We fought for priorities for the longer 5 year reauthorization and expansion while also pushing back on revisions that would restrict the impact of these critical services.”

MOVING FORWARD

How will the home visiting landscape in L.A. County change in the future? 

According to a number of home visitors from the Family Strengthening Network Summit, as well as other early childhood advocates, a welcome addition would be more father participation. 

So we asked Dr. Deborah Daro — one of the nation’s preeminent home visiting experts and a senior research fellow at Chapin Hall at the University of Chicago — about involving more fathers and other future forecasts for home visiting. 

As someone who has benefitted from the counseling and support of three different home visitors through various ups and downs —from the birth of her preemie DeShaun to her 1-year-old Nevaeh — Tiffany supports expanding home visiting across the county.

"They are sensitive to the child’s needs and the parent’s needs. It’s the best.” -Tiffany

But, as noted by home visiting experts and Tiffany herself, some parents may be reluctant to enroll.

“Most parents are scared to try new stuff,” Tiffany said. “They don’t feel comfortable with someone coming in your home. They’re afraid someone’s going to come in and take your child.”

Tiffany’s solution?  Recruit “Home Visiting Parent Ambassadors” — people in the community who have participated in a program to sing the praises of home visiting to other new parents.

“I tell other mothers to try it. Go for it,” she said. “Home visitors are very open-minded. They have a kind heart. They are sensitive to the child’s needs and the parent’s needs. It’s the best.”

Spoken like a true Parent Ambassador.

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