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Home Is Where the Heart Is

Most cute baby pictures prompt a smile. And then there is the baby picture that causes Juana Fernandez to cringe.

“There is actually a picture of me when I was a little baby holding a baby pin that I put through the electrical socket,” Fernandez recalled. “To my family, it was so cute.”

“Having kids and having done that, I’m so scared that that would actually happen to them.” -Juana Fernandez

Today, though, the San Fernando Valley mother of three sees nothing cute about it.

“Having kids and having done that, I’m so scared that that would actually happen to them,” said Fernandez, who participated in the Welcome Baby program at Valley Presbyterian Hospital in Van Nuys. “So babyproofing is a big deal. And I didn’t know that until Welcome Baby gave me all of those electrical outlet covers to babyproof my whole house.”

Learning how to babyproof a home is just one of the many benefits of Welcome Baby, a free and voluntary program from First 5 LA that provides Los Angeles County pregnant women and new families with information, support and a trusted parent coach to help them through the journey of pregnancy and early parenthood. By partnering with local home visiting programs serving the 14 Best Start Communities, Welcome Baby is offered to all women residing in Los Angeles County regardless of risk factors or socioeconomic status who give birth at one of the program’s participating hospitals.

Among the program’s key offerings: an in-hospital visit that helps new moms with breastfeeding and supports bonding; a personal Parent Coach who meets with families in the comfort of their home; an in-home appointment with a nurse shortly after delivering; referrals to additional resources; baby-and mom-friendly items; and important information on the health and development of their baby. 

“During the home visits, they are able to clear up any doubts I have,” said Juana Ramirez, a mother of six who enrolled in the Welcome Baby program at Providence Holy Cross Medical Center in Mission Hills. “For example, there may be dark spots that the baby may be born with and my questions about it were never answered before by my previous doctor. That’s one of the questions the parent coach was able to answer for me.”

Mothers who need more focused support and live in a Best Start Community are eligible for Select Home Visiting (SHV) program services funded through First 5 LA. In the 2016–17 fiscal year, 918 families were served by First 5 LA’s SHV program.

Just as kids grow, so has Welcome Baby. Since the first pilot program began in 2009, Welcome Baby has expanded to 14 L.A. County hospitals. Now new data reveals that Welcome Baby enrollment jumped 19 percent between fiscal years 2015–16 (11,429 families served) and 2016–17 (13,607 families served) — a significant climb towards the program’s full capacity, when an estimated one in four babies born in L.A. County will be a Welcome Baby infant.

“Welcome Baby is really unique in that it’s the only universal program in the county,” said Michaela Ferrari, Director of Policy for LA Best Babies Network. “It’s also a perfect example of how the program can be used to identify high-risk clients and direct them to the program that best fits their needs in terms of the select home visiting program. Welcome Baby also has the largest capacity of any program in the county so they are serving the most families.”

And while First 5 LA is but one of a number of home visiting providers in the county, the need for home visiting in the county far outstrips the current capacity to provide it (see chart on right).  

“First 5 LA has significant and long-standing investments in home visiting, and currently we are the largest funder of home visiting in the County.” - Barbara Andrade DuBransky

“First 5 LA has significant and long-standing investments in home visiting, and currently we are the largest funder of home visiting in the County,” said First 5 LA Family Supports Director Barbara Andrade DuBransky (see related article), the agency’s architect of Welcome Baby. “Sustaining existing efforts while addressing unmet community needs is one of the most pressing challenges facing the network of home visiting programs in Los Angeles.”

Recognizing these challenges, First 5 LA is working on a number of fronts with local home visiting providers, advocates, funders, county government, elected officials and other partners who share the vision that all L.A. County families have access to quality, evidence-based home visiting services. These efforts range from policy and systems change at the state and federal levels to collaborative partnerships to enhance home visiting at the county level.

“That is a big bold vision. That motivates us all,” First 5 LA Executive Director Kim Belshé said at an August 4 event touting three Welcome Baby programs at Valley Presbyterian Hospital, Providence Holy Cross and Northridge Hospital Medical Center, which hosted the event. 

While acknowledging that making the vision into reality “is hard, hard work” that is “going to take time and effort,” Belshé expressed First 5 LA’s confidence that, in collaboration with others, “we’re going to get the job done” for two reasons. First, she cited the leadership from parents, family serving organizations, and providers who bring strong voices and a tremendous amount of power to advocate on behalf of all families in LA County before local and state elected officials and decision-makers.

“Secondly, we know that home visiting services make a difference in the lives of families,” Belshé said. “The evidence tells us that children who participate in this program do better relative to their social emotional competence and communication. We know that moms who participate compared to moms that don’t participate show more affection and are more encouraging — critical skills that we know are important to putting a child on the best trajectory possible.”

Indeed, new research continues to emerge promoting the positive impact of home visiting, most notably from Nobel Prize winner James J. Heckman. This evidence joins a plethora of studies and statistics supporting home visiting’s benefits. 

First 5 LA Commissioner Romalis Taylor, the former chair of the Best Start Compton/East Compton leadership group, recognized the importance of having Welcome Baby available in his community and echoed the Board’s support for home visiting. Hear his comments in this video. 

A champion of home visiting in the county is First 5 LA Board Chair and County Supervisor Sheila Kuehl, who in December 2016 authored a motion with Supervisor Janice Hahn that directed the Los Angeles County Department of Public Health (DPH) to collaborate with First 5 LA and other county partners to develop a plan “to coordinate, enhance, expand and advocate for high quality home visiting programs.” This includes identifying strategies to maximize resources by leveraging existing and new funding.

 “The driving goal behind our motion is to create a coordinated system that closes the gaps in L.A. County’s current home visitation programs." -Sheila Kuehl

“When we introduced a home visitation motion for the County last December, we were aware of, and wanted to build on, the innovative model at First 5 LA,” Kuehl said this month. “The driving goal behind our motion is to create a coordinated system that closes the gaps in L.A. County’s current home visitation programs. Research has shown that home visitation improves family safety and parenting, health behaviors and outcomes, cognitive and social development and mental health, and decreases reliance on public assistance and criminal activity. First 5 LA has been an indispensable partner in this work.”

“This motion has provided incredible momentum to all County departments, First 5 LA and other community partners to work together in a coordinated fashion to plan for and realize this vision of sustainability for home visiting,” DuBransky said. “As a result, First 5 LA is engaged in planning for a number of promising pilot efforts with the Los Angeles County Department of Public Social Services (DPSS) and DPH, to name a few.”

With financial support from First 5 LA, for example, DPSS is committing to developing a pilot project in SPA 6 to refer participants receiving social services with children prenatal to 3 to home visiting supports. The pilot project, which is intended for families at high risk of involvement with the child welfare system, is expected to start by the end of December.

During a September 14 First 5 LA Board presentation, First 5 LA Alternate Commissioner Linda Aragon, who serves as Director for the Los Angeles County Division of Maternal, Child, and Adolescent Health at DPH, expressed enthusiasm over the level of collaboration between First 5 LA and the county departments on the home visiting motion planning effort. 

“It has just been tremendous. And it really has sparked not just this amazing partnership and collaboration between First 5 LA and the departments, but within the departments,” Aragon said. “I’ve been in this department for 26 years now, and this level of engagement is just unprecedented.”

So far, the effort has produced a common vision and guiding principles, with other developments and next steps highlighted in a June report to the L.A. County Board of Supervisors.

Among the partners in the county’s home visiting motion is The Los Angeles County Perinatal and Early Childhood Home Visitation Consortium (LACPECHVC, or the Consortium), which is co-funded by First 5 LA. Founded in 2012, the Consortium is a network of approximately 50 perinatal and early childhood home visitation programs, maternal and child health organizations, advocacy groups and stakeholders.

“First 5 LA is a funder, but it is also a member of the Consortium and has been actively involved in all of our work groups,” said Ferrari, who also serves as the Consortium’s Coordinator. “They also have been very supportive of not just the First 5 LA-funded home visiting programs, but all the home visiting programs in the county and in their efforts to coordinate those systems so that everyone gets access to those programs that suit their needs, even if it is not First 5 LA’s program.”

Among the Consortium’s recent accomplishments, Ferrari said, are a new resource directory for direct service providers; a set of outcome measures across all of the home visiting programs that will support financing strategies and a subsequent pilot to collect that data; best practice recommendations to support quality standards across home visiting programs in the county; and a home visiting webinar in June for agencies, nonprofits, government and philanthropists.

“We know that California is ready for statewide home visiting investments and that First 5 and existing home visiting programs are reliable and proven partners to help scale these efforts.” -Charna Martin

Meanwhile, First 5 LA is working with the Consortium, County partners and others to explore options to ensure the sustainability of home visiting programs in the county by researching multiple strategies: better leveraging existing funding, maximizing resources, expanding philanthropy, and examining effective sustainability strategies from other states. This work is critical, as noted in the Board of Supervisors June report, since “First 5 LA funding continues to decline with the loss of tobacco revenue, jeopardizing the long-term sustainability of the existing service capacity in the system.”

Key to this approach for future funding, support and sustainability of home visiting are First 5 LA’s policy and advocacy efforts, which were prioritized under the 2015–2020 Strategic Plan to support the agency’s new systems and policy change focus in order to maximize outcomes for a greater number of children and their families in L.A. County. 

“We know that California is ready for statewide home visiting investments and that First 5 and existing home visiting programs are reliable and proven partners to help scale these efforts,” said First 5 LA Senior Policy Strategist Charna Martin. “Our First 5 LA team is working to educate and engage with our partners across social services, public health and First 5’s to grow both intensive and lighter-touch models throughout the state.”

In California, First 5 LA supported AB 992 (Arambula) this year, which would offer voluntary home visiting to CalWORKs recipients with children under the age of 2 — creating the CalWORKs Baby Wellness and Family Support program to build off of existing home visiting programs county by county. The $100 million program, Martin said, is but one of the opportunities First 5 LA is looking forward to working on in the 2018 Legislative session, along with identifying more opportunities to “embed Home Visiting as an available option to all systems that serve our youngest families.”

“I think it’s an amazing program,” said Marco Santana, district representative for State Senator Bob Hertzberg (D-Van Nuys), who attended the Northridge Hospital event. “There are a lot of young moms who may not know what to do, and Welcome Baby helps them not only with the delivery of their baby, but afterwards. We’re glad to have Welcome Baby working with parents in the community.”

On the national stage, First 5 LA is involved in a tense drama that is expected to come to a close this week over funding for biggest federal player in home visiting, the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV).

Through federal grants from the MIECHV program, home visitors in California provided 31,007 voluntary home visits in Fiscal Year 2016 to 3,561 families statewide consisting of at-risk pregnant women and parents with young children. This included culturally appropriate, individually tailored supports to families in their homes, such as providing information about children’s health, development and safety and, when appropriate, referrals to support services.

But federal funding for the $1.5 billion program — which was originally funded in 2010 by the Affordable Care Act and extended twice since — is slated to expire at the end of the month without reauthorization of MIECHV by Congress.

“We have been working closely with our partners in the National Home Visiting Coalition to produce bipartisan support for MIECHV reauthorization before current funding expires at the end of the month,” Martin said. “Home visiting is a truly bipartisan issue: We all want healthier families, better education outcomes and a stronger economy. MIECHV has been reauthorized twice before, but we need a longer extension to be able to produce the long-term outcomes that are the cornerstone to these programs’ stability. We also need an increase of funding over the longer period so more families can benefit. We need more programs like this, not fewer.”

"They have given me the peace of mind that motherhood is not so hard after all.” -Juana Fernandez

As part of its communications strategy, First 5 LA is also using Facebook and Twitter to deliver the message that we proudly join fellow child advocates to urge Congress to support MIECHV.

Word of mouth, too, goes a long way to support home visiting.

“Right now, I told someone I know that I want her to enroll in Welcome Baby,” Ramirez said, “because I think it’s important for women who are going to have their first baby.”

For her part, Fernandez could not place a dollar value on Welcome Baby, except to say what it brings her: peace of mind.

“I would look forward to visits from Jessica Lopez, my Parent Coach, because every time, no matter what was happening, she would always say, ‘Hey you are doing great!’” Fernandez recalled. “That meant so much because me and my husband don’t have any family. It’s just the two of us. So raising three girls has been really hard. To hear those words from a stranger would change the color of the day. They have given me the peace of mind that motherhood is not so hard after all.”

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