If it’s Monday, Sandra Warren is headed west on Interstate 40 in Albuquerque to her weekly appointment with Carla Palacios and her 18-month-old son, Jonahven.
Warren is a developmental specialist whose job is home visiting.
Palacios is a 22-year-old first-time mother who welcomes the company.
For more than a year, home visitors from the University of New Mexico Center for Development and Disability’s VISION Program have come into Palacios’ home, at her invitation, to suggest ways she can help her son learn and develop.
An hour later, Palacios seemed to appreciate the session. But not all families provide feedback.
“I always wonder if I’m making a difference,” Warren says on the ride back to the office in mid-August.
Nationally, there are enough believers in the benefits of home visiting to warrant the federal government’s infusion of $1.5 billion for programs across the country. This fiscal year, the New Mexico Legislature voted to quadruple the state’s investment of just two years ago, from $2 million to $8 million.
That will allow an estimated 2,100 families to receive home visiting, up from 538 that were served when the state Children, Youth and Families Department began the initiative in 2006. But that’s still far from meeting the perceived need.
Of the more than 27,000 children born in New Mexico in 2010, 71 percent of those births were covered by Medicaid for low-income families. More than 50 percent of births in New Mexico are to single mothers, according to the New Mexico Department of Health.
Home visiting is getting rave reviews nationally for providing support, information, referrals and education to expectant mothers and first-time parents.
National research shows home visiting increases school readiness, cognitive development, parental engagement, parent-child bonding, and produces better maternal and infant health outcomes, according to the Pew Center on the States.
“If you can make a difference in those first three years, that’s where your greatest return is going to come. Kindergarten is too late,” said Anna Marie Garcia, the program coordinator of First Born, a leading home visiting program in New Mexico, which is overseen by the Los Alamos Foundation.
In the UNM program, home visitors teach parents how to get a baby’s attention and how to help when a baby is fussy; what toys and activities are appropriate for development; what skills make feeding, meal time and diaper changing easier; how to help a baby get to sleep; and how to better understand whether the child is hungry, tired, sleepy, lonely or sick.
Home visitors don’t dictate, Warren said, just suggest. And they look out for clues that mothers might be depressed or a family situation is changing and try to help.
Home visitors may be nurses, social workers or early childhood specialists and generally receive additional training focused on maternal and child health, parenting and child abuse and neglect. To be effective, services are supposed to be intensive – every week or twice a month in the beginning. The visits start prenatally in the UNM program and continue until the baby is 3 years old.
The boost in funding for home visiting this year came as the Legislature enacted new accountability standards to gauge the effectiveness of the New Mexico program. The first report card tracking outcomes is due Jan. 1.
Only nine other states have passed such a law, according to the Pew Center on the States, which helped New Mexico craft its legislation.
“There’s not an owner’s manual that’s given to new parents,” said Sen. John Sapien, D-Corrales, a co-sponsor of the accountability act. “If you can sit down with new parents to teach them how to be good parents … it lends itself to a child being better prepared to be educated.”
Who’s at risk?
Despite the enthusiasm for the concept, there’s no consensus on what kind of home visiting should be offered in New Mexico – programs based on specific national models with proven effectiveness or those that are a mix of research and best practices.
CYFD officials have adopted the latter approach, saying the national evidenced-based models aren’t suitable for New Mexico’s unique communities and are more expensive.
The Legislative Finance Committee staff and some legislators believe the state should target its resources to proven evidenced-based programs.
“It’s going to be nearly impossible to reach as many as you need to,” said state Sen. Sue Wilson Beffort, R-Albuquerque. “But at least if it can be scientifically based and strictly based toward the most in need, the state will maximize its return.”
Another debate: whether state-funded home visiting services should be limited to families most at risk. Currently, CYFD allows all income levels to receive the services free-of-charge.
“From where I sit, in New Mexico being 50th in the nation in terms of children’s well-being and in the bottom three of children’s likelihood to succeed in life, every child is at risk,” said Dan Haggard deputy director of CYFD early childhood services.
On this day, the home visiting lesson for Palacios and her son is as simple as stuffing cotton balls into a plastic bottle. But there’s much more happening to the trained eye.
“We’re getting him ready to write someday by teaching him to use his fingers, to pick up little pieces, to button his clothing. It’s important to start early,” said Dr. Dara Zafran, a clinical psychologist who oversees the two UNM home visitors who meet with 34 families once a week.
Palacios, who hopes to get her GED, said her pregnancy came as a “surprise.”
“The best thing about the program, when you’re first pregnant you’re so excited about having a baby, then he’s here and it’s like: ‘Oh, my God! What do I do?’ ”
Other parents in the 4-year-old UNM program aren’t always as verbal.
What’s the favorite thing they like about their child? Warren will ask.
“They will struggle to answer that,” she said. “Some of that is because of the stress that’s in their lives.”
Warren often videotapes portions of her one-hour meetings with first-time parents, in which she suggests certain parenting strategy and exercises.
“In one video I kind of showed the baby a thing or two, but the mother just sat back and watched TV. I videotaped that (her watching television) for a whole 10 minutes.”
Showing the videotape to the mother proved eye-opening.
“I asked her what she thought about that, and she said ‘I learned it’s nice to play with her (the baby).’ ”
Some clients have been drug users; others don’t speak English, or write Spanish or English.
“We’ve even had teen parents ask for the home visitor to be present at their birth because their parents have said that they’ve sort of disowned them,” Haggard said.
Zafran said her agency gets referrals from physicians, midwives and other professionals about potential home visiting clients.
Of those offered services from her program, about 85 percent enroll, she said.
Home visitors are mandated by law to report to authorities if they suspect child abuse or neglect.
But Garcia said the First Born program, particularly when the visits begin before the birth, is preventing child abuse, neglect and domestic violence.
Its home visitors identify postpartum depression and substance abuse in mothers and make referrals to other agencies for follow-up services.
“In some communities, we’re told that some of the parents who are on drugs or who have the most social problems are the ones who are volunteering not to be in First Born,” she said.
But Garcia said she’s heard reports that those same parents are picking up skills from friends who are enrolled in the program.
“What we’re seeing is they are going to the homes of others and learning. That’s our hope.”