Q: My new first baby and I are just fine! Why would we want a home visitor?
A: I often get this response when touting the advisability of taking advantage of one of the excellent home visiting programs around the state. It’s almost as if you, and others like you, think there has to be something wrong to benefit from a visit from someone acquainted with the problems and resource needs of new families.
That really isn’t so: Nearly everyone, especially new parents, would benefit from the visit of a kindly, knowledgeable home visitor. Europeans are very much used to visits made by nurses or other trained individuals after the birth of any baby (read about it), whether their questions deal with diaper rash or with domestic violence, or maybe especially if they haven’t thought of what questions they might want to ask.
I would like to explain some of my comments.
Several weeks ago, I wrote, in a column about child abuse prevention: “Home visiting is expensive, but far less expensive than providing medical care for injuries, incarcerating parents who have hurt children and placing those children in foster care. Home visiting is relatively inefficient, but so is the waste of so many aspects of a parent’s and a child’s life caused by adverse childhood experiences like child abuse.”
I suppose I would stand by that statement – home visiting is expensive, costing an average of $534 per home visit and an average of $5,962 per family, according to a study by Mathematica Policy Research (the New Mexico Children, Youth and Families Department, CYFD, indicates that state-funded programs in New Mexico cost $2,998 per year, while federally funded programs in New Mexico cost almost twice that). You can find their studies at mathematica-mpr.com/publications/pdfs/earlychildhood/EBHV_costs.pdf and cyfd.org/docs/NM_1st_Annual_Home_Visiting_Report_FY2013.pdf.
Driving from one patient’s home to another and spending adequate time with them is both expensive and inefficient – there’s all the windshield time, not to mention time for the home visitor to get ready for the visit, to find resources to recommend for the family and to set up a time that is mutually agreeable.
However, and perhaps here’s where my words offended my friends working in home visiting by not being emphatic enough, it’s worth the expense and the effort. In fact, when asked recently by one of our congressional delegation what I thought were the most important services needed by one of our disadvantaged populations here, the first words out of my mouth were “more and better-supported home visiting programs.”
But because my opinions aren’t enough, consider the data gathered by a highly respected research organization, the RAND Corp.: Visiting high-risk families saves a community $34,148 for each family served. That means that each dollar spent on home visiting saves $5.70, through improved prenatal health, fewer childhood injuries, fewer subsequent pregnancies, increased intervals between births, increased maternal employment and improved school readiness.
Measurable outcomes quoted in studies evaluating one national home visiting program, the Nurse-Family Partnership, indicate a 48 percent reduction in child abuse and neglect, 56 percent decrease in ER visits for poisonings and accidents, 59 percent reduction in child arrests by age 15 (amazing that the effect lasts so long!), 67 percent reduction in behavioral or intellectual problems by age 6, and 72 percent fewer convictions of mothers 15 years later.
I remember hearing with horror of my wife’s airplane flights some years ago on Mongolian Airlines, where the door had to be wired to stay shut and the plane was delayed to allow the pilot to recover from a bender the night before. I’d rather not save money in those ways, and I’d rather not save the money that is spent on home visiting programs. That CYFD has increased funding for home visiting by a factor of about 10 in the past decade speaks very well for this oft-maligned agency. That at this point only about 3 percent of New Mexico newborns and their families are served by home visiting programs (all would be served in the Netherlands!) means we have a way to go.
So even if home visiting programs can appear relatively expensive and inefficient, that’s only if we don’t consider what they save. As Carolyn Salazar, RN, director of one excellent Albuquerque home visiting program, says, “The Return on Investment (ROI) of home visiting is a home run!”
I urge my newest patients’ parents like you to happily accept home visiting; the benefits are quite remarkable.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to firstname.lastname@example.org.