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Home visit program reduces costly medical services for newborns

Antima Pena, 21, left, chats with Georgianne Bird-Chavez, a home visitor for the New Mexico First Born program, discussing Pena’s son, 7-month-old Dominic Cardenas, in 2013. (Marla Brose/Albuquerque Journal)

Antima Pena, 21, left, chats with Georgianne Bird-Chavez, a home visitor for the New Mexico First Born program, discussing Pena’s son, 7-month-old Dominic Cardenas, in 2013. (Marla Brose/Albuquerque Journal)

Newborns enrolled in a New Mexico home visiting program were significantly less likely to use costly medical services than other children in their first year of life, a new Rand Corp. study reported.

For example, children enrolled in the New Mexico First Born program were a third less likely to visit a hospital emergency room than newborns in a control group who were not enrolled in the program.

First Born is a privately funded program that provides in-home services in 17 counties to first-born children and their parents for one year to promote healthy child development.

“We find evidence that the (First Born program) model reduced medical contact in the children’s first year of life,” the study concluded.

In addition, the program achieved those results without relying on nurses, which largely staff most U.S. home-visiting programs, it said.

“These results demonstrate that it is possible to prevent costly health care use by using a staffing model that does not rely exclusively on nurses,” which are in short supply in New Mexico and much of the U.S., the study said.

More than 100 home-visit personnel employed by First Born programs across the state offer education about good-parenting practices such as immunizations, breastfeeding, well-child checkups and child safety. Workers also connect families to community services such as food banks and Women, Infants, and Children food and nutrition service, and helps families enroll in insurance plans.

The study focused on 244 Santa Fe County families from 2011 to 2014. Of those, 138 newborns were enrolled in a First Born program, and 106 were not enrolled. The results were published Dec. 15 in the online edition of the journal Pediatrics. It found that children enrolled in First Born were 33 percent less likely to visit a hospital emergency room and 41 percent less likely to make nine or more visits to a primary-care clinic than non-enrolled newborns.

On average, First Born families received 28 home visits before the child’s first birthday, and a third of families received prenatal visits, the report found.

The First Born model was created in response to New Mexico’s nursing shortage, said Rebecca Kilburn, senior economist for Rand Corp. and lead author of the study. Nonprofit Rand performs research for many government agencies and private organizations.

First Born’s staff “combines one nurse, or licensed health care professional, with about eight parent-educators who aren’t nurses to deliver the program,” Kilburn said. Nurses make home visits to offer medical services, “but you don’t have to be a nurse to make sure the family has a (child) car seat.”

The home visitors typically have social service backgrounds and include social workers, nurse’s aides and child care providers.

A key reason Rand chose to study the First Born program is that it offers a lower-cost alternative to programs that rely on RNs, Kilburn said. First Born costs average about $3,400 a year per child, a program official estimated.

First Born could serve as a model for other home visiting programs, because about half of U.S. counties have a shortage of health care professionals, Kilburn said.

Vicki Johnson, who founded the program in 1997 in Silver City, said that by providing services to first-born children, the program teaches skills that parents can apply to subsequent children. First-born children account for about 40 percent of New Mexico births.

First Born staff members, who make salaries ranging from $30,000 to $40,000 a year, mirror the backgrounds of the communities they serve, she said.

“The First Born programs really look like their communities,” Johnson said. “They are a mix of people with (college) degrees and people without degrees. Because you look like your community, that makes a difference.”

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