Universal Prenatal/Postpartum Care and Home Visitation

1 Universal Prenatal/Postpartum home is where care and home Visitation : the start is The Plan for an Ideal System in New York State October 2007. Acknowledgements This white paper is the product of two years of intensive research and discussion with a broad group of stakeholders. The Schuyler Center for Analysis and Advocacy (SCAA) wishes to thank the home visiting work group participants: New York State Department of Health, New York State Office of Children and Family Services, New York State Council on Children and Families, New York State Office of Mental Health, New York State Education Department, New York State Association of County Health Officers, Prevent Child Abuse NY, Fight Crime: Invest in Kids, Nurse-Family Partnership, Healthy Families NY, Parent-Child home Program, Parsons Child and Family Center, Perinatal Networks, and the New York CAN 0-5 Committee.

2 SCAA also extends our appreciation and our deep gratitude to the numerous others who made presentations, contrib- uted research, and otherwise invested their time to share their expertise with us. This paper is a true reflection of what collaboration can accomplish. Universal Prenatal/Postpartum care and home Visitation : The Plan for an Ideal System in New York State home is where Executive Summary the start is E very family with a newborn baby deserves comprehensive supports from the prenatal period to pre- school. While the birth of a baby should be a joyous event and the first few years of women, infants, and new families (including first-time parents and existing families with new babies).

3 This system of services would include Universal contact/screening of all pregnant women and new families; assess- a child's life should be filled with hope and ments for parent, child and family health, promise, parents usually find childbirth and mental health, developmental, social, literacy child-rearing to be challenging experiences. and other service needs; early intervention They are not experiences that any family and referrals to an array of coordinated should go through alone. supports and services; and home visiting This paper will describe a system of ser- services of varying duration and intensity vices that supports new families by provid- as needed.

4 In addition, it would reflect a ing three components: Universal prenatal pyramid-type structure (see diagram on page 3). care , postpartum screening, and compre- wherein all pregnant women and new moth- hensive home visiting. ers/families receive general services, those with identified needs receive more targeted All new families in New York State services, and those at high-risk receive very should receive assistance from a model- specific, intensive services. Finally, the sys- neutral system of support and services that tem would utilize proven practices and, in promotes optimal health, mental health, high-risk or high-need situations, evidence- family functioning and self-sufficiency.

5 Based Such a system would serve all pregnant Universal Prenatal/Postpartum care and home Visitation 1. make it easier for families to participate, since Background the home visitor comes to them. Staff can also visit with the entire family to get a better view of what factors are influencing a child, and are H. able to build on the family's strengths. Staff ome visiting for families with new may also become involved with the care of babies, as it currently exists in other children in the family (in addition to the New York State, is characterized one targeted for the visit), and can be helpful in as a number of programs that addressing issues affecting siblings.

6 Provide quality services but that are too nar- rowly defined to be considered a true system. Ideally, Universal home visiting programs The current models are limited in scope by their focus on primary prevention by addressing own eligibility requirements, lack of financing, and working to improve parenting skills, social- and geographic issues. Inconsistent integration emotional and cognitive development, and between programs means that needy families physical and mental health. Thus, they also may not qualify for services. And a lack of help to prevent child abuse and neglect, and funding means that too few programs exist in improve birth outcomes (including increasing the state to meet even the needs of those who the spacing between pregnancies).

7 Longer- do qualify. term outcomes for children include stronger school performance, fewer behavioral problems, The home Visiting Philosophy and higher high school graduation rates. For parents, programs that include life skills training In general, home visiting programs that are can result in longer-term outcomes including not a component of another system, but that are reduced welfare dependency, higher educational specifically focused on families with new babies, completion and increased job retention, and a work with those families in their homes by pro- reduction in the frequency and severity of abuse viding direct services or assessing need, connect- and The decrease in maltreatment is a ing families with appropriate services.

8 And moni- direct result of increased parental skills parents toring ongoing well-being. Some comprehensive learn in home visiting programs how to manage models follow a family and child until the child is their anger, how to discipline their children ready for school. home visiting is an extension effectively and without violence, and how to ask of the once societal norm of families passing for help and support when they need it. on knowledge about parenting from generation to generation. While at-risk families are more postpartum services for infants and toddlers likely to experience poor health and economic vary based on community need and priority.

9 Outcomes than other families, all families could Ideally, these programs focus on education. benefit from home visits. They promote early literacy and school readiness by teaching parents the importance of inter- Investments in home visiting programs have acting with their infant or toddler by singing, been shown to reduce costs associated with storytelling, reading, and drawing. Screening for foster care placements, unintended pregnancies, risk of health concerns like autism, hearing loss, hospitalizations and emergency room visits, and lead poisoning or developmental delays can be other costly home visiting can augmented by teaching techniques that address also assist with the identification of domestic those difficulties and offer early treatment.

10 Par- violence, substance abuse, and other negative ents can benefit by learning that resources are issues within the family. Staff is often the front- available to address their own literacy or educa- line reporting and referral system in those cases. tional issues, and by taking advantage of those home visits are particularly effective because resources to build a better future for themselves they occur in the home , allowing staff to observe and for their children. families in their own environment, where they are comfortable. These in- home visits also 2 Universal Prenatal/Postpartum care and home Visitation Intensive High-Risk Families Targeted Services for Children & Families with Identified Needs Universal All Pregnant & New Mothers/Families Prenatal health care Welcome Baby Contacts with referrals if necessary Birth certificate reviews Parent education Universal : home visiting services for all expectant and new mothers/families.