WICHITA – Emily Blomberg was 17 when she learned she was three months pregnant.
She didn’t know what to expect as a first-time mother.
From a friend she learned about the Sedgwick County Healthy Babies program, which is run by the county health department.
Within a month, a program worker began regular visits to Blomberg’s home to advise her.
“Each month, she came to my house and we talked about what I should be experiencing at that time in my pregnancy and what I should expect during the first couple months when the baby was here,” Blomberg, now 19, said. “She made sure I knew what to do when my water broke. She helped me get the room ready, and made sure I had car seats and everything that I needed.”
Blomberg’s daughter Aurora was born healthy and on time.
New federal health reform legislation over the next several years will pump millions of additional dollars into similar home visitation programs for new and expecting mothers with the goal of reducing rates of premature birth and infant mortality.
The Kansas Department of Health and Environment last month received a $900,000 grant to identify what the state needs in terms of home visiting programs.
Linda Kenney, director of KDHE’s Bureau of Family Health, said agency staff and others will develop a statewide plan for improving children’s health through home visiting programs.
The planning grants were included as part of the Affordable Care Act and are among the first being disbursed as a result of the massive, reform legislation.
Once the state plan is approved by the U.S. Department of Health and Human Services, more funding, perhaps more than $1 million, will be available to establish new home visiting programs, Kenney said.
A clause in the health reform act prevents states from using the new funds to supplement existing programs, she said.
The new funds, Kenney said, will be directed to areas where the risks are high for poor child health.
All programs that receive the money must have evidence they are effective, Kenney said. But it’s still not clear what programs will fit the federal government’s definition.
There’s still confusion about what constitutes a “home visiting” program under the definition, she said. For instance, some early childhood education programs take place both in homes and in schools.
“We’re having a lot of philosophical discussions about what is a ‘home visiting program’ and what is simply a location where services are provided,” Kenney said. “A lot of services, particularly for very young children, are provided in the home because that’s where the children are. As they get older, those same services are provided in schools.”
A handful of studies have found that home visiting can, among other things:
– Improve parenting skills;
– Help children with sleep problems;
– Improve intellectual development in children;
– Improve the likelihood mothers will find jobs or go to school;
– Help prevent injuries by removing hazards from the home; and
– Improve rates of breastfeeding.
The American Academy of Pediatrics earlier this year published a report that traced the history of home visiting programs in the U.S., which have existed in some form since at least the 1880s, despite the lack of a systematic definition for them.
The report said the programs are more widespread in other industrialized nations.
“In many other countries, home health visiting is free, voluntary, and embedded in a comprehensive maternal and child health system,” according to the report. “Although a causative link has not been demonstrated conclusively, countries with extensive home-visiting programs generally have lower infant mortality rates than does the United States, despite per capita health spending in the United States that far exceeds expenditures in other industrialized countries.
There are a number of home visiting programs in Kansas, said Sharon Homan, vice president for public health at the Kansas Health Institute.
Each tends to have different characteristics, she said, and they are coordinated through a variety of agencies, including school districts, community action agencies, state and local health departments, and social service agencies.
Reaching more moms
The Sedgwick County Healthy Babies program once focused entirely on home visits, said Susan Wilson, the program’s director. But a few years ago, a new model was adopted to also include peer counseling in group settings at the health department. Home visits were scaled back.
Sedgwick County has one of the highest infant death rates in the state, Wilson said. Funding for the Healthy Babies program remained flat even as the need for services grew and it was decided that the group gatherings would allow the health department to reach more mothers.
In 2009, the program saw more than 600 mothers and 400 babies and toddlers.
“We still have the ‘welcome home’ visit, because we want to see if they follow through with what we’ve talked about” in the group setting, Wilson said. “On the flip side, it’s important to have the group environment because we want them to hear what other families are talking about. But there are things you can see in the home that you don’t know about if you’re just doing office visits.”
Home visitors are, for instance, able to see where a baby sleeps, whether the home is safe and check to make sure parents know to put their baby to sleep on their backs, which helps to prevent Sudden Infant Death Syndrome.
Those working in the Healthy Babies program keep in touch with others in the community to make sure they refer new and expectant mothers to the right places for help. That communication also helps assure that services aren’t being duplicated.
Coordination among agencies is one of the things the new federal grant is designed to encourage.