Kalamazoo mom, daughter profit from Michigan’s home visit programs

Shauntiana Branson found herself unexpectedly pregnant -- and unprepared for motherhood two years ago. Having just reached adulthood and fearing backlash from her family, Branson did what she could to find her own help.

A visit to a local Women, Infants, and Children clinic led her to the Nurse-Family Partnership. Soon she was receiving regular home visits from registered nurse Sue Rhodes. During those sessions, the now 20-year-old – who had been regularly using birth control – started to learn about caring for her pregnant body and tips that would support her in motherhood.

Now, she’s feeling more secure about parenting her 8-month-old daughter, Aaliyah Sanchez.

“If you are broke down right now and don’t know what to do with your baby, (NFP) will get you and your baby together and help you with your needs,” Branson said.

Branson, of Kalamazoo, is one of many Michigan women participating in one of more than 330 voluntary home visiting programs in the state designed to help at-risk women do everything from achieving healthy pregnancy outcomes to ensuring their babies meet developmental milestones.

The Nurse-Family Partnership, for example, identifies first-time mothers, usually young and unmarried, by their 28th week of pregnancy and attaches a nurse to them through the child’s second birthday.

Rhodes says during the 90-minute visits, the nurse and client cover personal health, maternal-infant bonding, baby health, the environment, community services and other issues. The evidence-based program uses easy-to-read literature and worksheets, age-appropriate books and toys, and actual modeling of positive interactions with a child.

The Denver, Colo.-based program costs approximately $12,500 per woman over the three years of visits (in 2010 dollars), and has Congressional Top Tier Evidence standards, according to the Coalition for Evidence-Based Policy.

On average, enrolling 1,000 low-income families in NFP will prevent 78 pre-term births, 73 second births to young mothers, 1,080 child maltreatment incidents, 2,660 crimes by youth, 180 youth arrests, 230 person-years of youth substance abuse and 3.4 infant deaths, according to a 2012 reportcommissioned by Pew.

State moves to streamline oversight

Home visiting programs vary in both services and funding -- and there is no overarching entity that oversees them. A Michigan law, going into effect on March 28, mandates the use of evidence-based practices or promising practices if the program receives state funding. It also employs a standard data collection process that is yet to be determined – all with the goal of creating a continuous range of services in line with early childhood development.

“What we’re really hoping is that we’ll see a continuum of home visiting that is offered, so that what is happening locally is aligned and coordinated, and so that we can be thinking about the needs and gaps in that community and how can we fill those,” said Nancy Peeler of the Michigan Department of Community Health. “We want a system where all of these pieces are knit together rather than operating independently and in competition with each other.”

As policies for home visiting programs go, Michigan is a leader and has some of the strongest, according to Karen Kavanaugh of  The Pew Charitable Trusts. Pew’s Home Visiting Campaign pushed for the new Michigan law. “They are using data as a useful source of information to tweak program quality or discover the context of a community,” Kavanaugh said. “A particular program may achieve certain outcomes in a rural area but not an urban one because the context of the community.”

For Shauntiana Branson, that means she is best supported through home visits by learning how to keep her asthmatic daughter healthy and by having regular, supportive coaching as she enters trade school. Aaliyah was born two weeks early, weighing in at just 4 lbs, 2 oz. She was placed on oxygen immediately after birth. Now, Branson boasts with pride that Aaliyah is a healthy weight; is breastfeeding well; is up-to-date on her immunizations; and is trying to stand on her own.

Branson said she might have lost her baby if she didn’t have the NFP support. For instance, constant nausea in the early months of her pregnancy made her lose her appetite. Her nurse advised her to take her prenatal pills with a small amount of food, even if she couldn’t stomach an entire meal.

Branson’s home visitor, Sue Rhodes, was a labor and delivery nurse at a hospital before being trained in NFP home visiting at the organization’s headquarters. She has been serving in Kalamazoo since the program began about 4.5 years ago.

“We learned NFP protocols so that if we follow their guidelines, what’s been done over and over for years, and what they’ve found to work through research, we should be able to have the same positive outcomes,” Rhodes said.

Rhodes says she has seen a number of improvements in Branson’s life since she first began visiting her.

“When she got really anxious, I was somebody she could call and it would help her calm down and look for solutions. I was safe for her,” Rhodes said. “Now she’s doing much better and will be starting pharmacy technician school and has a safe environment and is very, very happy with her baby.”