Bringing home a new baby is an exciting time. But for parents it is also a time full of questions, worries, and physical and emotional challenges, whether they are caring for their first child or they are experienced parents responding to their baby’s unique temperament and health needs. For families of all backgrounds, questions can range from the baby’s eating, sleeping, and soothing habits to more complex questions such as the baby’s medical, safety, and child development concerns.
Getting the right answers and right support during this time is critical. Research increasingly shows that positive and negative experiences during the early years of a child’s life play a critical role in shaping a child’s brain architecture and long-term trajectory in life.
Family Connects is a new, voluntary, evidence-based home visiting program that seeks to help Texas families succeed during these critical first months and years. The program takes an exciting new approach to home visiting, although many of its features and results will look familiar to Texans who are knowledgeable about home visiting.
This model offers assistance to improve a family’s overall well-being at the start and has also been shown to decrease emergency medical costs over time. It offers a personal connection to a trained expert who can help answer medical questions, gauge and recommend ideas for social support, and readily offer community resources to improve both the mother’s and the child’s health and well-being. In Texas, Family Connects is overseen by the Prevention and Early Intervention (PEI) division of the state’s Department of Family and Protective Services (DFPS) using federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) funding.
Based on a North Carolina Program with Proven Results
Family Connects is based on Durham Connects, a program of the Center for Child and Family Health in Durham, NC. Durham Connects offers in-home nurse visit to all families with newborns within a specified community to provide information and referrals to social services based on the family’s individual needs.
Two rigorous evaluations of Durham Connects showed that families with a newborn had some level of need for support, with 94 percent of families either receiving requested information during the home visit, receiving a referral to a community resource, or receiving immediate help for an emergency situation. Notably, compared to a control group, families of six-month-old children in Durham Connects felt more connected to their community, developed more positive parenting techniques, experienced less maternal anxiety and improved mental health, created a safer and higher quality home environment, and accessed less infant emergency medical care. Researchers found that every $1 spent on Durham Connects yielded a return on investment of $3 in reduced health care costs. Since 2008, more than 200,000 Durham-area families have benefited from Durham Connects.
Serving All Local Families on a Voluntary Basis
What is different about Family Connects compared to other home visiting models is the goal to be available to serve all interested families with newborns, regardless of their circumstances, within a specified community. Of course, families can decline the opportunity to participate. This approach provides a critical opportunity to reach a broad number of families, who all have varying levels of need.
Through Family Connects, registered nurses visit families around three weeks after the baby’s birth as part of the continuum of care for both the mother and the baby. Adjustments in the timing of the visit are made for babies who spend additional time in the hospital, are adopted, or meet other criteria, but the initial visit always takes place less than 12 weeks postpartum. The scheduling of the visit can occur at the hospital or community clinic. During the 1½ to 2-hour visit, the nurse talks with the family and gauges what health or other needs the family has and any additional services that would support the parents and baby. The nurse shares resources and discusses with the family topics such as safe sleep practices, breastfeeding, or the schedule for the mother’s and baby’s upcoming doctor appointments. The nurse also connects the family to community resources that can address their individual needs, such as help for postpartum depression or anxiety or how to access affordable, high-quality child care.
In certain cases, a second or third follow up visit by the nurse may be needed. Additionally, all families receive a follow-up call four weeks after their last visit to ensure the family has been connected to services and is satisfied with the care they received from the program.
A Feedback Loop of Community Needs
Tailoring resources to a family’s needs not only builds a bridge to community-based family support services; it also creates a quick feedback loop of community-specific data to illustrate emerging issues and trends. Tracking this data makes it possible for the community to act quickly on a new issue and initiate community-wide changes that benefit all families. For example, communities have worked on car seat distribution and a community campaign for safe sleep practices after identifying these local needs.
Family Connects in Four Texas Communities
In Texas, there are four counties preparing to offer Family Connects: Bastrop, Bexar, Travis, and Victoria. Each has partnered with a health entity, called the organizational home, to hire the registered nurses, visit families, and collect data for community-wide changes and program monitoring. Each community is choosing its own method to roll out their program, such as starting the program at one hospital at a time in order to achieve a universal, countywide reach within approximately five years. Each community team receives training in Durham, and the organizational home trains the nurses participating in Family Connects in their community. Durham Connects supports each of the sites by providing technical assistance, ongoing evaluation, and help with creating or modifying their data collection systems.
In the coming weeks, Victoria County in southeast Texas will become the first community to start visits. The Victoria County Public Health Department, partnering with the South Texas Assessment and Referral Services Clinic (STARS), is starting by serving, on a voluntary basis, any interested Victoria County patient who gives birth at the non-profit hospital, Citizens Medical Center. Beginning in year three or four, Family Connects will be available to any Victoria County patient delivering at the second hospital in the community, DeTar Hospital Navarro. In year five, the program plans to serve any patient giving birth in the seven counties served by the two hospitals, which is about 3,000 births per year.
In Travis County, United Way for Greater Austin has partnered with the Austin Public Health Department to implement Family Connects. St. David’s South Austin Medical Center is the first location to identify new families to offer Family Connect, with visits starting in September 2018. Travis County's scaling plan is to serve all Travis County moms who deliver a baby in the next 5-10 years, depending on available funding. In 2014, there were just over 16,000 births in the county.
In Bastrop County, Bastrop County Cares has partnered with Lone Star Circle of Care, a community health center offering medical care to kids and families. Because the county does not have a hospital or birthing center, St. David's Medical Center in Central Austin is where the majority of the residents give birth. Bastrop will roll out the program for their families by using their Women, Infants, and Children (WIC) and Lone Star Circle of Care client base as their starting point. There were approximately 1,000 babies born to residents of Bastrop County in 2014.
In Bexar County, United Way of San Antonio and Bexar County have partnered with Catholic Charities. The community will roll out their program in the late summer or early fall of this year. In 2014, there were just over 27,000 babies born in Bexar County.
As these four communities welcome and support their newborns and give them the best start possible, continued funding and support is needed to increase the number of communities able to offer Family Connects. With these four communities at full capacity, it would only potentially reach about 11 percent of the births in Texas annually.
As health systems, county health departments, and community organizations come together to support Family Connects, it is important to keep in mind what this program can achieve for both individual families and communities as a whole. As Debbie Bresette, President of Bastrop County Cares, explained to us in a phone call, “We don’t know what we don’t know about our families. Family Connects will be a game changer for our community. More than a home visit, it increases community resilience.” Resilient families and supportive communities benefit all Texas children.