Successful Home Visit Program for Mothers and Infants Lacks Long-Term Funding

A hearing on the Maternal, Infant and Early Childhood Home Visiting Program revealed impressive results for the low-income families it serves, and the money it saves taxpayers. But its funding runs out in six months.

(left to right) Chrystal Towne, RN; her former client, Sheren Sucilla, and Darcy Lowell, MD, testify on the effectiveness of the Maternal, Infant and EArly Childhood Home Visiting Program in the hearing room of the House Ways and Means Committee. A.M. Stan

There’s little on which Republicans and Democrats in the House of Representatives agree, but questions and testimony delivered Wednesday in the vast and well-appointed hearing room of the Ways and Means Committee suggested that the value of little-heralded Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) may be one.

Rep. Dave Reichert (R-WA), chairman of the Subcommittee on Human Services, under whose aegis the hearing took place, expressed his appreciation, as a former policeman, for the program, because of its intervention in preventing domestic violence and child abuse.

Still, the program is not fully funded, and only on Monday won a six-month extension of its funding, which was scheduled to expire last month. “I think we need a little more certainty than going from year to year, or six months to six months,” said Rep. Lloyd Doggett (D-TX), the subcomittee’s ranking member. He then apologized for having to leave for a House Budget Committee mark-up of a resolution on the budget bill that resulted from the compromise eked out by House Budget Committee Chair Paul Ryan (R-WI) and Senate Budget Committee Chair Patty Murray (D-WA), noting his concern over funding for social services.

(On Wednesday, a small group of right-wing Republicans were threatening to vote against the budget deal, because of objections to the procedure by which the measure—known colloquially as the Medicare “doc fix,” which also included the MIECHV extension—was passed. The mark-up passed in committee on Wednesday night.)

MIECHV, which was enacted in 2007 under the Bush administration, does not reach every state, despite early evidence that the program improves the lives of low-income children and often reduces parents’ reliance on public assistance programs. The evidence-based program, which relies on visits by nursing and mental health professionals to the homes of low-income mothers, was expanded in late 2013 by the Department of Health and Human Services (HHS), via the Affordable Care Act (ACA), by the relatively modest sum of $69 million in grants to 13 states.

The gist of the MIECHV program is to fund home-visit programs whose models have proven to have positive outcomes in reducing child neglect and abuse, and in showing low-income families to thrive as a result of the program’s intervention.

Highlighted at the hearing were two programs that receive MIECHV funding, Child First of Connecticut, which specializes in mental health interventions, and the Nurse-Family Partnership, a multi-state program centered on an intensive visitation schedule by nurses to the homes of low-income mothers, beginning in pregnancy and ending when the child reaches 2 years old. Nurses come to the home every other week for two-hour visits, in which they advise their clients on everything from nutrition to breastfeeding to infant behavior and other issues in the women’s lives, but also take copious amounts of data in each visit that measure the family’s well-being and the challenges they face.

Crystal Towne, a nurse home-visitor from Yakima Memorial Hospital in Washington State, appeared as a witness at the hearing, together with one of her clients, Sherene Sucilla.

Sucilla spoke of how she grew up in foster care, beginning at the age of 12, and ending with her 18th birthday, when she was suddenly on her own. “In those six years, I attended seven different schools,” she said. Nonetheless, she managed to graduate high school, and to do so on time.

But when she found herself pregnant, Sucilla said, she was at a loss. “When I was younger, my mom wasn’t really a mom,” she said. “I didn’t really have a role model for parenting, and I knew I didn’t want to be the mom that she was … I was really scared … and I was in this by myself.”

Towne explained that her first visit with Sucilla took place when the young woman was only 10 weeks pregnant, and the visits continued for the next two-and-a-half years as Sucilla began raising her son. While the relationship between the two included the practical matters of mothering—Sucilla noted how Towne got a lactation advocacy organization to send her a breast pump by overnight delivery when she was panicked over her baby’s difficulty at breastfeeding—it also fed Sucilla’s dreams of a better job and getting an education. (She moved from waitressing to bookkeeping, and is exploring educational opportunities.)

Darcy Lowell, a physician and founder of Child First in Connecticut, testified on the measured positive outcomes that her MIECHV-funded program has shown in reducing depression and family violence in the families her program serves. Jon Baron, president of the Coalition for Evidence-Based Policy, testified that in a randomized controlled trial study with a sample of 157 in Bridgeport, a one-years follow-up “found 40-70 percent reductions” in “serious levels” of problems with child behavior and language development, and “mothers’ psychological distress.”

“At the three-year follow-up,” Baron’s written testimony reads, “the study found a 33 percent reduction in families’ involvement with child protective services (CPS) for possible maltreatment.”

Under questioning by members of Congress, Baron testified that the MIECHV program ultimately saves taxpayer dollars by helping families to become more self-reliant and avoid health risks and interventions by CPS. “It really does seem like you can have your cake and eat it, too,” he said of the program.

Rounding out the panel of witnesses was Rebecca Kilburn, senior economist with the RAND Corporation, a Washington think tank that conducts empirical studies, and is currently evaluating the MIECHV program for a report that will be released next year. While “the jury is still out on the MIECHV program, per se,” Kilburn said, preliminary findings are promising. But the success of any scaling-up of the program, she said, will depend on maintaining fidelity to the evidenced-based models offered by such organizations as Child First and the Nurse-Family Partnership.