According to science, the most important time in a child’s life occurs during pregnancy and his or her first two to three years. This is the most formative and rapid period for brain development. How a mother takes care of herself during pregnancy and then takes care of her baby once it is born profoundly influences how that child will develop and learn in the long-run. Preschool is too long to wait to take action to try to assure that every child gets off to the right start.
Healthier Births, Healthier Parenting
Mothers under heavy and constant stress, owing to low income or other disadvantages, are more likely to have adverse birth outcomes, such as prematurity, low birth weight, and brain impairments. They are also more likely to have more difficulty taking care of and being responsive to their babies. Of the roughly 8,000 Sangamon County children under the age of three, about 2,000 are in less advantaged families.
The evidence from research finds that protecting mothers from this stress can lead to better birth outcomes and more effective parenting at the outset of a child’s life, with lasting positive consequences. For parents of very young children, programs that involve service providers visiting families in their homes are considered to be more effective in this protective, stress-reducing function than many other types of services. Put simply, mothers (and fathers when present) are more likely to learn how to be good or better parents by learning in the place where they will do most of their early parenting.
Mothers having their first babies are apt to be the most receptive to the help of a visitor, since managing a pregnancy is a new experience for them and they haven’t yet decided how they will parent. There are an estimated 200 first births to low-income women in Sangamon County each year.
The most effective home visiting program for low-income, first-time pregnant women is the Nurse-Family Partnership (NFP). The NFP begins during pregnancy and continues through the first two years of the child’s life. Highly trained, registered nurses focus on three goals: 1) improving pregnancy outcomes, 2) improving the child’s health and development by helping parents provide more competent care, and 3) improving the mother’s own health and self-sufficiency. Evaluations have shown that the NFP produces a wide variety of short-term and long-term benefits for children and their mothers, and that, during the first 18 years of the child’s life, the program saves five to six times as much as it costs.
Recommendation 1: Sangamon County should adopt the Nurse-Family Partnership as the principal, local means to help low-income, first-time mothers in the county get their children off to a good start.
The Nurse-Family Partnership costs about $9,000 per participating family. Federal funding specifically for early childhood home visiting, like the NFP, has been available and may become available again. Many states also use Medicaid to help pay for the program. Springfield is home to a number of healthcare organizations that are familiar with the needs of young, less advantaged families and that could play a role in pursuing funding for the NFP and implementing the program once funding is obtained.
Several home visiting programs already exist in the community. These include Healthy Families, Family Case Management, and Early Intervention, all operated by the Sangamon County Department of Public Health, Parents as Teachers operated by Springfield Public School District #186, and Early Head Start operated by the Springfield Urban League. While each program is able to serve low-income, first-time mothers (the target population for the NFP), that is not their exclusive focus. Nor have these programs been shown to be as effective as the NFP in making a difference with less advantaged women having their first child.
Recommendation 2: Consequently, it is proposed that if the Nurse-Family Partnership is adopted in Sangamon County, redirecting the efforts of existing home visiting programs toward families other than low-income, first-time mothers and their babies may provide the most benefit for the community.
In the county, there is an estimated 1,000 to 1,300 disadvantaged families with two or more children, at least one of whom is under the age of 3. The existing home visiting programs probably reach at least half of these families. Expanding these programs to reach more families will require additional funding.
Increasingly, accessing funding for providing services to less advantaged families depends on being able to make a strong case for service effectiveness. The Nurse-Family Partnership has built into it ongoing and publicly transparent measures of its effects on mothers (e.g., parenting skill, completion of high school, entry into employment or training, delayed subsequent pregnancies) and children (e.g., birth-weight, home safety, avoidance of injuries, language development). Such measures provide critical, regular feedback that enable home visitors to make improvements and to be accountable to the community. The county’s existing home visiting programs currently make some effort to measure their performance. A closer look at these efforts to see how they could be strengthened and made more consistent across programs would be a step in the right direction.
Recommendation 3: The home visiting programs in Sangamon County should collaborate in developing ways to consistently measure their effects on mothers and children and use this information for the purposes of ongoing improvement and public accountability.
Access to Good Quality Healthcare
The first objective of most of the home visiting programs is to help pregnant women access and use good quality prenatal care. Sangamon County, particularly in Springfield, has substantial resources for providing prenatal care, including two federally qualified health centers serving the low-income population.
Recommendation 4: Because low-income pregnant women, especially when young, are more likely to be socially isolated and less engaged in managing their own healthcare, it is important for the community that efforts be made to identify at risk pregnant women early in their pregnancies and connect them with the prenatal care they need.
This may be accomplished through outreach activities by prenatal care providers through local institutions (e.g., churches) in neighborhoods with higher concentrations of low-income families. Another important access point is the federally funded Women, Infants, and Children (WIC) program run by the Sangamon County Department of Public Health. WIC provides food, nutrition and health information, and healthcare referrals. Shown to have positive effects on birth outcomes and use of healthcare by low-income people, WIC is often one of the first places at risk pregnant women turn for assistance.
Access to good quality healthcare needs to continue once babies are born. Healthy starts are important to long-term functioning. Springfield’s federally qualified community health centers – Southern Illinois University’s Center for Family Medicine and Central Counties Health Centers – provide less advantaged people with access to services at affordable prices. Valuable services, such as immunizations and health education, can be accessed through the Sangamon County Department of Public Health. And Medicaid pays for coverage of healthcare services for thousands of low-income families with children locally.
Recommendation 5: The steps taken to link at risk pregnant women to healthcare should be the first stage in a concerted effort, within the medical community, to assure that every child in less advantaged families, from the day he or she is born, can access, without undue difficulty, appropriate medical and dental care.
Adopting the Nurse-Family Partnership, improving the effectiveness of existing home visiting programs, and increasing access to good quality prenatal and early child healthcare together argue for making the prenatal to age three period of child development among the highest priorities for the community. Research demonstrates that the earliest interventions, when implemented well, have the most potential for changing lives. The community should take this truth to heart.
Recommendation 6: Accordingly, it is recommended that the community, under the auspices of its medical community, create a committee consisting of physicians, nurses, and educators to serve as a forum for promoting more attention to the earliest time in a child’s life.
In the same way that the community is intentional about the performance of its public schools, it needs to become intentional about enabling all children to start life under the best conditions possible. When this doesn’t happen, when the early period is neglected, the problems that are more common among less advantaged families are simply pushed down the road, where they grow larger, more complex, and more costly to everyone with each passing year. Getting it right at the beginning is the best chance Sangamon County has for assuring its children learn well and become successful, productive adults.