Our Children This Month, May 2022
Disrupting the Negative Child Developmental Trajectory: Home Visiting
There is growing national alarm, echoed here in Fresno, about the deteriorating status of children’s mental health and the rise in youth gang and gun violence. Mental health, which lies at the heart of much of these growing concerns, starts early in the well-documented processes of attachment. Babies learn to form healthy relationships and to manage, and express their emotions, build self-confidence and to cognitively learn–or not–in their earliest interactions with caregivers. There is growing evidence that, beginning prenatally, early adverse child experiences (ACEs) affect neural functions and structures that in turn shape future cognitive, social, emotional, behavioral, and health outcomes. Poverty has a huge impact. By 18 months of age, children from poorer households are much slower at identifying pictures of simple words, such as “dog” or “ball.” By kindergarten, there is a significant gap between poor and middle-class children in both reading skills and behavioral regulation. Emerging research shows that early trauma may negatively alter DNA and be transmitted across generations as traumatized children grow up and become parents themselves. Given the long-term impact of early trauma, it is important to effectively support challenged new parents from the beginning.
Fresno’s High Poverty Rate is Giving Rise to Many Child Development Challenges
With Fresno County’s high rate of child poverty (45% for children under age-6), far too many children face serious developmental challenges, especially children of color who, in addition to the cumulative impacts of structural racism, face higher poverty rates than white children. Children living in poverty are at higher risk of being born prematurely or at low birthweight, being abused and neglected, and lagging behind in educational achievements. Research shows that stable and supportive relationships with loving adults can mitigate and even reverse these effects of poverty and other adverse life events. Home Visitation (HV) reduces child abuse, helps in the early identification of developmental delays, and supports family self-sufficiency.
With Fresno's high rate of child poverty (45% for children under 6), many of our children face serious developmental challenges, especially children of color who, in addition to the cumulative impacts of structural racism, face higher poverty rates than white children. Children living in poverty are at higher risk of being born prematurely or at a low birthweight, being abused and neglected, and lagging behind in educational achievements.
Home Visiting Is a Proven Intervention That Disrupts This Negative Trajectory
HV is a proven prevention strategy with decades of research documenting its effectiveness in breaking this negative trajectory. Participation in an HV program is voluntary and can be discontinued by parents at any time. Home visitors are trained nurses or paraprofessionals who support parents in their role as their child’s first and most important teacher. The goal is preventive—to help new parents overcome serious challenges they may be facing. Visits focus on linking pregnant women with prenatal care, promoting strong parent-child attachment after birth, and coaching parents on learning activities that support their child’s development. Home visitors also conduct regular screenings to identify possible health and developmental issues and link a family to appropriate resources.
The Key Elements for Home Visiting are Already in Place in Fresno
Fresno has a long history of HV, but until recently it has been fragmented with 25 often overlapping and duplicative programs provided by 18 different agencies and community organizations. Beginning in 2015, an effort began to develop a more comprehensive, integrated and evidence-based HV approach. The need here is high. Fresno has approximately 14,000 to 15,000 live births annually of which 50% are characterized as “at risk” by MediCal data. While all Black births—regardless of income—are at high risk of preterm and low birth weight. Currently approximately 3,200 Fresno families are being served.
A collaborative effort, known as the Fresno County Home Visitation Network, is underway led by Lowell Ens, CEO of Exceptional Parents Unlimited, Inc. and Ge Vue, Senior Division Manager Fresno County Department of Maternal and Adolescent Health. The HV Network was launched in 2019 after HV was called out as a cross-cutting strategy across several domains in the Fresno Cradle to Career (C2C) Preconception to Age 5 Blueprint for Funding and Advocacy. The purposes of the HV Network are to:
- Integrate data on HV outcomes;
- Reduce duplications in services provided;
- Identify and serve families not being offered services;
- Match a family with the program that will best meet their needs.
This initial organizing effort culminated in including HV in the Central Valley Community Foundation’s DRIVE Initiative, a 10-year investment plan “to develop an inclusive, vibrant, and sustainable economy for residents in the greater Fresno region”. This in turn led to additional funding by First 5 CA for the development of a coordinated countywide HV system.
The initial focus of the HV Network has been to gather countywide data and target HV to the 25 highest-needs zip codes. Data silos exist between programs created by funding streams, types of services provided, and privacy considerations. Gathering comprehensive data and sharing it between programs is both extraordinarily complex and extraordinarily important. Integrated data will greatly benefit service providers and the families served and will enhance HV’s positive outcomes. One task of the HV Network has been to agree on what outcomes will be measured, for example, improved levels of maternal depression and preterm birth outcomes, especially for Black mothers. The HV Network has set a goal to increase the number of families served to 10,000 by 2030.
Home Visiting Is an Investment That Will Generate Significant Long Term Returns
While HV is not an inexpensive undertaking, it deserves to be viewed as a community “investment” rather than an “expense”. The average annual cost of HV in Fresno ranges from about $3,000 to $7,000 per family depending on the timeframe and type of services provided. According to rigorous longitudinal evaluation, the benefits of high quality HV far exceed its cost. Research shows high quality HV helps prevent child abuse, improves school readiness, increases the physical and mental wellbeing of moms and kids, boost parents' confidence in their parenting skills, and results in greater family economic self-sufficiency. By reducing contact with the child welfare, criminal justice, and mental health systems, improving educational outcomes, and increasing parental employment and earnings, HV is a smart investment.
Given HV’s proven benefits, Fresno County HV Network is developing a long term strategy to make home visits reimbursable by MediCal and Medicaid and is hoping to enlist First 5 CA, statewide HV networks, and other partners in making this happen. While by no means a silver bullet in dealing with the growing crisis in children’s mental health and youth violence, expanding HV is one of the wisest investments we can make locally, statewide, and federally to begin at the beginning of life to disrupt the negative developmental trajectory currently engulfing far too many children, their families, and our communities.
Resources
Help Me Grow
Fresno County Superintendent of Schools- Help Me Grow can answer questions about a child's development from birth to age five. Services are free and confidential. Trained call line Care Coordinators will listen and follow the family's questions. The goal is to identify more children with developmental concerns and link families to helpful services as early as possible in a child's life.
Call 1-866-KIDS-HMG (1-866-543-7464) or visit
www.helpmegrow.fcoe.org
All4Youth
All4Youth@fcoe.org, 559-443-4800 M-F 8am-5pm
All4Youth is a collaboration between Fresno County Department of Behavioral Health and the Fresno County Superintendent of Schools for children ages 0-22 who are experiencing difficulties that affect them at school and at home. It is an integrated system of care that, with one call, will give all youth and their families access to behavioral health services at school, in the community, or in the home.
United Way 211
211 is a 24/7 call center provided by United Way for help on a wide range of issues, e.g. mental health, housing, rent payments, employment and education, income, food and meal assistance, legal assistance, health and dental care, substance abuse programs, transportation, and more.
F.I.N.D.CARE
Central Valley Children's Services Network, 559-466-1100
CVCSN has trained Resource & Referral Navigators on duty Monday-Friday from 9am-4pm to help parents locate childcare that meets the family's individual needs. They connect families with childcare resources and provide information on what quality childcare may look like. Services available in English and Spanish.
https://www.cvcsn.org/find-care
Fresno County Community Calls
Join TCM Fresno each third Thursday of month for our community calls- presented by CalViva Health. Meetings will contain updates from Fresno County Department of Public Health, diverse guest speakers for a variety of topics important to the community, and question and answer session.
Mark Your Calendars!
The Children’s Movement (TCM) State of Our Children Breakfast brings together more than 600 community stakeholders to celebrate the impacts of our collective work, and to embrace the challenges that remain. Since 2011 this annual event has drawn representatives from education, health, housing, justice, non-profit, civic, business, and philanthropy.
Sponsorships are now available! Email kelsey@tcmfresno.org