How Home Visits From A Nurse Can Improve The Lives Of Low-Income Moms & Babies

When Tyesha Candler was pregnant with her daughter, she said she was afraid.

“I was scared of going into labor,” said Candler, a first-time mother. “Scared more of the pain than anything.”

At a prenatal visit during her third trimester, Candler, a 22-year-old resident of Champaign, learned about a nurse home-visiting program for new, low-income families. She was nervous at first about have a stranger come to her home, but said she “immediately clicked” with nurse Kathy Crowder.

Photo Credit: Christine Herman/Illinois Public Media

Crowder helped calm some of her fears about childbirth, Candler said. And having her visit every two weeks has helped smooth the transition into motherhood.

“I know that’s one of my resources I can call and depend on,” Candler said.

Crowder is with the Healthy Beginnings program, which launched in 2017 and provides regular home-visiting services to 150 families in Champaign-Urbana. The goal is to improve long-term health and educational outcomes for children and families by providing support and resources they may need throughout pregnancy and early childhood.

Healthy Beginnings is supported by private funding from the Carle Foundation, the not-for-profit parent company of the local hospital and other healthcare services. It’s one of several programs like it in the Champaign-Urbana area and is among hundreds of others nationwide, many of which depend on grant funding.

Recently, the federal U.S. Health Resources and Services Administration awarded $361 million over the next five years for home visiting programs, including $9 million for programs across Illinois.

What happens during a home visit

“Clients are very gracious, allowing us into their homes,” said Crowder, who transitioned into home visiting after years as a nurse in other departments. “It’s a vulnerable time. They’re pregnant, have other issues going on. We go in to help them in whatever category they need.”

So far, more than 80 babies have been born into the Healthy Beginnings program.

One of them is Candler’s daughter, Ca’Nylah Kelly.

During a recent visit, Ca’Nylah rests in her mother’s arms, while her dad, Christopher Kelly, gets formula ready for her feeding.

Over the course of an hour, Crowder sits with Candler and Kelly in their living room and talks about how things are going with the new baby. They discuss mom’s transition back to work, talk about the importance of good nutrition and staying hydrated, and they measure baby’s weight.

Crowder asks about Candler’s long-term career goals of becoming a nurse, and they discuss what steps she’ll take to achieve it. Crowder also prompts Candler to consider things about her upbringing that she hopes would be the same for her daughter, and what kinds of things she wishes to be different for her.

How regular nurse visits help families

Healthy Beginnings is based on a decades-old program, known as the Nurse-Family Partnership. Numerous studies have found the approach can improve health and educational outcomes for both mothers and children, even years after the visits have ended.

The idea is to intervene in the lives of at-risk children at the earliest possible stage.

Children who grow up in poverty or experience other forms of adversity or trauma are likely to have worse health and educational outcomes later in life, because of the way trauma hinders normal brain development.

But research shows having a stable, nurturing relationship with a parent or caregiver can offer protection against the long-term consequences of early-childhood adversity. For this reason, one of the primary aims of home-visiting programs is to bolster the parent-child relationship.

To learn more about the home-visiting approach, Illinois Public Media spoke with Dr. Dina Lieser, senior advisor at the Health Resources and Services Administration Maternal and Child Health Bureau’s Division of Home Visiting and Early Childhood Systems.

The following interview has been edited for clarity.

Christine Herman: What do we know about the effectiveness of nurse home-visiting programs for improving outcomes for both women and their children?

Dr. Dina Lieser: Home visiting helps prevent child abuse and neglect, supports positive parenting, improves maternal and child health, and promotes child development and school readiness. These program have also shown effects on school dropouts, substance use among adolescents, teen pregnancy and crime, maternal mental health and economic self-sufficiency.

There are so many components to home visiting. The basis of it is an established, regular connection with a professional, who honors the power of the parent in shaping that child's development.

So, they may be teaching positive parenting skills, teaching parents about the importance of early language, promoting early literacy activities, providing information and guidance on a wide range of topics, including breastfeeding, safe sleep practices, injury prevention and nutrition, conducting screenings and providing referrals. They may address things like postpartum depression, substance abuse and family violence, and help link them to resources that are supportive.

Herman: One of the components of home-visiting programs involves offering parenting guidance, including efforts to promote an attachment between the parent and the child. What does this involve and why is it important?

Lieser: We know that positive, early experiences, and in particular, warm, loving, nurturing, safe and stable relationships provide children with a strong foundation, building sturdy brain architecture, setting the stage for lifelong health and success. It really is through relationships that children begin to feel safe and loved and secure enough to explore the world, and learn how to think, understand, communicate, behave and show emotions and develop social skills.

Herman: How effective can this type of approach be at breaking cycles of poverty, if the family is still facing other challenges: housing issues, homelessness, lack of access to healthcare, unemployment and myriad other things?

Lieser: Adverse fetal and early-childhood experiences can lead to physical and chemical disruptions in the brain that can last a lifetime. We know that exposure to adversity or toxic stress in the absence of nurturing relationships and the absence of connection to other resources can really cause poor outcomes, including school failure, substance use, mental illness, and even adult heart disease.

But safe, stable, nurturing relationships serve as a protective factor, in addition to connections to resources that meet the family’s needs. Those are really important protective factors that have the potential to mitigate those risks and really change cycles of poverty, and change and address so many of the public health challenges that our nation is facing right now.

Herman: Any program costs money to run. In this case, there's $361M being invested in programs across the country for home visiting. What do we know about the return on investment for this kind of public health intervention?

Lieser: There is an incredible window of opportunity that exists for interventions focused on helping young children and families thrive. Early interventions like home visiting can have tremendous cost-savings in the long-term by taking a preventive approach and building health and well-being, as opposed to intervening when there is a significant costly challenge later on that may be difficult to address.

One study has shown that as a result of home visiting, benefits generally exceeded costs over long periods of time with significant returns on investment. For example, over an individual's lifetime, benefits appear to exceed costs by amounts ranging from 20 percent to more than 200 percent.

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