NewPublicHealth Q&A: Libby Doggett
The first three years of a child's life are key, and problems then can lead to poor school achievement and poverty and crime later in life. Home visiting programs match at-risk families with trained professionals who offer support and resources during that critical time. A new report from the Pew Center on the States examines the extent to which all 50 states and the District of Columbia support evidence-based home visiting programs and tracks whether public expenditures are producing the expected outcomes.
Libby Doggett, Ph.D., director of the Pew Home Visiting Campaign, says many states are beginning to receive initial installments of a $1.5 billion, five-year federal funding stream to support home visiting programs but those public dollars must be tied to effective, efficient programs. NewPublicHealth spoke with Libby Doggett about the report and the effectiveness of home visiting programs.
NewPublicHealth: What advantages to the community does a home visiting program offer?
Libby Doggett: Home visiting programs match parents with trained professionals, often a nurse or a social worker, sometimes a well-trained paraprofessional, who provide information and support during pregnancy and throughout the child’s first few years, which is a critical developmental period. I think what’s most exciting about our visiting programs is the research behind them. We’ve found that infant mortality falls by about 60%, that the mother is half as likely to deliver a low birth weight baby, the children are less likely to end up in an emergency room or be treated for injuries and accidents, and they’re more likely to be ready for school and a have a more successful school career.
And for mothers, there are additional really good outcomes: an 83% increase in employment by the child’s fourth year, a 20% reduction in welfare use, and 46% increase in the father’s presence in the household. Those are the kind of outcomes that we want for children and for families. Most importantly, the programs reap good returns for taxpayers as well. For every dollar invested, you’re likely to get $5.70 back. That’s a pretty good rate of return. Some of that return is in cost savings because you don’t spend the money on children in ICU, for example, related to child neglect and abuse. So it’s both savings projected from the program as well as some actual savings in terms of welfare costs, food stamp costs and other expenses.
NPH: What were the key findings in the Pew report?
Libby Doggett: This is a first of its kind report on the funding of home visiting programs across the 50 states and the District of Columbia, and what we found is that states make available about $1.4 billion for home visiting and early learning programs but they couldn’t document the use of about 40% of those available funds. The states don’t really always know what’s happening because in some cases they’re sending them to local governments or local organizations but don’t have requirements that they’d be spent in certain ways, meet certain standards, and most importantly, have certain outcomes.
But we see this changing, fortunately, because there is a new federal opportunity. States have received the first installment of a $1.5 billion five-year federal home visiting funding stream and it is requiring states to spend 75% of those new funds on evidence-based programs and to put in place many of the things that our report calls for: data systems, accountability systems and training systems, for example, so that the states have home visiting systems that really bring us the results that we know we can get from strong programs.
NPH: Who is eligible to be visited under the federal funding stream?
Libby Doggett: The federal government funding is targeting high-risk moms, generally including teen moms and first-time moms. States are being asked to put criteria, risk factors in place, and then actually target the dollars in that way. Right now we know that that’s often not happening.
NPH: How does the new funding stream build on existing programs and funding?
Libby Doggett: Nearly every state has some sort of home visiting program. Some of this is at the local level and some at the state level. Because it’s such a powerful intervention, lots of state agencies, education, human resources or child welfare services and health departments, as well as children’s bureaus, have used home visiting in one way or another. The federal dollars are going to help states pull that together into a system, and I think the federal opportunity is an amazing one as well because it’s going to require that states spend 75% on programs with the highest evidence base. In fact, that’s one of the few times the federal government is really letting research drive the expenditures.
NPH: Who is administering the federal funds?
Libby Doggett: It’s actually being jointly administered through the Department of Health and Human Services through the Health Resources Services Administration because both agencies have a vested interest and have numerous other pots of money that have at times gone into home visiting.
NPH: Can you share a story of a mother and child who really thrived because of a home visiting program?
Libby Doggett: We recently were able to hear the story of a teen mother in Colorado. When her family found out that she was pregnant they kicked her out of the house. She had nowhere to go. Luckily, someone put her in touch with the nurse/family partnership and they helped connect her to the resources that she needed to find a place to stay and then they provided the support that any pregnant mother needs—such as getting to the doctor and taking prenatal vitamins. She had a great birth.
She said until she had this baby she never felt like she was worth anything, her family made her feel kind of worthless, and that through her visits with her home visiting nurse, she was really able to turn her life around and could see that she did have a great future ahead. I also saw her young son, who was about 14 months toddling around the meeting; and really meeting all the developmental milestones that you would like to see. And the mother had gone back to school, raised her self-esteem and was hoping to be a nurse in the future.