A Nurse, a Friend and a Parenting Teacher: Home-Visit Program Helps Low-Income Mothers

Registered nurse Jocelyn Cruz meets with 20-year-old Merced mother Oyuny Bahena, who holds her 4-month-old son, for a regular home visit funded by the federal Maternal Infant and Early Childhood Home Visiting Program. Photo: Lisa Renner.
Registered nurse Jocelyn Cruz meets with 20-year-old Merced mother Oyuny Bahena, who holds her 4-month-old son, for a regular home visit funded by the federal Maternal Infant and Early Childhood Home Visiting Program. Photo: Lisa Renner.

Oyuny Bahena was pregnant and living in a homeless shelter in Merced County when she first met with a home-visit nurse.

The nurse offered to help guide the 20-year-old through the challenges of parenthood over the next two years at no cost. Bahena remains grateful.

“I love her support (and) how she’s very attentive with me and my baby,” she said.

The nurse, Jocelynn Cruz, is paid through funding from the federal Maternal, Infant and Early Childhood Home Visiting Program, created in 2010 by the Affordable Care Act. The goal of the $1.5 billion national program is to help first-time, low-income mothers get the skills they need to raise children who are ready to learn.

The program, which is built on decades of research, is also designed to help prevent child abuse and neglect and encourage positive-parenting techniques for guiding children in non-punitive ways. In March, Congress voted to extend funding for another year.

The program is administered in California by the state Department of Public Health through the California Home Visiting Program. Twenty-one at-risk communities have received a combined $20 million in funding and are contracting with two nonprofits, Healthy Families America and Nurse-Family Partnership, to offer the services. The program is available in five rural Northern California counties, the Bay Area, Sacramento, much of the Central Valley, and Los Angeles, San Diego, Riverside and Imperial counties.

During the last two years, 2,455 mothers in the state enrolled in the program. As of July 1, the program had 1,782 active clients.

About 27 percent of mothers who have enrolled in the program have dropped out, according to the California Department of Public Health.

In order to complete the program, mothers must be enrolled for at least two years. Some mothers drop out because of changes in their life or distractions. Some have a hard time keeping appointments or following up on directions. Some nurses also change jobs and move.

Angela Rothermel, policy associate with early learning and development team at Children Now, an advocacy group, said the program targets a very specific, high-needs population dealing with poverty, housing instability and job instability.

“There can be turnover on caseloads due to general circumstances,” she said. “There is attrition. This is a reality due to their lives.”

Support for mothers

Cruz, a registered nurse with training in public health advocacy, works under the Nurse-Family Partnership model. She works with 21 mothers, spending her days driving across Merced County to visit them at their homes.

While some critics express concern that the program is too much government intervention in mothers’ personal lives, the program is voluntary. The women have the option to drop out at any time.

Cruz visits Bahena twice a month at a mobile home in Merced where the single mother now lives with her mother and her four younger sisters. After meeting Cruz, Bahena moved out of the homeless shelter and reconnected with her family.

On a recent visit, Cruz asked Bahena about her 4-month-old son’s sleeping and eating habits, the status of his teeth and how much time he gets on his stomach, which helps babies learn to crawl. When the infant surprised everyone by trying to roll for the first time, Cruz whipped out her company-issued iPad and took a video that she was able to share with Bahena.

The stay-at-home mom said Cruz has helped her with a lot of concerns, like how to deal with a crying baby and manage breastfeeding. Bahena said she might have stopped nursing her baby if Cruz and her mother hadn’t offered their encouragement. Now she said breastfeeding is going well. “It’s so easy and it makes the bond better,” Bahena said.

Cruz said Bahena has a lot of support compared to some mothers she sees. She recalls one mother who had no family and was alone at the holidays. Others aren’t sure where their next meal is going to come from.

Cruz said she often helps the mothers get access to other services, such as food stamps and health care.

“They see me as somebody they can talk to — a friend,” she said.

Program proven successful

The nurses are trained to help the mothers with a range of issues that may come up. For example, if a woman is struggling financially, they will help her work out a budget and set monetary goals. The nurses also encourage mothers to find their “heart’s desire” and think about where they want to be in five or 10 years.

Research proves the Nurse-Family Partnership model works. Three randomized, controlled trials found that the participating mothers improved their economic self-sufficiency. Two of the trials found that the mothers used less welfare and government assistance, found more jobs than women not in the program and had fewer closely-spaced subsequent pregnancies, making it easier to advance in their jobs.

Regina Vittore, the supervisor for Nurse-Family Partnership’s four-nurse Merced County program, said the mothers listen to the nurses because of their strong relationship. The nurses get to know the women so well that they can tailor their messages to individual learning styles. They keep each lesson short and to the point.

“We understand they only retain 10 percent of what we’re telling them,” she said.

The Merced County program also offers the women extras that can make their lives easier- like free nursing pads, cookbooks, menu planners, children’s music CDs and toys.

Help to improve their lives

Mothers enroll in the program no later than 28 weeks into their pregnancies and then work with the nurses until their children are at least 2.

“It’s a very intensive long-term program,” said Leslie Brouillette, nursing supervisor for Nurse-Family Partnership in Alameda County. “It’s a commitment on everybody’s side.”

In Alameda County, mothers usually find the program through referrals from clinics, schools, friends or family.  Common questions from the mothers include how to change diapers, what shampoo is best and how to deal with temper tantrums.

Angelica Carranza, a Nurse-Family Partnership nurse in Alameda County, said mothers have asked her to help them find cheaper housing and help them navigate the Medi-Cal system.

“I like the one-on-one interaction and the ability to learn about people’s lives and empower them and link them to resources and education and support,” she said.

Nurse-Family Partnership staff say many mothers have made advances in improving their lives with the help of their home-visit nurses.

“It’s nice to see the change when they have one person who is behind them 100 percent,” Brouillette said. “It may be the first time someone has given them that one-on-one focus.”

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