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New Jersey Steps Up Home Visitation for Pregnant Women and Families With Young Kids

Professional presence in home helps reduce the risk that children will end up victims of abuse and neglect.

New Jersey is launching a major expansion of its home visitation programs, in which nurses and other professionals make regular visits over several years to pregnant women and families with young children. The goal is to strengthen families and reduce the risk that kids will wind up victims of abuse or neglect.

A $9.4 million federal grant is doubling the state's budget for these programs to about $20 million a year, and will increase the number of families served from about 3,500 to about 5,500.

That still falls far short of the need: the state estimates conservatively that 12,000 families could benefit from home visitation programs, which target at-risk populations like teenage mothers and low-income families.

But Cecilia Zalkind, executive director of Advocates for Children of New Jersey, said that the state is actually ahead of the country in its commitment to home visitation. She said New Jersey has been under a federal mandate to improve its child protection efforts since 2004 "And one of the byproducts has been an investment in a system to help families at a much earlier time, before the abuse occurs, and home visitation has been a big part of that."

Allison Blake, commissioner of the state Department of Children and Families and State Health Commissioner Mary E. O'Dowd recently convened a conference on the state's home visitation programs, which are run collaboratively by the two departments.

The state supports about 35 home visitation programs that are evidence-based, meaning they have a documented impact on child health and family stability. The major programs include the Nurse Family Partnership, in which a visiting nurse begins working with the mother early in her first pregnancy, and Healthy Families and Parents as Teachers, which is open to enrollment once children have arrived.

During the session at the Central Jersey Family Health Consortium in North Brunswick, staff talked about how they have created a network that steers families to the most appropriate program, as well as to other community resources like employment training and job placement.

"What we know from the research is that the earlier we can intervene, the more likely we can have success with families, we can help strengthen them, and they can achieves success in the community," Blake said. She added that since the state embarked on a child welfare reform effort in 2005, there has been a 44 percent reduction in the number of New Jersey children in foster care "and that is because we are really focused on working with families in their homes."

O'Dowd said improving prenatal health screening is a key goal of home visitation. "We want to get people into the system and deal with issues that would otherwise escalate in the future. To help both the mother and the baby have a better foundation, we have to provide services and intervention sooner rather than later."

One of the three core programs that will be expanded with the new funding is the Nurse Family Partnership, a program led by the United Way of Central Jersey that sends visiting nurses to work to new mothers beginning early in their pregnancy. Gloria Aftanski, president of United Way of Central Jersey, said making sure babies get immunizations on schedule is one key objective of the program, which serves low-income families with language and cultural barriers who may not immunize their children until kindergarten. "They are very fragile families, and the nurses are their teachers, helping them get access to the community."

The nonprofit Prevent Child Abuse New Jersey oversees two other major programs: Healthy Families, which does home visitation during pregnancy and early childhood with a special emphasis on families receiving public assistance, and Parents as Teachers, which is focused on child development, health screening and, parenting assistance through age five.

Gina Hernandez is division director of prevention programs at Prevent Child Abuse New Jersey. She said Healthy Families served 2,453 children in fiscal 2011, and she cited a number of benchmarks that reveal the program's impact. Nearly all the children -- 96 percent -- were enrolled in health insurance programs. Healthy Families makes sure that children who qualify are signed up for Medicaid or for the state-run children's health insurance program. Also, 93 percent of the families had a primary care provider, and were not dependent on hospital emergency rooms;91 percent of those eligible for food stamps were enrolled; and 87 percent of the families had books in the home for infants or toddlers.

Hernandez said home visitation works because "when you are in someone's home, you have the opportunity to work with the family to empower them to learn more about balancing work and life. This ultimately prevents child abuse and neglect, because you are reducing the stress on that family and offering then a support system."

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