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Report: Home Visiting Makes Health Care Work Better

Early Childhood

Washington – A paper released today by the bipartisan children’s advocacy organization First Focus examines a successful effort that integrates pediatric primary health care with voluntary home visiting for newborns and their families. Coordinating Comprehensive Healthcare with Home Visits for New Families assesses a South Carolina effort with a 16-year track record of improved efficiency and better health outcomes for children. The paper was authored for First Focus by Katy Sides of the Institute for Child Success, with contributions from Sally Baggett, Director of Patient and Family Support at Carolina Health Centers, Inc., which pioneered the integrated home visiting and primary care approach.

“In healthcare, the three-trillion dollar question is how to deal with costs, so we stop spending more to get less,” said First Focus president Bruce Lesley. “Here’s one answer: for more than 16 years, putting home visiting and health care together has yielded more efficient care and better health for kids.”

The paper examines how the integration of evidence-based early childhood home visitation and behavioral health services into pediatric primary health care can improve children’s health. Voluntary home visiting employs evidence-based strategies to provide parents knowledge, support, and nurturing needed for their children to thrive. The paper looks at The Children’s Center, which is administered by Carolina Health Centers, Inc., a nonprofit, federally qualified health center providing family practice, pediatric and pharmacy services in a medically-underserved area in western South Carolina.

“Our work has taught us that the real key to the significant and sustainable changes in families that lead to improved child well-being is an integrated approach utilizing the strengths of each discipline to reinforce, extend and enhance each other,”  said Sally Baggett, Director of Patient and Family Support at Carolina Health Centers, Inc.

The paper examines gains in health and health care efficiency as the Children’s Center transitioned from co-located family services toward a comprehensive approach that breaks down the silos to connect home visiting, mental health, and primary care. Integration can improve access to care. For example, the Center has seen a 78 percent increase in developmental screening rates for all children with a 98 percent rate for children served by home visiting and a 57 percent increase in access to behavioral health care, responding to concerns about maternal depression.

“The American Academy of Pediatrics is focused on meeting three of every child’s most basic needs: sound nutrition, nurturing relationships and safe environments. Home visiting and primary care work together to meet these needs by addressing the health of the whole child—emotional, mental, and physical—and by helping to ensure that the child’s home environment is as safe and supportive as possible. The report released today confirms what pediatricians have long understood: when pediatricians and home visiting professionals work together, children can thrive,” said American Academy of Pediatrics President Sandra G. Hassink, MD, FAAP.

These gains were realized by integrating administrative and leadership functions, allowing improved supports for area families, as well as gains for providers and the health care system:

  • Parents of babies receiving care through Carolina Health Centers clinics are offered home visiting support and screened into one of three models based on each family’s needs;
  • Home visiting coaches help families with breastfeeding, sleep issues, and other routine childcare challenges that, if not effectively managed, can become child health issues;
  • Feedback from home visiting coaches and shared recordkeeping helps physicians identify potential problems early, improving the effectiveness of corrective care;
  • Shared planning helps home visiting coaches and health care providers work jointly with parents to set health outcome goals, provide effective support, track potential problems, and keep children healthy.

“The old healthcare model ignores the fact that, from basic nutrition to toxic stress, what happens at home has huge health consequences,” said Lesley. “But with an integrated approach, parents get help to identify potential problems for their children, manage them, and avoid scary and costly health problems.”

The paper is part of First Focus’s compendium Big Ideas: Pioneering Change. The publication includes more than a dozen papers by expert authors offering innovative solutions to problems facing America’s children and families. Other papers address issues ranging from education to housing, poverty to asthma management.

Federal funding through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program supports home visiting efforts in every state, including the home visiting initiatives at The Children’s Center. MIECHV’s congressional authorization will expire at the end of March, unless Congress acts first. Neither the United States Senate nor the U.S. House of Representatives has passed legislation to extend it.

“Decades of researched-backed results show home visiting delivers better outcomes for kids and families and reduces avoidable health care and social costs,” said Lesley. “Extending home visiting funding should be a no-brainer, and instead we’ve got no action,” said Lesley.

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First Focus is a bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions. For more information, visit