Home medical visits and other help for first-time mothers pays off

Symphonie Dawson was studying to be a paralegal while working part time when she learned that the reason she kept feeling sick was that she was pregnant.

Living with her mom and two siblings near Dallas, Dawson, then 23, worried about her pregnancy and what giving birth would be like, not to mention how to juggle having a baby and being in school.

At a prenatal doctor visit, she learned about a group that offers help for first-time mothers-to-be called the Nurse-Family Partnership. A registered nurse named Ashley Bradley began to visit Dawson at home every week to talk with her about her hopes and fears about pregnancy and parenthood.

Bradley helped Dawson sign up for the Women, Infants and Children Program, which provides nutritional assistance to low-income pregnant women and children. They talked about what to expect every month during pregnancy and watched videos about giving birth. After Dawson's son, Andrew, was born in December 2013, Bradley helped her figure out how to manage her time so she wouldn't fall behind in school.

Dawson graduated with a bachelor's degree this month. She's looking forward to spending time with Andrew and looking for a job. She and Andrew's father recently became engaged.

Meanwhile, Bradley will keep visiting Dawson until Andrew turns 2.

"Ashley's always been such a great help," Dawson says. "Whenever I have a question - like what he should be doing at this age - she has the answers."

Home-visiting programs that help low-income, first-time mothers have a healthy pregnancy and develop parenting and other skills have been around for decades. Lately, however, they're attracting new fans. Such programs appeal to people of all political stripes because the good ones manage to help families while reducing government spending.

In 2010, the federal health law created the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program and provided $1.5 billion for evidence-based home visiting programs. There are now 17 such models approved by the Department of Health and Human Services, and Congress reauthorized the program in April with $800 million for the next two years.

The Nurse-Family Partnership, which operates in 43 states, is one of the largest and best-studied programs. Decades of research into how families fare after participating in it have documented reductions in the use of social programs such as Medicaid and food stamps, reductions in child abuse and neglect, better pregnancy outcomes for mothers and better language development and academic performance for their children.

"Seeing follow-up studies 15 years out with enduring outcomes, that's what really gave policymakers comfort," says Karen Howard, vice president for early childhood policy at First Focus, an advocacy group.

But some experts say that only a handful of the approved models have as strong a track record as that of the Nurse-Family Partnership. They say the standards for what constitutes an evidence-based program are too lenient.

"If the evidence requirement stays as it is, almost any program will be able to qualify," says Jon Baron, vice president of evidence-based policy at the Laura and John Arnold Foundation, which helps encourage policymakers to make decisions based on data and other reliable information. Maintaining strong evidence-based standards is important to the continuation of the program, he said.

Nurse-Family Partnership founder David Olds, a professor of pediatrics at the University of Colorado at Denver, began testing the model in randomized controlled clinical trials starting in 1977 and continues to conduct follow-up research.

A study by the Pacific Institute for Research and Evaluation found that the Nurse-Family Partnership reduced Medicaid spending on a first child by 8 percent, resulting in a savings to Medicaid of $12,308 per family served. After adding in cost reductions in food stamps, special education, child protective services and criminal justice, total government savings are closer to $19,000 per family, the study found.

However, many of the models approved by HHS do not have a lengthy track record nor strong evidence of having made meaningful changes in mothers' or their children's lives, according to Baron.

Although MIECHV programs must show statistically significant effects to be considered evidence-based, those effects need not have any policy or practical importance to qualify, Baron says.

He offered the example of one program that increased the percentage of mothers who brought their babies to the doctor for a one-month checkup. But further evaluation a few years later found that this program had no statistically significant effect on child health or safety.

"We think this is an important program," Baron says. "I testified for its reauthorization. We just think that as it goes forward, the loophole needs to be adjusted."

• This column is produced through a collaboration between The Post and Kaiser Health News, a nonpartisan health-care-policy organization.