NaTosha Robinson has stage four lymphoma and after losing her left lung in 2020 she often struggles to breathe. Her 5-year-old daughter, Sierra, struggled to develop a speech delay. Robinson wanted to prepare her for school, but didn’t know how to deal with concerns such as Sierra’s difficulty holding a pencil, while dealing with her own health issues.
“It’s a lot to be a single parent and do it alone,” she said.
Things changed in 2021, when Jackie Nguyen came into their lives through a federal program that provides in-home support to pregnant people and families with young children at risk of poor physical and mental health.
Nguyen helped Robinson find an occupational therapist, taught Sierra how to write letters, and even found an air conditioner for their apartment before a heat wave.
“We meet families where they are,” said Nguyen, a nurse with the Mabel Morris Family Home Visit Program, one of the Philadelphia-based organizations that uses federal dollars to work with families.
But funding for the Mothers, Infants and Early Years Home Visiting Program, or MIECHV, expires in December. Early childhood education, health and family advocates like the Robinsons hope Congress will not only reauthorize the program, but also commit more money to it.
In Pennsylvania, the MIECHV has supported nearly 30,000 home visits to over 2,800 homes in fiscal year 2020. Approximately 70% of these households were low-income and 12% had a child with developmental delays or disabilities.
Home visitors are not all nurses. MIECHV allows states to use the funding to support different interventions that promote maternal and child well-being, said Meredith Matone, scientific director of PolicyLab at Children’s Hospital of Philadelphia. This gives communities the flexibility to respond to local needs.
In a evaluation of the MIECHVMatone’s team found that the Pennsylvania program led to healthier behaviors, such as mothers quitting smoking, and that families generally found the program helpful in preparing their children for school.
“When we spoke to the families, we found great satisfaction,” Matone said.
But the need is beyond the scope of the program. A 2020 needs assessment by the PolicyLab found that only 1.5% of Philadelphia families eligible for home visits received support.
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Congress funds the program in five-year increments, which would have expired on September 30. Funding was extended until mid-December in the Short Term Spending Bill passed last month to prevent a government shutdown.
In 2017, Congress allowed the funding to expire for a few months.
Home visits have continued, but lack of funding has created stress and uncertainty for program organizers and families who rely on these services, said Lizz Tooher, senior director of health and raising children at the Mabel Morris Family Home Visit Program. Some programs have frozen hiring and stopped enrolling new families. The smaller programs “have really struggled to keep the doors open,” she said.
A MIECHV reauthorization invoice making its way through Congress with bipartisan support.
In addition to reauthorizing the program, the bill would increase funding for home visits. Pennsylvania received approximately $11 million via the MIECHV in each of the past two years. The bill would double that figure within a few years, according to a projection shared by the office of Representative Dwight Evans, a Democrat from Philadelphia who is a co-sponsor of the legislation.
“For the parents, for the kids, the benefit this will be is huge,” Evans said.
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Nguyen, the home visiting nurse, finds that the families she works with often need a lawyer familiar with the resources available in the community.
Working with a family in a home gives her a more complete view of their health needs than she could see in her previous role as a neonatal intensive care nurse at the hospital.
“I’m their cheerleader,” she said.
Robinson said working with Nguyen changed her life and, more importantly, her daughter’s. Sierra is now in kindergarten. Not only does she hold a pencil, but she writes letters.
“Thanks to her, I’m fantastic,” said the mother.
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