Johnna French smiles when she talks about her job helping families with a new baby.
“It’s a more intimate relationship, so if I don’t get everything accomplished in one visit, I know I’m going back,” she said.
French is a maternal child health home-visiting nurse with Albany County.
Her services often prioritize low-income families, she said. She visits before birth and up to two years after. Other home-visiting programs last even longer.
Sometimes, the work involves teaching parents about nutrition and developmental milestones. Other times, it just means easing their minds.
French recalled one woman who had thoroughly researched how to create a safe sleeping space for her baby, but was doubting herself and was visibly anxious about whether a fitted sheet was fitted enough.
“Actually, it was perfect. It was one of the best nurseries that I ever saw,” French said. “But then I could just visibly see this mama relax, like ‘oh, OK! I am getting it. I can do this motherhood thing.’”
Parental anxieties and mental health can affect a newborn, French said, and supporting both the parents’ mental health and the baby’s physical health is essential.
That support can help parents avoid an emergency room visit when something unusual happens, she said. It can also teach them how to build a stable family unit they might not have had as kids.
“When any family brings a new baby into the household, that can be a time when they can make some positive motivational change because they want to do better for that little baby,” she said.
The grant funding that makes French’s work in Laramie possible — including Maternal and Child Health and Temporary Assistance for Needy Families funds — is relatively stable, but not everyone providing home visits is so fortunate.
Hundreds of Wyoming families rely on home visits funded by the federal Maternal, Infant, and Early Childhood Home Visiting Program, or MIECHV. That program’s funding nearly lapsed late last month. A last-minute stop-gap measure Congress passed to delay a federal government shutdown will keep the lights on until mid-December, but beyond that the program’s future is uncertain.
The financial close call has some in Wyoming deeply concerned about funding for programs they say are crucial for creating healthier communities statewide. Wyoming’s congressional delegation, meanwhile, hasn’t shown support for legislation that would boost the funding and provide extra support to tribal communities.
Primary prevention
The Wyoming Department of Family Services funds a home-visiting program called Parents as Teachers, and around 95% of that money comes from MIECHV, according to DFS Program Analyst Brittney Thyarks.
Thyarks turned to a massive binder to double-check the specifics.
When the department is fully staffed — which it is now — there are 12 parent educators and three supervisors in the home visiting program, she said. In the program year 2020-21, that crew served 243 families, which they can work with up until a child is in kindergarten.
“It’s a really great program, and we hope funding is reauthorized,” Thyarks said.
DFS is beginning to look for other funding avenues to expand the program, she said, but the department’s current MIECHV grant lasts through 2024. Still, that grant was only about $1.16 million for fiscal year 2022, which Thyarks said isn’t enough to support all the families who could benefit, just those with the highest needs.
“MIECHV requires that we prioritize individuals that meet specific criterias,” Thyarks said. “Low-income families is one of them. Families in priority communities … pregnant women under the age of 21, families that have a history of child abuse or neglect, families with a history of substance misuse or family members that need treatment for substance misuse.”
The priority communities include all of Albany, Laramie, Sweetwater, Natrona and Fremont counties.
Other priority categories include families with tobacco users; families with students that have low student achievement, developmental delays or disabilities; and families involved with the armed forces.
According to child advocacy group First Five Years Fund, fewer than 1% of eligible families have access to MIECHV funding in the U.S. Despite those numbers, Thyarks and French say the funding could ultimately save tax dollars — and ensure better health outcomes for Wyomingites — in the long run.
“We know that home visiting is a primary prevention for abuse and neglect. So the more families that we can provide home visiting to, the less DFS has to be involved,” Thyarks said.
Savings may also come from avoiding foster care costs, according to Debra Hibbard, policy and program manager for the state’s Social Services Division.
There is a bill in Congress to increase MIECHV funding and matching grants. The Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022 also authorizes virtual home visits, funds home-visitor-retention efforts and tries to ease paperwork burdens to access the grants.
A bipartisan coalition of 109 lawmakers had cosponsored the bill as of Oct. 10 — but not yet anyone from Wyoming’s delegation.
Neither Sens. John Barrasso or Cynthis Lummis, nor U.S. Rep. Liz Cheney, returned requests for comment on how they would vote on the legislation.
Tribal set-aside
Increased MIECHV funding and access aren’t the only things H.R. 8876 includes, though. It heeded the call from hundreds of child welfare organizations to double the amount set aside specifically for Native American tribes.
The National Home Visiting Coalition said in a statement, “Historical and ongoing inequities within [American Indian and Alaska Native] communities have only been amplified by COVID-19. Currently, Tribal MIECHV receives $12 million annually for the more than 600 eligible Tribes and Tribal-serving organizations.”
Allison Barlow is the executive director for the Center for Indigenous Health at Johns Hopkins Bloomberg School of Public Health, which signed onto that document.
While the 3% of total funding that is currently set aside may match the approximate percentage of American Indian and Alaska Native people in the U.S., Barlow said it doesn’t match their needs.
“We’re just seeing much more stress among young parents due to the effects of COVID. Native children have lost parents at a rate of 4.5 times higher than white children,” she said. “So now more than ever, these extra comprehensive supports are so important.”
Native communities traditionally had strong family support structures, Barlow said, but partially thanks to the U.S. federal government, that has also suffered.
“The history of residential schools, boarding schools and relocation acts have really dismantled the traditional supports for raising healthy kids. So there’s a real desire on the part of tribal communities to reclaim healthy families through support for the families who need it the most,” she said.
Barlow also found that one tribal home visiting program in particular, called Family Spirit, produces measurable results. It involves people within a tribal community helping others there, and Barlow said case studies show it promotes effective parenting skills, diminishes mothers’ illicit substance use and promotes children’s social and emotional development.
“Basically, there’s a measure of infant/toddler social-emotional development that has been shown to be very predictive of long-term trajectories without intervention,” she said. “So if a child measures poorly in early life and have no intervention, they have much greater risk for problematic substance use, suicide, delinquency, trouble with the law, drop-out, early pregnancy.”
The children of mothers who were part of a Family Spirit home visiting program had stronger social-emotional development that can lead to better long-term outcomes, Barlow said.
A Family Spirit program on the Wind River Indian Reservation was funded by sources other than MIECHV, but has faced its own funding difficulties. A doubling of tribal grant opportunities through MIECHV could help support such programs.
Funding uncertainty
Increased tribal MIECHV funding isn’t assured, though. Nor is MIECHV’s reauthorization.
That kind of uncertainty is especially disheartening to tribal communities, according to Michelle Sarche, who works in the Centers for American Indian and Alaska Native Health within the University of Colorado Anschutz Medical Campus.
“I think there is already so much mistrust in tribal communities that the federal government is going to uphold its end of the bargain with respect to treaty rights and all of the things that were promised in treaties to support the health and well being of communities,” she said.
Congress’ stop-gap measure to keep the federal government open, and to keep MIECHV afloat, only lasts through Dec. 16.
Meanwhile, the bill proposed to increase MIECHV funding and the amount going to tribes is still in the House Ways and Means Committee, where it was introduced Sept. 19.
Back in Laramie, French extolls the benefits funding home visiting can have for the state.
“It’s the mom and the baby. And that turns into the family unit. And that turns into the community,” she said. “If we can start there, it’s only going to be [to] the betterment for the overall health of the community, which is what public health is.”