It’s time to modernize the California home visiting program

OPINION – Becoming a new parent has always been a time of both joy and uncertainty. Pregnancy and birth bring new challenges to our bodies, emotions, relationships, and finances at the same time a new baby is relying on us for their every need. Now, a new study demonstrates families with low incomes are facing more pressures than ever, with maternal deaths soaring to their highest rates in nearly 60 years and as communities are still struggling to recover from the trauma of the COVID-19 pandemic.

Providing the support that helps pregnant people and new parents succeed and infants thrive is the role of public health nurses and other professionals in the California Home Visiting Program.

We don’t always see them, but they’re always there and their impact is significant. Many of the trained professionals come from the diverse communities they serve and their ability to relate to the cultures, languages and customs of their communities is what makes them welcome in the homes of families who have often gone underserved by the medical system.

Pregnant people receive pregnancy and postpartum checkups, breast-feeding support, nutrition counseling, and coaching on positive interaction with their newborns. Babies receive health checks and are screened for developmental delays.

At-home or in community (for unhoused families) visits can also identify issues of substance abuse or family violence, and counseling and referrals are provided to support families navigating these issues.

These evidence-based preventive interventions have been shown to improve maternal and child outcomes during the first three years of life – producing not just healthier families but also averting the need for more costly health and social service interventions down the line.

Today, our world feels more uncertain than ever. The soaring costs of daily life has taken its hardest toll on people with low-incomes and long standing health inequities that were magnified by the COVID-19 pandemic. A widespread crisis in mental health is affecting many Californians, and the clients served by the California Home Visiting Program have not been immune.

It is time to modernize the program to address emerging needs by providing local public health professionals with the flexibility, resources and tools they need to address the new challenges families are facing.

A widespread crisis in mental health is affecting many Californians, and the clients served by the California Home Visiting Program have not been immune.

Dr. Akilah Weber, an assemblywoman who is also an ob/gyn, has introduced legislation to enable the program to better serve this generation of young parents. She says her perspective as a physician has taught her a fundamental lesson: “I know that preventing disease is better than curing it.”

Weber’s proposal, AB 1057, would boost the reach and impact of the California Home Visiting Program by addressing gaps that have become more apparent during the pandemic. For example, it would remove barriers to supporting families with more than one child and serving unhoused communities. It would also enable local public health departments to embed mental health support services to better address the mental health needs of the pregnant people and families they serve.

The proposal is consistent with Gov. Gavin Newsom’s ambitious plans to improve access to behavioral health services for the benefit of California families and children – an issue the governor has called “one of the greatest challenges of our time.”

It is well understood that during the weeks and months that follow child delivery new parents are at higher risk for depression and other mental health challenges. It is common for new parents to feel exhausted and overwhelmed. Reaching out for help and treatment is all the more difficult for parents with low-incomes in underserved communities.

When at-home visits identify symptoms of these conditions, public health home visiting staff need tools and resources to help parents and their families recover and thrive.

During National Public Health Week (April 3-9), public health departments across the state are celebrating the value of home visits in getting families off to a healthy start, and pushing to modernize the California Home Visiting Program. Home visits are more valuable today than they’ve ever been, and ensuring the program can help families meet new challenges must be a priority for California leaders this year.

Kimi Watkins-Tartt is Alameda County Public Health Director