Engracia Sampaio-Dunn was strolling through the Buffalo Juneteenth festival in 2018 when a banner advertising help for new parents caught her eye. Sampaio-Dunn and her husband had recently learned they were expecting their first child, and her own parents and relatives were hours away in New York City.
The first-time mom, now 26, was thrilled to learn that Healthy Families would provide weekly home visits to help guide her through motherhood, and she soon began meeting with family specialist Eunice Robinson.
When Sampaio-Dunn had trouble finding a doctor, Robinson quickly dialed a midwife she knew at a nearby hospital. Before the birth, she found the new parents a free car seat and baby clothes. Once baby Aura came home, Robinson set them up with a federally funded lactation consultant.
More recently, Aura, now an energetic toddler, tripped and began bleeding from her mouth. And once again, Sampaio-Dunn’s first call was to Robinson. The panicked mom shared her fears for her daughter’s safety, as well as her worry that, as a Black mother, bringing an injured child to the doctor could put her at risk of being investigated by Child Protective Services. Robinson reassured her that such accidents were normal and encouraged her to seek medical care.
“She’s become like an auntie or a grandma who I can always call and she already knows my situation,” Sampaio-Dunn said. “It’s just amazing that she chose to be in our lives.”
Healthy Families – one of more than a half dozen home visiting models offered throughout New York state – is a free, voluntary service open to any expecting or new parents for up to five years. Early on, a family specialist paid for through public funds and donations, typically visits for an hour every week, with frequency tapering off as parents meet their goals.
Through referrals from doctors, social workers and shelters, home visiting programs make a particular effort to support younger parents – some barely into their teens – and those navigating challenges like poverty, homelessness or addiction. Their goal is to bolster family stability and healthy child development while preventing serious problems like neglect, abuse or removal to foster care.
The outbreak of the coronavirus pandemic this spring was the first time nearly all home visits were forced onto screens, as video chats or phone calls. While many New York programs continue doing virtual visits only, early last month, Healthy Families Buffalo began offering in-person visits outdoors.
About 3 out of 4 families asked to resume these face-to-face meetings, said program manager AnnMarie Correa. “We thought they might be reticent, but the families were excited to have us back – we might be the only friendly face or other adult they talk to all day,” Correa said. “Our staff build a lot of trust with parents, and they teach them to build a support system of their own.”
For many, though, the reunion was short-lived. Nine of the 29 Healthy Families visitors are now being laid off as the program, funded primarily by the state Office of Children and Family Services, is among those squeezed by a budget deficit that has ballooned to $13.3 billion. Half a million dollars in funding owed from the last quarter is still stuck in Albany, of which 20% will now be withheld by the state. And funding for the current fiscal year has not yet been approved, so it cannot be paid out.
The shortfalls could leave as many as 200 families – nearly half of the Buffalo program’s clients – without the regular home visitor they’ve grown to trust, and far fewer visits for non-urgent needs. Because remaining employees can’t absorb all of the families served by laid-off colleagues, only the families with the most urgent needs or highest risk of falling into a crisis will be reassigned to other specialists, Correa said. The rest of the households will get occasional phone calls to check in and see if they need referrals – but no visits for the foreseeable future.
“I feel bad because we were just getting back after COVID,” Correa said, “and now some are losing their worker all over again.”
Buffalo’s Healthy Families was one of the first home visiting programs in the country when it began 25 years ago, boosted by a federal grant. It now serves more than twice as many ZIP codes as it did when it started, including several suburban towns that ring the city. Correa had hoped to continue expanding its reach to outlying and rural areas, but that now seems unlikely.
The cuts come at the same time as dozens of early childhood organizations belonging to the statewide coalition Raising New York are urging the state to further invest in home visiting programs. There are currently fewer than 18,000 funded spots across the state, enough to reach just 6% of babies born to low-income families and 3% of children from birth through age 3, according to a new report by the group. In a recent virtual news conference, Jenn O’Connor, director of policy and advocacy at member organization Prevent Child Abuse New York, warned that if funding is cut and positions are lost during the pandemic, it could take years to build back to even the current service levels.
Parents who receive home visits report lower rates of abusive parenting practices – especially among young, first-time mothers and mothers with a previous report of child abuse or neglect – according to a 2010 study of all Healthy Families program sites in New York by the University of Albany and the state Office of Children and Families. State officials have credited wider use of preventive services like home visiting for contributing to a one-third decline in the number of children placed in foster care over the last decade, although it is difficult to isolate the precise impact of specific programs.
Children were more likely to have health insurance and less likely to have a low birth weight if their parents received home visits, according to another study of New York’s Healthy Families program, suggesting the program could help mitigate the crisis of elevated mortality rates for Black babies. In New York, Black babies face more than double the risk of dying in their first year of life compared with babies of any other race. A statewide task force also recommended expanding access to home visiting programs as a way to protect the lives of Black mothers, who in New York face a maternal mortality rate three times higher than women of other races, according to data from the Centers for Disease Control and Prevention.
Citing such evidence and a broader movement toward prioritizing prevention services in child welfare, Raising New York is urging the state to work toward a universal home visiting program. As a first step, the group is calling for home visits to be offered to all pregnant and postpartum parents in low-income areas and communities of color, which have been hit the hardest by COVID-19 infections and job losses.
“We are going to get over this virus, but the children – low-income, Black and brown – will be dealing with this for years on end,” said Melodie Baker, who co-chairs Raising New York. “We really need to do as much as possible so that the burden of inequity, racism and implicit institutional bias does not continue to fall on the shoulders of the same vulnerable populations.”
Recently, a statewide task force charged with identifying ways to reduce Medicaid costs recommended that home visiting services be considered an approved service for parents with public health plans, a change that could open the door to additional federal funding. Raising New York supports that change, and is also advocating for the inclusion of $100 million in the next federal stimulus package to support training and technology for virtual home visits.
Also supporting the coalition’s calls to action is Assemblymember Pat Fahy (D) of Albany, who on a recent press call worried that parents may now struggle more than ever as they face job losses, school closures and social isolation.
“I’ve never met a mother of a newborn who wasn’t overwhelmed,” she said. “We are living in a very unsettled time, but we know prevention works, and that’s what home visiting is.”