In health care, there is often a focus on cutting-edge, technical innovations as the solution for many of the woes that ail us. Indeed, technology has offered amazing advances in imaging, intervention, and even cure of conditions that once were untouchable by anything we had to offer. However, for some of our biggest issues, it is not high-tech but high-touch approaches that are the clear and convincing solution.
One of the most concerning situations in our society is around factors which impede parents from being able to provide the strong, nurturing, mutually responsive relationships that drive the development of young children forward — in fact, engagement with loving adults in this manner is the only meaningful factor that causes children to progress and wire their brains for learning and interaction with the world. (Note well: All those DVDs and apps that claim to teach your infant or toddler? They do nothing of the sort. The only time they are of benefit is when an adult participates — which tells you that it’s not the app, it’s the parent!)
There are a number of factors that can get in the way of parents engaging with their children, however. Sometimes it may be a parent having to work multiple jobs due to the lack of a living wage. Or extreme fatigue caused by a parental medical condition and unaddressed due to a lack of health insurance. Sometimes, though, it may simply be that the parent is unsure of how to engage a young child well in such interactions. Far from being automatic, these are behaviors we learn by watching others do them. But if you don’t have such role models, it’s not necessarily so easy to know what to do, particularly if you’re unsure of your own ability to “teach” your baby skills.
This is where a marvelous intervention known as home visiting comes in. Home visiting is where a skilled, trained professional visits you — often in the early months and years of a child’s life — learns about you and your family, and offers support, modeling and coaching. A number of home visiting programs have impressive track records, with clear and convincing evidence of long-term benefit. Among them are Early Head Start, Nurse-Family Partnership, and Parents as Teachers, to name a few. There are multiple aims: maternal and child health, prevention of child abuse and neglect, coaching and modeling of positive parenting, and promoting child development and school readiness.
In 2010, Congress enacted the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which offers funding as a federal-state partnership to support these kinds of evidence-based, voluntary home visiting programs. This funding has quadrupled those served since 2012, representing over 160,000 families.
In my practice, home visiting makes a meaningful difference. It allows me the confidence to know there is another trained individual with a strong relationship engaging with the family during times between appointments. When home visitors accompany families to well-child visits, they often help prompt parents to ask questions and offer additional context. I also know that advice and messages I share will frequently be amplified in later weeks by the home visitor. It builds upon and enhances the work I do in well-child visits.
Much like the Child Health Insurance Program (CHIP), MIECHV’s funding authorization expired on Sept. 30. A bipartisan bill (S. 1829) to reauthorize MIECHV for five years has been introduced, but as of this writing has not yet progressed forward. Some proposals include problematic new requirements designed to offset funding costs by taking dollars from other programs. We should guard against those provisions being introduced in the final version of the bill. Rather than pitting worthy programs against one another, we should be working on ways to fund them all to work synergistically.
Vulnerable populations need all the help we can provide.
Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health and also holds master’s degrees in public health and children’s librarianship. Engaged in primary care pediatrics, early literacy, medical education, and advocacy, he covers a variety of topics related to the health and well-being of children and families.
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