Universal Newborn Home Visits

Sheilah H. Dooley, RN, BSN, MS

At Pernet Family hHealth Service, we recognize newborns do not come with an owner’s manual. Caring for a newborn is challenging under the best of circumstances. Traditional prenatal and pediatric care is often based on the assumption that parents have the basic knowledge and resources to provide a nurturing, safe environment and provide for the emotional, physical, developmental, and health care needs of their infants and young children. Unfortunately, many low-income, at-risk families encounter barriers to basic health care, may face food insecurity and have insufficient knowledge of parenting skills and an inadequate support system of friends, extended family or professionals to help.

Pernet’s Maternal and Child Health Program began serving Worcester mothers and newborns in 1955. More than 200 people are served by this program each year. The program has grown from basic infant care and parenting skills training to a robust menu of assistance in navigating the world with a newborn. We offer nursing care for medically complex infants in the home, screen for developmental delays, and make referrals linking parents to the support they need and the child to the services they may require to thrive.

Maternal Child Health visits have significant impact preventing newborn hospital readmissions; protecting against preventable childhood diseases through immunizations and regular medical care; preventing developmental delays or long-term consequences of unaddressed developmental delays; preventing child abuse and neglect; and addressing early, root causes for remedial education and juvenile delinquency. State law mandates a new mother receive a home visit if she went home within 48 hours of giving birth, but the city of Worcester lacks the capacity to ensure all eligible mothers receive such a visit. For an at-risk mother, this specialized care is a chance to break the cycles of poverty, violence and diminished opportunities.

While much evidence points to the positive impact home visits have on at-risk mothers and newborns, there is equally compelling data that all mothers, regardless of socioeconomic status, home environment, or presence of risk factors, benefit tremendously from a newborn home visit. The physical and mental health and wellbeing of the mother is improved with these visits as well.

The City of Worcester’s Community Health Improvement Plan calls for investment in early assessment and intervention services. Worcester Health Babies Collaborative, Together for Kids Coalition and other community partners have worked to improve outcomes for at-risk newborns and questioned what more can be done. Forums held in conjunction with Clark University, Greater Worcester Community Foundation and Early Intervention programs have explored early childhood mental health. There is continued support for devising a continuum of care for all newborns so they have the best possible start in life. There has been examination of this topic in Worcester, but no comprehensive strategy had emerged – until now.

In response to this evidence, as well as compelling local need, Pernet has joined forces with community partners – The Worcester Healthy Baby Collaborative, Family Health Center of Worcester, and Edward M. Kennedy Community Health Center – to design and implement a Universal Newborn Home Visit program, to ensure all Worcester newborns are visited. A grant from the Worcester Together Fund’s Reimagining Phase has been an early catalyst for this work. Our goal is for all Worcester mothers and newborns, regardless of circumstance, culture, socio-economic status or background, receive a home visit within the first two weeks of the infant’s life. That visit will be a source of reassurance and comfort or a lifeline to supportive services and intervention, depending on the child and mother’s needs. This program will grow over time into a sustainable resource that any Worcester mother can count on.

While the program is in its early stages, Pernet continues to make home visits based on referrals from the UMass Memorial Newborn Nursery and St. Vincent Hospital. Funding and the challenge of recruiting qualified staff make expanding this program a slow, but steady process. In the near future, the partner agencies will recruit, train and support a sufficient number of family health advocates to make visits to all newborns in the City of Worcester within the first month of life. Our team will provide culturally appropriate support and supervision around basic infant care, parenting, appropriate parenting skills, coaching for breastfeeding mothers, screen for postpartum depression, and impart the importance of regular medical follow up for both mother and child. These visits will provide lasting, longterm change to the way all new parents are supported, in particular those who experience risk factors. Connecting families with supportive resources from the very beginning supports the health of a baby during the first year of life and can prevent developmental and behavioral problems at a later stage. Teaching parents the skills necessary for positive parenting early, enhances the child’s emotional and educational advancement. A healthy start makes all the difference.

There is universality to this program. All families need support in some way. This program will make significant strides in improving maternal health, promoting good parenting practices and ensuring every one of the nearly 2,500 babies born to Worcester mothers each year has the chance to have a healthy start.

“A baby’s health is the community’s wealth,” said former Commissioner of Health and Human Services Leonard Morse. Infant mortality is a mirror on the community. Universal Newborn Home Visits are a start to having healthy babies, healthy families and a healthy community.

Sheilah H. Dooley, RN, BSN, MS, is the Executive Director of Pernet Family Health Service in Worcester, a graduate of Boston College School of Nursing, Affiliate Faculty at the University of Massachusetts Chan Medical School Graduate School of Nursing, and the Clerk of the Board of Directors of the United Way of Central MA.