The Early-Childhood Intervention That Can Make Even Congress Stop Fighting

Political support for evidence-based home visiting programs is so broad-based that Congress approved a funding extension earlier this spring.

Darnell Bowen Sr., Markita Logwood and thier 18-month-old son Darnell Bowen Jr. The family has participated in a Memphis-based Parents as Teachers program operated by a local nonprofit, Porter-Leath, since Markita was 12 weeks pregnant. The couple say the program has given them a new way to think about parenting. 
National Journal
May 9, 2014, 11:22 a.m.

MEM­PH­IS, Tenn. — De­mat­rise Givens knows her fam­il­ies. With­in seconds of pulling in­to the park­ing lot out­side the sun-rav­aged blue pub­lic-hous­ing com­plex in South Mem­ph­is where 18-month-old Dar­nell Bowen Jr. is liv­ing with his par­ents this month, Givens is out of her car, col­lect­ing the day’s es­sen­tials. 

There isn’t, it seems, a mo­ment to waste.

“Ms. De,” Dar­nell Bowen Sr., 22, an­nounces while hold­ing open the fam­ily’s front door. Bowen starts talk­ing be­fore the 4-foot-10½-inch Givens’s hur­ried stride hit the side­walk. “I’ve got news.”

Givens, 41, is a par­ent edu­cat­or cer­ti­fied in the Par­ents as Teach­ers meth­od — a 30-year evid­ence-based home vis­it­ing pro­gram with a cur­riculum de­signed to en­cour­age the kind of day-to-day par­ent­ing that sup­ports chil­dren’s in­tel­lec­tu­al, so­cial, and emo­tion­al de­vel­op­ment dur­ing the crit­ic­al first five years of life. That’s a peri­od when chil­dren’s brains have a sin­gu­lar ca­pa­city to gain found­a­tion­al skills needed to ex­cel at school, on the job, and in life.

Givens is vis­it­ing Bowen, baby Dar­nell, and his mom, Markita Log­wood, 25, to talk par­ent­ing skills, brain-build­ing activ­it­ies, and ba­sic life coach­ing. She’s armed with a black bind­er and what looks like a half-ream of work­sheets. The mul­ti­colored zip-top bag she car­ries in­to the apart­ment is stuffed with over­sized, con­nect­able plastic blocks that are ir­res­ist­ible to tod­dlers.

Twice each month, Givens and thou­sands of oth­er par­ent edu­cat­ors with Par­ents as Teach­ers vis­it the homes of low-in­come or oth­er­wise at-risk fam­il­ies in all 50 states and sev­er­al coun­tries. They, and oth­er out­reach work­ers in­clud­ing nurses and so­cial work­ers, work with fam­il­ies that have chil­dren un­der the age of 5 and are vol­un­tar­ily en­rolled in the evid­ence-based home vis­it­ing pro­gram.

Forty-five per­cent of U.S. chil­dren live in fam­il­ies with in­comes that meet the of­fi­cial defin­i­tion of poverty or earn in­comes just above it, ac­cord­ing to Columbia Uni­versity’s Na­tion­al Cen­ter for Chil­dren in Poverty. Even those slightly more well-off fam­il­ies of­ten struggle with in­stabil­ity, in part be­cause they make too much money to qual­i­fy for as­sist­ance but not enough to live com­fort­ably. In the worst cases, chil­dren in these fam­il­ies face peri­od­ic food in­sec­ur­ity, fre­quent moves, and of­ten home­less­ness. Many have lim­ited ac­cess to the kinds of books, par­ent­al in­ter­ac­tion, and oth­er ex­per­i­ences that help to de­vel­op young brains. By the time chil­dren start school, that kind of poverty of­ten pro­duces low test scores, lim­ited vocab­u­lar­ies, and even so­cial and emo­tion­al de­fi­cits.

Since the 1990s, Ten­ness­ee and a col­lec­tion of oth­er states have op­er­ated a vari­ety of home vis­it­ing pro­grams that tar­get first-time par­ents, low-in­come fam­il­ies, house­holds with his­tor­ies of ab­use or neg­lect, and chil­dren with de­vel­op­ment­al delays and dis­ab­il­it­ies. They’ve been fun­ded with a com­bin­a­tion of state and loc­al gov­ern­ment dol­lars, fed­er­al funds, and private dona­tions. The in­ter­ven­tions seemed to make a dif­fer­ence in the lives of the chil­dren they reached, but their scope was lim­ited.

Then, in 2010, a pro­vi­sion of the Af­ford­able Care Act changed the game. Sud­denly, a pot of $1.5 bil­lion fed­er­al dol­lars be­came avail­able to states will­ing to im­ple­ment one or more of 14 evid­ence-based home vis­it­ing pro­grams. In the years since, even states that have loudly re­jec­ted core fea­tures of the ACA — such as the Medi­caid ex­pan­sion — have jumped at the money, vol­un­tar­ily de­vel­op­ing or ex­pand­ing a range of in­ter­ven­tions.

Some of the pro­grams send nurses in­to the homes of first-time moth­ers and wo­men with his­tor­ies of de­liv­er­ing pre­ma­ture or low-birth-weight ba­bies to mon­it­or their health closely dur­ing preg­nancy and help moth­ers ad­dress everything from high blood pres­sure to the causes of el­ev­ated stress. Oth­ers de­ploy so­cial work­ers and less-cre­den­tialed com­munity-out­reach work­ers to fam­il­ies liv­ing in com­munit­ies where poverty and its of­ten-in­dis­tin­guish­able causes and symp­toms — low-qual­ity schools, crime, drugs, un­em­ploy­ment, and in­car­cer­a­tion — have shaped gen­er­a­tions.

A cor­nu­copia of data ana­lyzed by child de­vel­op­ment ex­perts, eco­nom­ists, and child ad­voc­ates af­fil­i­ated with Har­vard, Yale and Cor­nell Uni­versit­ies as well as the Uni­versity of Chica­go may ex­plain why. Re­search­ers have con­firmed that these pro­grams boost child health, re­duce ab­use and neg­lect, boost par­ti­cip­at­ing fam­il­ies’ eco­nom­ic well-be­ing, and help chil­dren ar­rive bet­ter pre­pared for school.

To sup­port­ers, home vis­it­ing pro­grams are the Swiss Army knives of so­cial policy and should be a key fea­ture of any plan to make Amer­ica more com­pet­it­ive and re­duce in­equal­ity. Polit­ic­al sup­port for evid­ence-based home vis­it­ing pro­grams is so broad-based that in March, the na­tion’s fre­quently dead­locked Con­gress ap­proved a six month fund­ing ex­ten­sion. The move will keep the pro­grams op­er­at­ing un­til next year.

In Mem­ph­is, just whom that fund­ing might reach is clear. “Juice, juice, juice,” Dar­nell Jr. chants as Givens enters the apart­ment. There’s none of the tell­tale middle-class clut­ter of fam­il­ies with young chil­dren. There are no clusters of toys, no rub­ber play mat or shelves over­flow­ing with books or baby equip­ment.

Givens put the zip-top bag on the liv­ing room cof­fee table, near the spot where Dar­nell Jr. is busy test­ing the lim­its of his sippy cup. Tak­ing a seat on the couch, Givens opens her bind­er and spreads out a few work­sheets.

“Ok, let’s hear it,” Givens says.

“I got a job,” Bowen tells her, smil­ing broadly.

“You know we couldn’t wait to tell you Ms. De,” says Log­wood, Bowen’s girl­friend of six years. “You are like fam­ily.”

Dur­ing the ex­change, Dar­nell Jr. aban­dons the sippy-cup pro­ject and be­gins shak­ing the bag.

“Oh my good­ness,” says Givens. “That is just great! I knew it would hap­pen.” She switches seam­lessly from en­cour­age­ment to ob­ser­va­tion. “Now, Mom, Dad, do you see what Ju­ni­or is do­ing? This is the kind of activ­ity that builds his aware­ness of sounds and lets him work on those gross and fine mo­tor skills that a curi­ous and in­creas­ingly mo­bile 18-month-old needs.”

Re­turn­ing her at­ten­tion to Bowen, Givens says, “Okay, now, Dad. Tell me about it. What kind of job?”

The con­ver­sa­tion is an ex­em­plar of Giv­en’s work with the fam­ily. She’s there to help Log­wood and Bowen un­der­stand their son’s emo­tion­al, phys­ic­al, and in­tel­lec­tu­al needs. But she also cov­ers some deeply sens­it­ive and per­son­al top­ics that can be closely con­nec­ted to fam­ily well-be­ing: birth-con­trol op­tions, fin­ances, com­mu­nic­a­tion, and ef­fect­ive dis­cip­line. To cre­ate the best en­vir­on­ment for Dar­nell Jr., Givens has helped the par­ents identi­fy fin­an­cial and oth­er goals.

For the fam­ily, the struggle for fin­an­cial solvency can of­ten get in the way of what they want and need to do to help the tod­dler de­vel­op. Log­wood, Bowen, and Dar­nell Jr. have spent much of the past year couch-surf­ing, stay­ing with fam­ily and friends. When both par­ents lost their jobs last year, un­paid rent forced them to leave their apart­ment. Each grew up in what Givens de­scribes as troubled fam­il­ies where their health, safety, and de­vel­op­ment were not con­sist­ent pri­or­it­ies.

Log­wood and Bowen each de­scribe them­selves as “af­fil­i­ated,” Mem­ph­is-speak for loy­al to but no longer con­sist­ently act­ive in gangs. They have also weathered in­ter­mit­tent waves of de­pres­sion and grief over the past few years. Long­wood’s first preg­nancy ended with a mis­car­riage at sev­en months gest­a­tion. The healthy birth of Dar­nell Jr. was an oc­ca­sion for cel­eb­ra­tion, but Log­wood’s third preg­nancy ended less than two months ago when she mis­car­ried twins.

“To me, this fam­ily is really em­blem­at­ic of what this pro­gram is all about,” Givens says back in her of­fice after the vis­it. “Their life in­cludes lots of sad real­it­ies, rolled in­to one. But the same love and hope that so many people have for their chil­dren is there. They just need the tools, a little something to get Ju­ni­or where he is per­fectly cap­able of go­ing.”

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