Keeping Newborns Home with Voluntary Home Visits

Queens native Kendra Perry had recently lost her mother when she found out she was pregnant at age 25. Parenting was not something she had planned on at that point.

“A newborn comes with a lot,” Perry said. She had helped other friends and family care for their kids, but “it’s a whole other thing when you gotta keep it, when it’s yours.”

A friend referred her to Sheltering Arms, one of 38 home visiting programs in the state’s Healthy Families New York (HFNY) network that offer voluntary support to new and expecting mothers.

Perry credits the program with helping her prepare for parenthood during tough times. “They helped to prepare me and make me feel I wasn’t alone in this situation,” she said.

State officials say HFNY is the primary reason why the number of newborns removed into foster care in the state has plummeted while most states have seen the opposite trend occurring. The number of infants placed into foster care in the state was cut by 33 percent from 2012 to 2016, according to the most recent federal data, obtained by The Imprint for its data reporting project, “Who Cares: A National Count of Foster Homes and Families.”  

The drop is a small but significant part of an overall decline in the number of New York children entering the foster care system. In a 2018 budget briefing reporton New York’s human services programs, the state attributed the overall decline “to the state’s emphasis on preventative services.” This overall decline has also run countercurrent to increasing foster care numbers on the national level.

Supporting Prevention, Decreasing Maltreatment

Since 2002, the New York Office of Children and Family Services (OCFS) has poured hundreds of millions($635 million in this year’s budget) into prevention programs each year, aimed at everything from averting child maltreatment from occurring in the first place to helping families steer clear of future abuse after an allegation has been logged with a child protection agency. Services run the gamut from substance abuse treatment to parenting classes to monetary supports to help stabilize a family.

“It can be difficult to measure the direct impact of prevention – essentially because you are preventing something from happening,” said Kari Siddiqui of the Schuyler Center for Analysis and Advocacy. “But, we have to believe that services that get to families early on and help connect parents to the supports and resources they need to care for their children, do have an impact.”  

When it comes to newborns, the state credits Healthy Families New York (HFNY), its network of 38 home visiting programs for the downward trend in newborn removals. Home visiting, which pairs professionally-trained workers with new or expecting mothers who choose to accept the help, serve more than 6,000 families each year, according to OCFS.

Evaluations of HFNY show a significant impact in preventing further maltreatment incidents for parents involved with child protective services. Parents already known to the system are the most likely to have a child removed at birth.

“New York has made a significant investment in home visiting that has a proven positive impact on child welfare outcomes for children,” said Craig Smith, a spokesman for OCFS.  

Keeping Infants Safe at Home

In just over a decade, New York has seen a 53 percent reduction in the number of all children removed and placed into foster care. The total in the state was 37,000 in 2003, according to state budget records. This year, it is down to 16,500, according to data provided to The Imprint by OCFS.

Recent federal data shows that New York has drastically cut the number of newborn babies who are removed within the first three days of life – from 260 in 2012 down to 175 in 2016, according to federal data obtained from the Adoption and Foster Care Analysis and Reporting System (AFCARS).

The trend is notable in light of the nationwide upward trend in the removal of newborns. The total number of removals rose 11 percent between 2012 and 2016, and 33 states saw an increase in this category.  

A combination of various preventative programs has led to the decline of childhood removals in New York. But it is the Healthy Families New York home visiting program that’s had one of the most significant impacts on preventing the removal of infants from their homes, according to observers.    

“In terms of documented proof, home visiting is the one that we know absolutely works,” said Timothy Hathaway, executive director of Prevent Child Abuse New York, whose organization provides trainings for home visiting staff around the state. “We know that there is a real prevention aspect to the home visiting program and so there is no denying that and it is well documented.”

Most of the funding for the Healthy Family program comes from the state, which for almost a decade has been more than $23 million annually. The funds are distributed amongst the 38 HFNY programs, which are located in mostly high-need communities across the state.    

Like most state home visiting operations, HFNY got a funding boost in 2010 with the boom in federal funds as part of the Maternal, Infant and Early Childhood Home Visiting (MIECHV)program. That funding stream, once a tiny federal program, now allocates $400 million per year for certain home visiting models, including the Healthy Families America(HFA) model used by New York. The state brings in about $9.2 million each year through MIECHV.

The HFA model, which has the highest rating of effectiveness on the California Evidence-Based Clearinghouse, uses home visiting professionals trained to help prepare new or expectant families for parenting, with biweekly visits before birth and weekly visits for at least six months after birth.  

“We are actively seeking out families based on their risk of removals and based on their background, their history and current stressors and we intervene with a strength-based approach in pregnancy and early infancy,” said Samantha Wilson, director of maternal child health at Sheltering Arms, a nonprofit that serves about 150 people per year in its home visiting program in Queens. “That way, we are able to identify risk factors in the child’s life which lowers the chances of removal.”

When 25-year-old Kendra Perry sought out Sheltering Arms seven years ago, she was connected to home visitor Luz Holder. In addition to serving as a counselor to Perry as she moved toward birth, Holder helped set up child care arrangements.

Perry “was really self-driven,” Holder said. “She was trying to go to school and had two different jobs, but she was able to manage to give me the time to visit her, and was always open to visitation.”

Holder “helped to prepare me and make me feel I wasn’t alone in this situation,” Perry said. “Sheltering Arms was essential in reassuring me that I can do this.”

The results of a 15-year randomized control study on HFNY have not yet been published. An interim report on the first seven years of the study shows there was no difference between participants and the whole control group on the metric of future confirmed abuse or neglect reports.

But among the subgroup of women who had already been substantiated for abuse or neglect, HFNY produced “unexpected and unprecedented differences in rates of subsequent confirmed reports.”

That is critical, as newborn removals are most likely to occur in the case of parents with a previous report.

“I can say from our work that families with previous CPS involvement are at lower risk of receiving a second confirmed report due to the intensive work we do with them around bonding and attachment, anticipating and navigating challenging developmental milestones and providing emotional support as well as referrals to resources,” said Wilson.

Focusing on the “Right”

Some say the program’s success is due to the fact that participants voluntarily enroll.

“Unfortunately, a lot of participants in our community face a lot of other programs that are not voluntary,” said Sofia Nivar, program administrator, of the South Bronx Healthy Families of Bronx Care Health System. “With our program they feel like there is a kind of space for them to build trust with our staff and our goal is always to empower them,” she added.  

Another important element of Healthy Family is that trained professionals use what they call a “strength-based” approach to work with families. Rather than focus on the “wrongs” of the family, “We start by acknowledging all that they are doing ‘right’ and show them how they can leverage their strengths to accomplish even more,” said Wilson, of Sheltering Arms.

“It’s just a different lens through which we see the families we work with,” Wilson said. “People are more than just their challenges, and everyone has something positive to offer,” she said.  

In Queens, Kendra Perry recently gave birth to her second child. She didn’t need Sheltering Arms to prepare the second time around, but she stays in touch with Holder.

“We still talk from time to time,” Perry said.

Ahmed Jallow is a freelance reporter in New York.John Kelly contributed to this article.