Using Partners for A Healthy Baby to Achieve Program Outcomes

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Improved Child DevelopmentThe Chicago Public Schools’ Cradle to Classroom program used Partners for a Healthy Baby and LearningGames toimprove developmental outcomes for children of teen mothers. Program outcomes include:• When the Ages and Stages Questionnaire (ASQ) was administered at 3 years of age, 59% of the comparison group andonly 9% of the intervention group were classified at increased risk and of special concern.• Mean scores on the ASQ for children who received the intervention were well within the normal range, whereas themean scores for the comparison children were below the cutoff points between 4 and 36 months.—York, V., Sparling, J., & Ramey, C. (2001). Cradle to Classroom Evaluation. Unpublished manuscript.Partners for a Healthy Baby includes LearningGames, the well-researched early childhood curriculum developed for theCarolina Abecedarian Project. Positive benefits for the children who received the Abecedarian intervention include:• higher IQ detected as early as 18 months of age• improved school performance in reading and math• reduced retention in grade• higher likelihood of high school graduation and college attendance• fewer teen pregnancies—Ramey, C. T., & Campbell, F. A. (1984). Preventive education for at-risk children: Cognitive consequences of the Carolina AbecedarianProject. American Journal of Mental Deficiency, 88, 515-523.—Martin, S. L., Ramey, C. T., & Ramey, S. L. (1990). The prevention of intellectual impairment in children of impoverished families: Findingsof a randomized trial of educational daycare. American Journal of Public Health, 80, 844-847.—Burchinal, M. R., Campbell, F. A., Bryant, D.M., Wasik, B. H., & Ramey, C. T. (1997). Early intervention and mediating processes incognitive performance of children of low-income African American families. Child Development, 68, 935-954.—Campbell, F. A., Ramey, C. T., Pungello, E., Sparling, J., & Miller-Johnson, S. (2002). Early childhood education: Young adult outcomesfrom the Abecedarian Project. Applied Developmental Science, 6(1), 42-57.• A total of 11,889 developmental screenings were completed on children enrolled in the Tennessee HUGS programand of these 1,740 (14%) indicated developmental delays.—Tennessee Department of Health, Maternal and Child Health. (2011). Tennessee Home Visiting Programs Annual Report: July 1, 2009–June 30,2010. Nashville, TN: Author. Retrieved from http://health.state.tn.us/statistics/PdfFiles/Home_Visiting_Programs_Annual_Report_2010.pdfCore Element 2: Conform to a clear consistent home visitation model that has been in existence for at least threeyears and is research-based; grounded in relevant empirically-based knowledge; linked to program determined outcomes;associated with a national organization or institution of higher education that has comprehensive home visitationprogram standards that ensure high quality service delivery and continuous program quality improvement; and hasdemonstrated significant positive outcomes.Core Element 3: Serves pregnant women and/or parent/s or other primary caregivers and their children under the ageof entry into kindergarten who are low income or at risk of poor outcomes.With respect to Core Elements 2 and 3, the Partners for a Healthy Baby series is unique in that, to our knowledge, itis the only comprehensive curriculum that addresses issues of child health and development within the context of themultifaceted needs of families. Developed by a multidisciplinary faculty at Florida State University and piloted at theFSU Early Head Start program, the series provides the home visitor with a planned sequence of critical topics that areessential in achieving both family and program outcomes.The Partners curricular series is used by more than 3,700 programs in a variety of research-based home visitation modelsthroughout the nation including Healthy Families, Healthy Start, and Early Head Start—the nation’s premier programfor low income infants and toddlers. These programs all have national affiliations, long histories of effectiveness, andthey serve pregnant and parenting families and their young children who are low income or at risk for poor outcomes.The Partners curriculum helps Healthy Start programs achieve better birth outcomes by addressing topics such as:prenatal care, diet and exercise, smoking cessation, healthy lifestyles, the physical and emotional changes of pregnancy,bonding and attachment, and the importance of spacing pregnancies. The Partners curriculum supports Healthy Familiesprograms efforts in child abuse prevention and family stability through its focus on positive parenting, child safety, familyrelationships, healthy birth outcomes, infant mental health, and child development. The Partners curriculum supportsEarly Head Start’s goals of family empowerment and child development through topics on economic self-sufficiency,4 Florida State University Partners for a Healthy Baby • www.cpeip.fsu.edu • September 2011
fatherhood, nutrition, parenting, and developmental skills. The Partners for a Healthy Baby series is also widely used in teenparent programs, state health departments, and other community-based home visiting programs that serve low incomeor at risk families. (See below for descriptions of programs using the Partners curriculum and their reported outcomes.)The Partners curriculum is sometimes used in conjunction with the Born to Learn curriculum in programs following theParents as Teachers model. Some agencies implementing the Nurse Family Partnership model have reported also usingthe Partners curriculum.Core Element 4: Delivered by nurses, social workers, child development specialists, or other well-trained and competentstaff, as demonstrated by education or training and the provision of ongoing and specific training and supervision in themodel of service being delivered.The Partners curriculum is designed for use by both professional home visitors—including nurses, social workers, childdevelopment specialists—and well-trained paraprofessionals in home based programs. On-going training is essential tothe effective use of the curriculum. Intensive training on the Partners curriculum series is offered in Florida for programsusing the curriculum. On-site training is also available. The Baby’s First Year Training Supplement CD-ROM is a selfguidedoverview of Baby’s First Six Months and Baby’s Months 7-12.Programs Using the Partners Curriculum: Program Description & OutcomesHealthy Families New York (HFNY) has used the Partners for a Healthy Baby curricular series since 1999. HFNY isa home visitation program for mothers at risk for developing abusive or neglectful behaviors toward their children.Goals are to promote positive parenting, prevent child abuse and/or neglect, support prenatal care and child healthand development, and improve parental self-sufficiency. A three-year evaluation of the program was conducted by theBureau of Evaluation and Research in collaboration with the University at Albany. Pregnant women and adolescentswere randomly assigned to either an intervention group receiving bi-weekly home visits (n=236) or to a control group(n=265). Home visitors encouraged healthy prenatal behavior, offered social support and provided linkage to medicaland other community services. The risk of delivering a low birth weight (LBW) baby was significantly lower for theHFNY group (5.1%) than for the control group (9.8%). HFNY mothers also delivered fewer small for gestational age(SGA) babies than control mothers (8.8% vs. 11.6%). In summary, the home visited mothers were approximately halfas likely as control mothers to deliver LBW babies. Mothers offered home visitation services earlier in their pregnanciesexperienced even greater reductions in the number of LBW deliveries, suggesting the benefit of engaging vulnerableexpectant women early in pregnancy. In addition to the study of birth outcomes, evaluators assessed maternal/childinteractions. By the child’s third year of life, HFNY mothers were more likely to use positive parenting strategies (e.g.,cognitive stimulation, attentive and responsive to affective cues) than mothers in the control group.—Lee, E., Mitchell-Herzfeld, S., Lowenfels, A., Green, R., Dorabawila, V., & DuMont, K. (2009). Reducing low birth weight through homevisitation: A randomized controlled trial. American Journal of Preventive Medicine, 36(2), 154-160.—DuMont, K., Rodriguez, M., Mitchell-Herzfeld, S., Walden, N., Kirkland, K., Greene, R., Lee, E. (2008). Effects of Healthy Families New Yorkon maternal behaviors: Observational assessments of positive and negative parenting. Rensselaer, New York: New York State Office of Children andFamily Services.Healthy Families Florida (HFF) is one of the largest home visiting programs using the evidence-based Healthy FamiliesAmerica model. Well trained paraprofessional family support workers provide home visiting services, beginning prenatallyor at the birth of a baby, to families living in geographically targeted areas who have been assessed as experiencing stressfullife situations. These visits may continue for up to five years. Goals are to prevent child abuse, promote positive parent/child relationships and healthy child development, and enhance family functioning and problem solving skills. A fiveyearindependent evaluation was conducted between 1999 and 2003, during which time 22,708 families were servedand the Partners for a Healthy Baby series was the primary curriculum. The evaluation, which used a quasi-experimentaldesign, found that HFF children were 3.7 times less likely than the comparison group to experience child maltreatmentand more likely to be up-to-date with their immunizations (92% compared to 77% statewide) and have a medical home(97%). There was 58% less child abuse in families who received 3 or more years of service or completed HFF comparedto families who received less than 3 months of services or no services. HFF mothers were 1.5 times more likely to beemployed and, when involved in the program 3 years or more, were significantly more likely to read to their child thanmothers in the comparison group. An impressive 92% of HFF mothers delayed subsequent pregnancies.—Williams, Stern & Associates. (2005). Healthy Families Florida Evaluation Report: January 1, 1999–December 31, 2003. Retrieved March 26,2009 from www.healthyfamiliesfla.org/pdfs/Final_Evaluation_1999-2003.pdfFlorida State University Partners for a Healthy Baby • www.cpeip.fsu.edu • September 2011 5
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