As the program analyst for Start Early Washington, Anna Contreras is always thinking about what works best to support the children and families that participate in Washington’s home visiting programs. She collects and analyzes a mixture of quantitative raw data as well as the often-overlooked qualitative feedback needed to truly improve and enrich the home visiting experience for children and families. This includes collating information gathered from numerous home visiting professionals across the state.

Anna has dedicated her professional career to understanding how relationship-based supports impact lifelong outcomes for young children and their families. She’s particularly interested in families grappling with adversities, such as migrant and seasonal farmworkers, immigrant communities and dual language learners. “My Latinx background not only identifies me but defines me. As a second-generation immigrant, I relate to the challenges of those who are growing and learning from their native culture while also adjusting to new societal norms and navigating American culture.”

Anna’s commitment to improving the home visiting experience and creating more equitable and inclusive systems that recognize and respect diversity begins with her mother. Home visiting has been part of Anna’s life since the day she was born. Anna’s mother received home visiting services in Washington state when she was pregnant with Anna, a support that was not provided for Anna’s siblings. Because of this experience, her mother was better connected to her community’s resources and felt more comfortable talking through the various roadblocks she was experiencing. In addition, her home visitor helped her better understand the services and supports available to her. They were a trusted partner to nurture and support Anna’s healthy development. This was especially important to Anna’s mother because she didn’t have her mom (Anna’s abuela) near at the time.

Recalling her personal experiences and her experience helping her parents navigate data collection and other complex information, Anna finds it essential to create inclusive forms and dashboards for the home visiting support team.

Anna also shared the importance of considering the impact on the person collecting information. “When creating forms, we consider the impact on the staff asking the questions — such as, what does the answer mean for the respondent? How is this information going to be utilized? What are the unintended consequences for the person sharing the information? People must feel comfortable enough to share this information. They also want to ensure that necessary changes will follow and that they are not wasting their time answering another set of questions; it is hard to be vulnerable, especially when you are unsure of what will happen next with the information provided.”

Whether it’s a first-time parent connecting with a home visitor or staff sharing their experiences with each other, trust and respect are vital to collecting meaningful information. Relationship-building is foundational to Start Early Washington’s work and a key ingredient to affecting meaningful change.

“As a first-generation college student, relationship-building was important to me. Feeling seen and heard was fundamental to my growth and development, and therefore I carry that experience in my work today.” Feeling accepted, safe and connected to a community of support helped push Anna past moments of self-doubt and projected her toward future success in her home life, career and beyond.

The Subtle Differences

Data showcasing the subtle differences in home visiting provider experiences and the depth of variation between the family dynamics they support helps inform the resources and learning opportunities needed for the home visiting field as well as the various elements required to support the children and families they partner with. In addition, such data-driven insights are vital to maintaining an inclusive and collaborative decision-making process for system improvements.

Anna primarily works with Start Early Washington’s home visiting team to improve home visiting services and outcomes for children and their families in Washington state. Anna works closely with the home visiting team to assess customized coaching and mentoring offered to home visiting programs. Similarly, she evaluates how Start Early Washington can best support comprehensive learning opportunities, transparent data collection and thoughtful analysis.

For example, surveys are designed to answer questions such as: Does the home visiting field have the professional development opportunities they need to grow their skills? What additional support is needed for home visitors to feel confident in their role? How can Start Early Washington help home visiting professionals achieve individual and programmatic goals? These questions and more help to ultimately measure how we can support positive system changes —such as gains in knowledge, better time management, improved staff retention and the creation of better family engagement protocols.

Qualitative feedback helps Anna understand the story of home visiting in our state, connecting the necessary data points to improve system outcomes and inform policymakers. Data allows us to see how and when priorities shift for programs, and feedback and discussion help us understand what success and challenges look like for home visiting programs and the families they work with. Qualitative feedback from our home visiting team helps uncover trends in discussions, typically hidden among quantitative numbers alone. This data complements ongoing performance monitoring to ensure continuous quality improvement for home visiting professionals statewide.

Anna’s work strengthens home visiting programs by showcasing the power of relationship-based work, reinforcing the deep connections and trust between home visitors and families. Recognizing the unique identities, heritages, cultures and human emotions while celebrating differences and bolstering representation validates and supports an environment of inclusion for the entire home visiting system.

Trust Is Pivotal

While data is critical to support a high-quality system, trust is pivotal to accessing quality information and rich feedback. Some things for home visiting teams to consider when collecting data:

• Use simplified language; the frame of information is important.
• Are questions clear enough to capture the needed information?
• Do all parties understand how the data collected will inform the home visiting system?
• Does the reader understand their rights and role in responding to the questions?

Co-Creative Learning Opportunities for Home Visiting Professionals

Start Early Washington facilitates learning opportunities as well as unstructured co-creative opportunities for home visiting professionals statewide to build knowledge, seek mentorship, connect and decompress with others in the field experiencing similar situations. Together, they work through obstacles and celebrate successes; since 2020, Start Early Washington’s work has reached nearly 8,235 children and families. Our approach to supporting the home visiting field includes mindfulness practices, reflection, sharing experiences and knowledge that builds trust in a strengths-based learning environment.

As a parent, you want to ensure that your child is being compassionate and empathetic towards the people around them. However, according to research, children in preschool and kindergarten are still developing the cognitive skills to understand empathy.

In order for children to grasp the concept of “empathy”, they must first be able to recognize their own emotions. Understanding what we are feeling and why will give children the tools they need to talk about deeper concepts of feeling and emotion as they grow.

Home visiting is about finding strengths in human connection, building trusting relationships – and all the messy stuff in between.

After a remarkable three decades of shaping the home visiting landscape, Quen Zorrah – Lead Facilitator and Co-Developer of NEAR@Home – is retiring.

Start Early Washington shares our collective love, respect and appreciation for Quen Zorrah and her lifetime of work supporting human connection and relationship building between children and their caregivers. Her expertise in supporting families has shaped how programs work with families to promote strong relationships.

Raising the Bar

Prior to her time with Start Early Washington, Quen was a public health nurse and one of the first nurses in the nation to provide home visiting services to families through Nurse-Family Partnership. Her work has integrated infant mental health and Neuroscience, Epigenetics, ACEs, and Resilience (NEAR) science into home visiting through teaching, coaching and reflective supervision. As the Lead Facilitator and Co-Developer of NEAR@Home, Quen has developed trauma-informed practices for building resilience and uniquely positions home visitors to safely and effectively talk with families during a critical period of development – the earliest years of a child’s life.

“I was fortunate enough to work with Quen for 20 years, as a teacher, supervisor, consultant, co-author and an esteemed colleague. I’ve never known anyone who got what reflective listening was, or who was freer of professional pretense, than Quen. She is so unpretentious that it would be easy to underestimate her real genius for this work.” — Dr. Marian Birch, DMH, Psychologist

The Journey

Like many staff on Start Early Washington’s home visiting team, Quen’s firsthand experiences as a mother led her to pursue a lifelong career devoted to children and their families.

At the age of 19, Quen distinctly remembers the first day she met a home visitor. “My child was only two days old when a woman from King County Public Health knocked on my door. She was so humble and respectful, but as persistent as a boot wedged in my doorway! Somehow, she knew how much I needed to hear words of compassion.” Seemingly, Quen’s home visitor intuitively knew that Quen was in need of positive reinforcement and support as a young, first-time parent.

Quen admired the compassion and hopefulness home visitors brought to her life, but she was still apprehensive at the thought of home visiting with her second child. “I wasn’t as put together and I was worried about what they would think of me, my mess and my reality.” Unsurprisingly, her home visitors lauded her efforts and bolstered her confidence, helping her tackle the many challenges of parenting. With each visit, Quen’s self-talk started to shift substantially, “College is achievable!” “My voice matters!” “I can do this!”

Quen’s home visitors changed the course of her life. “Not only my life but my kids’ lives as well. We take for granted the power of finding strengths and being human with each other.” After witnessing the power of home visiting support, Quen was determined to make a difference to others just as her home visitors did for her; she was determined to be a catalyst for change.

Quen completed her GED and carried her remarkable determination and fortitude as a young parent with her to nursing school at Seattle Central Community College. Upon graduation, Quen worked as a nurse for renowned medical centers and rural based community hospitals in remote mountain towns, before joining Nurse-Family Partnership, where she flourished for the next 20 years, supporting families with young children, pregnant women, grandparents, foster parents and fathers as primary caregivers.

Quen’s passion and perseverance to provide comfort, compassion and support led her to the creation of the highly successful, nationally acclaimed NEAR@Home toolkit, a tool providing home visitors with information and skills to talk about trauma and Adverse Childhood Experiences (ACEs) during home visits, while building trust and hope.

“Quen reminds me that I do not always have to fix things; my presence alone can bring value to any given situation.” — Amy Houser, Consultant 

Finding Balancing

Home visitors often face their own challenges with trauma and Adverse Childhood Experiences (ACEs). These lived experiences bring motivation and strengths to the field of home visiting, but they also add another level of strain. The exposure to challenges and trauma of others can contribute to burnout and poor mental and physical well-being. Quen notes gardening as her antidote to secondary traumatic stress or “compassion fatigue” inherent to those supporting families directly.

Quen appreciates the balance that gardening brings to the intensity of her work. Influenced by her great-grandmother, Quen cherishes time outside to slowly walk around her garden and admire each of her plants. “Gardening is a wonderful balance to all seriousness. It’s creative and offers exercise and most importantly, if I mess something up in my garden, I just compost it. But of course, it’s not that simple with humans. With plants, the worst that will happen is a compost pile.”

“Quen’s thoughtfulness, reflectiveness, kind, calm and peaceful way of being, is something I strive to incorporate into my work and personal life.” — Amanda Costello, Director of National Home Visiting, Start Early

Home visiting stories of success and triumph were also a grounding element for Quen. She recalled all the knowledge accumulated over the years: “That’s what kept me going for so long. When working long hours or flustered with bureaucracy, budgets and funding, I’d think about the stories we accumulated. My hope for home visitors is that they will share stories for inspiration and as a guide to move past challenges together.”

A Career to Remember

“Quen has shown me how to focus on people and building relationships before focusing on the work.” — Valisa Smith, Executive Director, Start Early Washington

While Quen may no longer be part of the thick of home visiting life, her profound impact has left a lasting legacy, disrupting the way we interact with each other by offering tools that will transform how we build and foster relationships for generations to come.

Start Early Washington is proud to be part of Quen Zorrah’s story. Her ability to reach parents and children at an intrinsic human level is immeasurable. We are honored to continue to share NEAR@Home with the world – a toolkit designed to allow users to rediscover hope and strive toward healing, fostering strong and healthy relationships.

We thank Quen for her incredible contribution to the field, honor her on all she has accomplished in her professional and personal life, and congratulate her on retirement and her future endeavors.

Raising a child is one of life’s most pivotal roles. Parents often turn to each other for support during the critical stages of their child’s development, but not all parents have access to the resources they need.

For Alex, home visiting helped bridge the missing pieces of her Native heritage and supported her in reclaiming family traditions stripped from her through her great-grandfather’s U.S. Native boarding school experience.

Alex received home visiting services for the first time when she was pregnant with her oldest son, Mateo. But growing up, home visiting was already a part of her life as her mother was a tribal home visitor and a passionate advocate for early learning. Inspired by her mother, Alex felt she was destined to work in early learning, yet it wasn’t until motherhood that she intimately understood the precious rewards of home visiting support.

“Learning about the growth and development of my baby from my home visitor was fascinating! And that feeling like I’m succeeding as a first-time parent took me a long way.” Alex experienced a substantial shift in knowledge and confidence through her relationship with a home visitor; she was determined to support families in a similar way.

Bridging the Missing Pieces

The concept of home visiting is not new to Native families; Alex shared that home visiting is one of the most traditional things a Native family can do. Its critical process passes down knowledge and skills to preserve generational culture and heritage. In addition, home visiting creates a strong sense of community where the intrinsic needs of a child – during a foundational time in life – are addressed through trusted partnerships and shared goals.

Through home visiting, Alex established a special connection with local tribes as well as her own. Alex is an enrolled member of the Tlingit and Haida Indian Tribes of Alaska but lives and works in Washington state. Connecting with other members of the Haida Tribe and creating a sense of community was not easy so far away from Alaska. However, her home visitor was able to help connect her to local resources and inspire her to the place where she is now — celebrating her cultural heritage and reclaiming family traditions lost through her great-grandfather’s boarding school experience.

Native children were forcibly removed from their families and placed in government operated boarding schools between 1869 and the 1960s. The schools used “systematic militarized and identity-alteration methodologies,” to force white assimilation. They changed children’s names, cut long hair, and prohibited any use of Native languages and cultural practices — or else they faced brutal punishment. – “All the hurt and the rage: Elders recall trauma of Native boarding schools.”

Alex’s great-grandfather had 17 siblings. He was displaced from his family when he was taken to a boarding school – never to be reunited. As a result, her family lost a great deal of their cultural heritage and traditions; Alex knows very little about her native language, songs, dances, or traditional medicines because her great-grandfather was deprived of his cultural identity.

Instead of a rich sense of cultural identity, the historical trauma of Alex’s great-grandfather’s experiences were passed down through her aunts, uncles and mother. For Alex, home visiting support provided a way to heal from this generational pain by offering resources to traditional activities and connection to a shared community. Home visiting helped Alex find a new sense of hope and resiliency. In realizing that she was experiencing the collective intergenerational trauma of losing language, culture and identity, Alex now has a path forward for her family and tools to support other families experiencing generational trauma.

Alex’s great-grandfather, George Nix, was Alaska’s first professional football player (1926)

Near@Home is a great resource to help home visitors have difficult conversations, particularly when reflecting on times of trauma. When home visitors are equipped with tools to tackle difficult conversations, they can safely, respectfully and effectively discuss ACES (adverse childhood experiences), trauma, and other hard topics with parents by focusing on hope, respect and resilience.

Communities of Practice for Home Visitors

Communities of practice are another support Start Early Washington facilitates for home visiting professionals. Our community of practice, “Supporting Native Families,” aims to provide opportunities for professionals to understand tribal communities better and walk away with strategies and ideas to better serve Native families in Washington.

Washington state is home to 29 federally recognized tribes. Each tribal nation is uniquely different, including the size of the reservation, number of citizens and financial resources. Similarly, they each have unique cultural identifiers and shared experiences.

With this in mind, there’s a lot for home visitors to learn when engaging with Native families. Families feel more connected and appreciate when home visitors make the time to understand family culture and dynamics.

“I think all home visitors want to achieve that goal — to understand each member of the family. But when families know that someone wants to learn about their culture and identity, when someone takes an interest in what’s important to the family and genuinely supports the caregiver and child — that’s empowering.” – Alex

Visit our page to learn more about home visiting work in Washington and supports provided by Start Early Washington’s home visiting team.

Playing pretend with your child might seem silly at times, but it’s actually pretty serious business when it comes to learning. Whether you’re new to playing dress up or having a pretend concert in your kitchen, or you are looking for more ways to spark your child’s imagination, we have tips for you!

We asked our Start Early experts for advice for parents and caregivers on the best ways to support your child’s learning and development through imaginative play, and they delivered.

Check out what Melissa Spivey, Teacher Assistant at Educare Chicago, a program of Start Early shared when it comes to making imaginative play a fun part of your everyday routine.

Home visiting supports have meaningful impacts on the lives of children and families. Start Early Washington supports new and existing home visiting programs with coaching, consultation, training and professional learning to ensure the highest quality home visiting services for families.

Our staff includes professionals whose expertise is enriched by lived experiences and practical knowledge. As one of our proudest achievements, Start Early Washington staff hold over 165 years of combined home visiting experience!

This blog post introduces our senior home visiting manager, Cassie Morley, who draws from nearly three decades of home visiting experience to oversee a talented team that supports 63 home visiting programs statewide.

Cassie swinging with her 5-month-old granddaughter, Loveday (2021)

Visit our main page to learn more about Washington’s home visiting team.

We don’t know much about art, but we know what we like—and that’s seeing young children find ways to express themselves and spark creativity while they’re learning. Whether you have a little Picasso on your hands or you are actively looking for ways to introduce art to your child, we have tips for you!

We asked our Start Early experts for their advice for parents and caregivers on the best ways to use art to support your child’s learning and development. And the teachers of Room 114 at Educare Chicago, a program of Start Early, delivered.

“My personal experience with ParentChild+ will last a lifetime!” Marcella shares her memories as one of many families who benefited from working with an early learning specialist through the ParentChild+ program.

Marcella and her daughter Taylor-Corrine participated in the ParentChild+ (PC+) program more than 16 years ago. Marcella admired the program’s ability to support the whole family in shaping a bright path for her daughter’s future. As a result, she was inspired to become an early learning specialist for PC+, supporting other families to build strong foundations and thriving futures. Currently, she is the PC+ program manager at Start Early Washington, where she supports 16 PC+ programs with technical assistance, professional development, coaching and consultation.

How Positive Reinforcement Builds Confidence

Positive reinforcement amplifies what is already working well and PC+ early learning specialists do that in numerous ways. They remind families that they are already doing a fantastic job with their child. Conversations are always positive, confidence building and reassuring to families that they know their child best. Marcella noted this as an element she appreciated most as a participant. “I knew that someone wasn’t coming into my home to judge me or my parenting style.”

As a new mother, Marcella learned to use high quality parent-child interactions in everyday moments that are often overlooked as learning opportunities, such as parent self-talk and narrating routine activities. For example, Marcella experienced how easy this could be while talking aloud in the grocery isles about ingredients on her shopping list to her daughter Taylor-Corrine.

She quickly realized the value of her simple teachable moments when a stranger at the grocery store commented, “I love how you interact with your daughter.” That acknowledgment further reinforced that she was doing a fantastic job as a parent. “It elevated my confidence to a new level.” This positive feedback loop continued throughout the program and Taylor-Corrine’s life.

Shared Language and Culture Fosters Meaningful Relationships

As a unique component of the PC+ program, early learning specialists are matched with families who share their culture and language. A shared culture often plays an intricate role in fostering meaningful relationships. Notably, early learning specialists are hired from within the communities where they work and 25 percent of early learning specials are former parents who participated in the program.

“An authentic relationship and cultural match with our specialist was really important to our family when we participated,” Marcella noted fostering a trusting, authentic relationship with families is vital for successful engagement. “Families are more comfortable discussing difficult topics and asking for support,” she added.

Families develop a close bond with their early learning specialists over the course of 2 years. During that time, they receive 96 home visits and acquire several high quality books and educational materials selected specifically for their child’s age group, ranging from 2 months to 5 years of age. In addition, they receive various guide sheets to help facilitate learning through play.

Strong Foundations Lead to Future Success

The PC+ program aims to improve parent-child engagement and connect families with culturally appropriate information and materials to support school readiness, early literacy and lifelong success.

Access to culturally appropriate books and toys provided by the program opened an entirely new world for Marcella and her family. Books such as “Please, Baby, Please,” by Spike Lee and his wife, Tonya Lewis Lee, allowed Taylor-Corrine to be surrounded by characters who looked and felt like she did. “It was the first book Taylor-Corrine saw herself in,” Marcella explained.

Marcella noted that key representation through her child’s learning helped Taylor-Corrine feel inspired and confident to try new things. “It was life-changing for her, in so many ways, PC+ helped us provide the tools our daughter needed to be successful throughout life.”

Marcella’s testimony of her family’s experience offered a few tangible examples of strong foundations leading to future success. Marcella leveraged the many tools provided by the program to make learning fun and effective for her daughter. As a result, by the time Taylor-Corrine entered kindergarten, she loved learning and Marcella was confident in communicating Taylor-Corrine’s academic needs with her teachers.

Today, Taylor-Corrine is thriving as a sophomore at the University of Southern California studying African American Studies, Philosophy, Politics and Law. She plans to practice law as a civil rights attorney someday.

Taylor-Corrine
(2022)

Taylor-Corrine continues to inspire her mother every day: “I am so proud of the woman she has become — I look at her and say, I want to be her when I grow up! She is independent and comfortable owning her space as a Black woman; she is confident and never questions if she belongs. Her success moves me forward to do better every day!”

Although the credit goes to Taylor-Corrine and her family, it is evident from speaking with Marcella that strong foundations were likely set in action through teachable moments discovered and supported through their participation in the PC+ program over 16 years ago.

Marcella and Taylor-Corrine explored Alki Beach after receiving an ocean-themed puzzle from their early learning specialist.
(2005)

As the world shut down in response to the COVID-19 pandemic, countless families were left in crisis. Suddenly, parents were full-time caregivers, employees and teachers; they needed support more than ever. When Gaby Rosario began working as the new Parents as Teachers state leader for Start Early Washington last year, she admired how home visiting programs quickly and effectively adapted to virtual visits to continue meeting the needs of families.

Flexibility is Key

Home visitors strive to build strong relationships with parents and encourage positive parent-child engagement to support healthy child development and future outcomes. One of the most powerful tools they have is connecting with families face to face, but when all in-person services shut down due to the pandemic, physical contact was no longer an option.

“Challenges brought on by the pandemic allowed us to stretch our minds and creatively support home visiting services,” Gaby highlighted. Home visiting programs pivoted to individualized services meeting the unique needs of families from a safe distance. “We shortened check-in periods and checked in more often, utilizing various methods of engagement such as email, text messages and phone calls to support families as they worked through learning and reflection.”

Conducting home visits on a virtual level meant staff had to think outside the box to ensure all the required components for a visit were still in place. Parental engagement unexpectedly increased for many families. “It was deeply meaningful when parents shared videos and pictures of their children thriving with the individualized activities created specifically for them. Gaby shared, “Our relationships with families deepened and it was rewarding to witness the positive parent-child interactions.”

With social distancing precautions in place, home visitors’ roles during visits shifted dramatically. They relied on families to lead parent-child interactions, which brought unexpected benefits as families took on leadership in the learning process. Home visitors leaned into coaching, supporting, answering questions and facilitating rather than leading home visits.

Gaby described, “We saw a new level of enjoyment with families that chose to participate virtually; parents’ confidence in leading individualized activities grew and we saw deeper connections between parents and their children. Parents’ messages of excitement, ‘Look what my child did today!’ were so inspiring.”

Reaching Rural Families

“One of the key things the pandemic taught us was that we could reach families further away through virtual systems.” As an expert in serving families in rural communities, Gaby was determined to partner with her team to harness technology-based services. By offering virtual home visiting services, they managed to overcome the challenges of long-distance travel and access to remote areas in bad weather.

Staff repurposed travel time to spend more time intentionally individualizing services for families. “Without the need to be physically present, home visitors provided more flexibility, accommodating family scheduling constraints or last-minute changes, if necessary,” explained Gaby.

Some families did not have access to technology at all. To meet this challenge, programs developed innovative solutions, including purchasing tablets and providing families with internet and cellphone assistance. Other strategies included scheduling virtual meetings at community agencies or public libraries, where families accessed broadband and technology-based services.

A few families lived in extremely isolated areas. Consequently, home visitors preplanned connections with families when they traveled into town and had access to virtual services. Gaby added, “One family lived deep in the mountains on the outskirts of the small city of Tonasket. When it wasn’t possible to connect in town, staff journeyed into the mountains to drop off activities and make a personal connection, even if that meant they had to share stories from 6 feet apart. We made every effort to ensure families had what they needed during this difficult period of isolation.”

Letting Families Know They’re Heard

Although bilingual resources were available for families, not all programs had home visitors that spoke languages other than English. Fluent in English and Spanish herself, Gaby understood the importance of connecting with families in a language they felt most comfortable. Before the pandemic, programs arranged in-person translation and interpretation or utilized call-in services for interpretation during in-person home visits. However, with social distancing precautions in place, it became necessary to adapt this practice. As a result, programs pivoted to virtual translation and interpretation tools, which took extra planning but were well worth the effort. Staff coordinated within agencies to share translation and interpretation services, and translators provided services over three-way calls or virtual platforms.

Gaby shared, “There was a learning curve as teams and families navigated multiple platforms and new methods of technology. Families tried new things they never thought they would try, and we continued to provide the one-on-one support they needed to feel comfortable.”

The technical support provided by staff did more than help with home visiting services; it offered families a window to the outside world again. Gaby explained, “The assistance we provided for a Spanish-speaking mother living in Brewster gave her confidence to support her three school-age children with their virtual classes. At the time, families did not know what virtual engagement looked like or how to navigate tools like Zoom. Together, we made sure her tablet settings were in Spanish, downloaded useful apps and walked through navigating virtual engagement.”

The world has had to find new ways of navigating everyday life since the onset of the COVID-19 pandemic and Start Early is no exception.

“One of the most significant things we learned during this new period of virtual-based engagement is that a willingness to be flexible is essential to both the home visiting support teams and families,” Gaby reflected.

Washington’s home visitors continue to work on adaptations needed to meet program requirements. In support, Start Early Washington curated a list of resources for home visitors to guide technology-based engagement.

Gaby Rosario supports professional development, training, technical assistance and coaching for 27 Parents as Teachers home visiting programs statewide.