Nurturing others comes naturally for Victoria Barajas, who has found her true calling as a home visitor. After spending 10 years working at an early learning school, she was drawn to home visiting’s ability to create supports for the whole family that build a strong foundation for years to come.

The “Yes Moment”

Home visitors like Victoria help parents engage in their children’s education and get a better understanding of developmental milestones. “A lot of parents are not aware that what they bring to the table impacts their child’s development,” she shares. “As parents get more involved, they’ll tell me things like, ‘Wow, I didn’t know my child could do this. I thought they were too small,’ and it makes them more eager to be involved.”

This builds a strong foundation for future learning. “Having the parent involved shows the child that their parent took the time to be with them and interact with them, so they feel confident enough to detach and interact with other adults,” she explains. When the child gets older, they’re more receptive to what they’re learning, are better able to problem solve and have increased communication skills.

For Victoria, the “yes moment” comes when parents begin to follow their child’s curiosity and development. “We can’t choose their interests for them — if we don’t follow their curiosity, they won’t want to learn anything else,” she says. “I know it clicks when parents say, ‘Wait, I know we planned for this because that’s what they were interested in last week but they’re not interested in that anymore. Can we do this instead?’”

Meeting Families Where They’re At

As a Spanish-speaking Latina, Victoria knows being part of a diverse home visiting workforce is essential to fostering intimate relationships with her families.

“You need to be empathetic and meet parents and families where they are at. It’s beneficial that I can connect with families in their language. It’s where they feel more confident in speaking and interacting with me because that is how they’re communicating with their child,” Victoria explains.

It is important to consider each family’s home culture and how they interact with their child. “Even among Latinos, Mexicans speak different dialects and Ecuadorians have different vocabulary so you can’t go into the home assuming everyone speaks the same type of Spanish.”

By building relationships with every adult in the home, including grandparents, Victoria builds a foundation of professionalism, empathy and cultural sensitivity. “When you do that, the adults give you so much more to work with and are open to receiving whatever you bring to their home,” she shares.

Supporting the Whole Family

In addition to helping parents build strong relationships with their children, home visitors connect families to the resources and supports in the community they need to thrive. Particularly during times of high stress, a parent may feel unable to give their full self to supporting their child. That’s why home visiting provides comprehensive supports to families. It’s only when a parent feels 100% that they can be fully present.

“I tell families that I’m here to work with the family as a whole, not just the child,” she shares. “If parents are focused on what they’re going through financially or dealing with depression, I know only supporting children’s development isn’t going to help. Once we address families’ basic needs and supports, we start to see an increase in parent interaction.”

During the pandemic, Victoria helped her families access basic needs like diapers, baby wipes, formula, cleaning supplies and gift cards to purchase additional items. “All my families said they really appreciated it, especially those who lost their jobs. It kept them afloat,” she recalls.

One of the biggest challenges during COVID was helping families with technology needs. Victoria helped her families navigate a variety of issues, from lacking access to a laptop or tablet to not having enough data to download the new apps required for virtual meetings. When some of her parents struggled to download mobile apps because the instructions were in English, she shared screenshots and instructions in Spanish.

As the pandemic ebbs and Victoria is able to resume in-person visits, she continues to prioritize each family’s perspective and comfort zone. “There are some families that are very relaxed and open to visitors and others that are very cautious as to their interaction with the rest of the world. I work with each individual family and meet them where they are.”

The Impact of Her Work

Now nearly 20 years into the work, Victoria remains passionate about being able to make a difference in children’s lives and help their parents understand why it’s important for them to be a part of their children’s development. Her reward is the pictures and text messages she receives from parents sharing a video of a first step, a photo from a birthday party, or an update from school.

“I got into this work for personal reasons, but working with families so closely and seeing the impact of my work is incredibly meaningful.”

Plenty of adults have a hard time staying on top of their own dental health and may even dread going to the dentist for care. Some people may even wrongly think that baby teeth aren’t important since little kids are just going to lose those baby teeth anyway. However, it is very important to start building healthy habits early on. Did you know that a child’s dental health can have huge impacts on their school readiness and their ability to learn?

“Who am I?” From the moment babies are born, they are learning about who they are, how to express their feelings and what makes them special. Their earliest relationships with parents and caregivers help develop a sense of belonging and set the foundation for their future learning and success.

Parents and caregivers can help young children along as they grow and learn more about who they are, their feelings and how they fit into this world.

Vehr reflects on how even a 3-month policy wouldn’t have felt sufficient. “With a 3-month policy, I would have spent about a third of my leave with at least one child in the hospital. The extended 6-month leave meant that I could spend meaningful time, especially in those precious early days, focused on establishing new routines and caring for my children.”

Decreasing an employee’s salary and retirement savings opportunities at a time when their expenses are increasing causes high levels of stress, conditions that have been shown to negatively affect children’s growth and development. Start Early’s parental leave program also aligns with research evidence about the impact caregiver stress and access to high-quality healthcare has on young children by providing employees with 100% of their salary and benefits during parental leave.

“I was really one of the fortunate parents in the NICU,” says Vehr. “I think about mothers who have to return to work before they’ve fully healed or parents who are forced to return to work when their little ones are so very young because not receiving a paycheck is simply not an option.”

A comprehensive paid parental leave program can aid in retaining women in the workforce. One study from Institute for Women’s Policy Research found that implementing paid parental leave policies in California and New Jersey resulted in a 20 percent reduction in the number of women exiting their jobs in the first year after welcoming a child and up to a 50 percent reduction after 5 years.

“When you invest in your people, they invest back in the organization which ultimately leads to increased retention,” notes Byville. “I feel a much stronger sense of loyalty to Start Early because of the space they made for my family.”

Vehr agrees, “I feel a deeper sense of commitment to our organization and more cared for as an employee.” She adds, “it really calls on employers to consider a far more empathetic, humane approach to parental and family leave, and it also calls on our lawmakers to support employers with that aim.”

The benefits of paid parental leave set families, employers, and our communities up for success, which is why Start Early will continue to advocate for family-friendly policies that support time for parents and caregivers to bond with and care for their children without jeopardizing their ability to afford basic needs.

Tomorrow, President Joe Biden is expected to sign the American Rescue Plan, a sweeping $1.9 trillion stimulus package to help families across the country struggling with the impact of the COVID-19 pandemic.

The legislation includes investments in child care, health care, housing assistance, special education, mental health services, stable access to food and other supports for families that will go a long way to alleviating many of the challenges the pandemic has brought to families across the country -particularly those who live in communities that have been historically under resourced and overburdened.

It provides $39 billion in child care funding, includes immediate supports for child care providers who have been hit hard by the pandemic economically, allows states to ensure essential workers can access child care with little- to no-cost to them — regardless of income — and includes funding for the important work of rebuilding and strengthening state child care systems.

The legislation also includes significant investments for other critical parts of the prenatal-five system, including $200 million to support preschoolers with disabilities and $250 million for infants and toddlers under the Individuals with Disabilities Education Act (IDEA), $1B for Head Start programs, and $150 million for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program.

In response, Kristin Bernhard, senior vice president of Policy and Advocacy at Start Early issued the following statement:

“Start Early applauds Congress for passing one the most significant investments in young children in decades, the American Rescue Plan. There has never been a more critical time to support children, families and the early childhood workforce.

“The last year has illuminated how the ongoing impact of historical and systemic racism continues to magnify the stressors so many of our youngest children and their families face, such as homelessness, food insecurity, and financial instability.

“While our early childhood education system was broken well before the pandemic began, the pandemic has left child care in America on the verge of collapse and in a state of crisis never seen before.

“Millions of families are struggling to provide the high-quality care needed for their children’s well-being and their ability to work. Doulas, home visitors, preschool teachers, in-home providers and other early childhood professionals have been forced to put their lives on the line or shutter their doors, all while being compensated at levels that don’t reflect their expertise or the importance and complexity of the work they do.

“Our nation has underfunded this crucial support for families for decades. This funding has the potential to improve access to quality early learning and care for all families.

“Perhaps most importantly, the American Rescue Plan creates an opportunity to build towards a bright and just future for all children. Now our efforts must focus on supporting states to effectively use the funds to repair and redesign early childhood systems and supports to be more equitable, to increase access for Black, Indigenous and people of color (BIPOC), to reach more children with disabilities and their families, and to target funding to build capacity of currently under-resourced communities.”

The U.S. Department of Health and Human Services (HHS) is home to several federal offices that set key policies for children and families. As President Biden’s nominee for HHS Secretary, Xavier Becerra, appears before the Senate Health, Education, Labor, and Pensions Committee on February 23, we hope he will keep the needs of children and families at the forefront of the agency’s ongoing work and its efforts to rebuild and recover amidst the COVID-19 pandemic.

Families, providers, and community and state systems leaders have spent this last year learning and innovating as the pandemic forced swift action and adaptation related to key issues of access, inclusion, and equity in early care and learning. Here are the lessons we hope new HHS leadership will heed from early childhood stakeholders as they take the agency’s helm:

1. For the Centers for Medicare and Medicaid Services: Enable and scale innovations related to home-visiting and early intervention services.

HHS’s Centers for Medicare and Medicaid Services (CMS) should explore new ways to leverage federal funding streams — like Medicaid — to expand access to evidence-based home visiting programs and doula services. By making access to MIECHV supported doula services a priority, HHS has the opportunity to address disparities in maternal health outcomes, improve engagement in home visiting, and strengthen the continuum of health-supportive interventions starting prenatally. Here in Illinois, Start Early has supported legislation to expand the Medicaid program to cover evidence-based home visiting and doula services, helping to ensure families have access to these high-quality supports that keep them and their children healthy. Expanding Medicaid to cover these important interventions will allow for state-wide expansion of home visiting and doula capacity and coordination of services and supports for children and families from before birth through early childhood. Under its new leadership, we encourage CMS to continue working with Illinois and other states who are working to remove barriers that prevent low-income women from accessing home visiting and doula services, provide guidance and support to states like Illinois that are looking to expand Medicaid coverage of these services, and replicate those efforts at the federal level. This includes timely approvals of flexibilities such as the 1115 waiver which extends postpartum coverage for women on Medicaid for up to 12 months.

Since the start of the COVID-19 pandemic, CMS has issued waivers and flexibilities that support the use of telehealth among Medicare beneficiaries. This has benefitted many underserved and priority populations, including children and families in rural areas and those receiving Early Intervention services. HHS has the opportunity to ensure that telehealth remains an option for delivery of all Early Intervention services beyond the current public health emergency. We strongly encourage CMS to use this unprecedented moment as an opportunity to learn from states and local communities where continuation of Medicaid-funded telehealth might benefit kids and families.

2. For the Administration for Children and Families: Promote cross-program collaboration and funding stream innovations that strengthen the U.S.’s child care infrastructure.

HHS’s Administration for Children and Families is home to the federal Office of Child Care and Office of Head Start, two entities that are positioned to continue making great strides in strengthening our nation’s child care infrastructure.

A key lesson from the pandemic is that simply stabilizing child care is not sufficient. We must also focus on improving, strengthening and redesigning our child care system to make it more equitable and accessible and supportive of the unique needs of home-based child care providers and family choice. We urge the Office of Child Care to explore how staffed family child care networks and shared services alliances can fulfill these goals, by increasing providers’ access to technical assistance and families’ access to embedded health, mental health and family engagement services. An investment in research is also essential, to determine the effectiveness of different types of networks for increasing supply, improving quality, enhancing child outcomes and to identify effective programs that support family, friend, and neighbor caregivers to maintain safe, stimulating home environments and earn livable wages.

We also encourage the Administration for Children and Families to explore how existing federal funding streams — including the Preschool Development B-5 funds, Head Start funds, and Child Care Development Block Grant — can be leveraged to ensure providers and networks of providers can partner effectively to best serve the children and families in their communities. While the pandemic has revealed the fragility of our under-resourced child care sector, it has also illuminated the importance of providers being able to braid or layer different funding sources to provide comprehensive services to families. Strong programs braid funding from various sources in order to ensure that the families they serve have access to a comprehensive, high-quality early childhood education experience. The Administration for Children and Families should work closely with state administrators to ensure providers at the local level can partner effectively by encouraging layered funding. This would go a long way toward improving the quality of experience for families with young children by increasing the opportunities for pre-k, head start, early head start and child care partnerships. Family child care networks and shared services alliances can be one of the vehicles for building those partnerships, as can the Early Head Start Child Care Partnerships model, which helps raise the bar on what quality infant and toddler care can and should be.

3. For the Health Resources and Services Administration: Learn from families and home visitors about their COVID-related funding and flexibility needs.

HHS’s Health Resources and Services Administration is home to the Maternal, Infant, and Early Childhood Home-Visiting (MIECHV) Program. Nearly one year into the COVID-19 pandemic, home-visitors and their clients have learned a lot about the limitations of home-visiting funding sources and the additional flexibilities needed to deliver high-quality services during this time. Pending the inclusion of additional MIECHV funding in future COVID relief packages, HHS should continue to support the home visiting field and MIECHV program by offering the utmost flexibility to state grantees. Without losing sight of the goal to return to in-person home visiting when the pandemic subsides, HHS should capitalize on the opportunity to evaluate what the field has learned from the shift to virtual service delivery, from ways to creatively engage families to new sets of workforce supports. As the field works to understand the blend of service delivery strategies that will best serve families in the long-term, research should ensure key equity issues are investigated including access to and comfort with technology, and disparities in health risks and comfort with in-home services moving forward.

Racial inequities embedded in our current health care system make prenatal and maternal health care less accessible and less responsive to Black mothers regardless of their socio-economic status.

In a recent Block Club Chicago article exploring how doulas can help even the playing field in maternal health for women of color, Denise Cain — a mother in Start Early’s (formerly known as the Ounce) Healthy Parents & Babies program — spoke about how she benefitted from having a doula guide her through her second pregnancy and postpartum care.

“Support from a doula — who is trained to advise and offer emotional and physical support to mothers before and after birth — can make a big difference in the unequal health outcomes women of color face,” Diana McClarien, vice president of Start Early’s Early Head Start & Head Start Network shared in the piece.

In the piece, Start Early doula Patricia Ceja-Muhsen explains how doulas help inform women about all the different choices they can make, empowering them to have more control over their pregnancy and birthing process. She also adds that doulas can make sure doctors listen, address all of an expecting mom’s concerns and fully inform women about their options and the care they are receiving.

Start Early’s direct-service programs provide critical supports to young parents for building strong relationships with their baby and creating a safe and stimulating home environment. It is programs like these that can ensure all new moms and babies, including Black moms and babies, receive the quality physical and emotional care they need and deserve.

Read the full article at Block Club Chicago.

The second Starting Early Begins With… speaker series discussion painted a grim and preventable reality that exists for new Black mothers and their babies. The United States continues to report the highest rates of maternal mortality for birth parents when compared to 10 similarly wealthy countries.

Dr. Joia Adele Crear-Perry, MD, FACOG, a nationally recognized thought leader around racism as a root cause of health inequities, kicked off the event by sharing the background of the maternal and infant health crisis and its disproportionate effect on families of color.

“The United States was not built on a human rights framework… You should have the right to education, to housing, to food. Not to be a billionaire. But, for just a basic income – having a living wage,” Dr. Joia framed. “We don’t invest in things like paid leave, child care; the things we know that we desperately need right now, like free health insurance.”

Both systematic racial and gender racism generate chronic stressors for Black women that contribute to higher rates of maternal death. In addition, racial inequities are embedded in our current health care system, making care less accessible and less responsive to Black mothers and children as it should be, regardless of socio-economic status.

Later in the discussion, Start Early President Diana Rauner added how, “the COVID-19 pandemic has exasperated the stressors that exist for Black women and health care providers in under-resourced communities.”

Fortunately, Dr. Joia and Diana shared many solutions for overcoming this avoidable and tragic reality – services, such as doulas and home visiting, and programs that offer universal newborn supports, which are proven to ultimately reach more under-resourced families. In addition, Dr. Joia noted that, “… we [need to] stop racializing things like Medicaid. We all need health care, not just Black people.”

Start Early’s direct-service programs provide critical supports to young parents for building strong relationships with their baby and creating a safe and stimulating home environment. It is programs like these that can ensure all new moms and babies, including Black moms and babies, receive the quality physical and emotional care they need and deserve.

In the last three decades, scientific research has demonstrated how deeply adversity in childhood becomes embedded into biology, behavior, and risk, and how these can be passed on to future generations. This body of science — Neuroscience, Epigenetics, Adverse Childhood Experiences (ACE), and Resilience research, or NEAR — is one of the largest public health discoveries of our time.

Home visitors knowledgeable about the NEAR sciences and research are interested in bringing this information to families but worry about causing harm. The NEAR@Home toolkit addresses these concerns and provides strategies for engaging parents in discussing NEAR sciences and using the ACEs questionnaire in a safe, respectful and effective way for both home visitor and family.

Home visitors are uniquely positioned to help families mitigate the effects of past, present, and future adversity through supporting protective, responsive parenting and safe attachment relationships. The NEAR@Home process gives parents choice, offering information, assuring safety, being respectful, allowing time and space for reflection, and by always closing with hope and resilience.

The NEAR@Home toolkit was created, tested, and revised by home visitors, mental health providers, and other experts in the field of NEAR and home visiting in Alaska, Idaho, Oregon, and Washington. The NEAR@Home toolkit is designed as a training manual with guided processes to help you learn and practice language and strategies to safely and effectively talk about the trauma of ACEs. We emphasize safety and reflective support for the home visitor as a critical element in this process.

The NEAR @Home toolkit was developed as a self-study process and is being shared without cost because we believe that all home visitors deserve to have access to this guidance. Many home visitors discovered that while self-study of the NEAR@Home toolkit was useful, they preferred a supported learning experience and have informed the development of NEAR@Home Facilitated Learning. Learning how to be safe, respectful, and effective while talking about the NEAR sciences with parents is a complex process that requires and deserves time and support.

The NEAR@Home Facilitated Learning process is very different from most training programs. Thinking about, talking about childhood trauma stirs feelings in all of us, whether ACEs are part of our life story or not. Our learning process is guided by Facilitators who are relationship focused, trauma sensitive, and fluent in infant mental health concepts and processes. The Facilitators model self-regulation, co-regulation, spacious listening, and reflective processes to walk with home visitors and supervisors through learning how to do a NEAR home visit. Implementation Science guides the structure of the learning process from a mutual exploration of fit and feasibility to follow up reflective consultation to support home visitors as they integrate these new skills.