Impact of Home Visitation in Alberta

New families overcome challenges with the help of home visitors

By Cheryl Moskaluk

What does home visitation really look like? Alberta mothers and home visitors talk about the vital role this program has in starting families off on the right footing.

The Dickinson family was overjoyed when their baby girl was born safely and brought home to a busy home that already was buzzing with the energy of two preschool boys. But as soon as the new baby came home, her two-year-old brother stopped talking; their mom Linda was on the brink of sinking once again into depression. The baby developed pneumonia at 18 months.

After tending to the baby for a week in hospital, an exhausted mother brought her daughter back home again, this time on oxygen. When the public health nurse told Linda that someone from the voluntary Healthy Families program could visit her regularly at home, Linda immediately said, "Yes."

Because of her history of post-partum depression coupled with the overwhelming circumstances, Linda felt she needed someone to talk with.

"When Judy started coming over, I didn't think there were ANY strengths in my family. It took some time to realize what they were."

Two and a half years later, Linda tries to find the words to explain what her home visitor has meant to her. It turned out that her second son was severely delayed in his speech development and was on a waiting list for therapy. In the meantime, her home visitor helped her access early intervention programs. The boy was later diagnosed with autism and his older brother with Attention Deficit Hyperactivity Disorder.

Through it all, Linda had built a trusting relationship with her home visitor through the program's weekly visits, to talk about care of the new baby, how to handle behavior issues with her other children, to set goals for the family and to brainstorm solutions. The family benefited from staying in the program for the longer term as they navigated a whole new bewildering world of mental health issues, assessments, programs and assistance. Judy helped the Dickinson's evaluate their progress each week and could celebrate their successes during the regular visits. Judy constantly built on what the family was doing right. Her former experience in intensive behavior intervention also gave the Dickinson's a wonderful sounding board.

"We had to make big decisions regarding Tyler's treatment in such a short time. She helped my husband and I evaluate different options. I had someone to talk it out with, brainstorm ideas and just be able to let go and say, 'This is how I feel.' "

"I think because of Judy's help I am more confident in talking with the people who work with my son."

And as their baby started growing, Linda worried about delays in her daughter's speech development. Their home visitor helped by bringing along a developmental screen for all areas of growth. This simple tool helped ease Linda's fears and let her see where her baby girl was making great progress. Judy also helped Linda learn about what she could do to help her baby.

"It's just so excellent. This gave me confidence. She helped me with some rhyming games to stimulate her development. My daughter is doing fine now."

Linda's story of hope is echoed time and again by dozens of Alberta families who have chosen to have a home visitor support them through the earliest years of child raising. Parents describe the wonderful benefits of feeling supported. But ultimately it's home visitation early in a child's life that marks the fundamental success of the program.

Home visitation is a program of ongoing, consistent support that builds a trust relationship with parents in the interests of helping them create the best possible healthy start for their children by doing the following:

  • providing encouragement to parents in all aspects of their parenting roles
  • affirming and helping families build on their strengths
  • recognizing achievements of the family
  • helping families connect with appropriate community resources
  • helping families make appropriate connections with other families
  • modeling healthy teaching and parenting behaviors
  • providing culturally relevant information and resources
  • advocating for and with families
  • being a liaison for the family when they deal with other service providers

There are plenty of effective ways to provide early child development interventions that address some of these goals. However, home visitation remains unique in its approach of meeting families on their own terms, in their own homes. The practice is reflective, holistic and personal. It provides a consistent, ongoing anchor for families struggling to stay centered in the job of raising children. Surveys of parents by many home visitation providers find that families dwell on the nature and quality of their relationship with their home visitors. It seems life-saving for a mother of three young children to have in-home support that she never would have accessed if she needed to travel outside the home to get it. Families under stress need the positive mirror that home visitors provide to be able to see what's working. Other parents emphasize the importance of caring, non-judgmental support that helps them just be themselves. Then they open up to their own potential as parents.

"My home visitor doesn't care if my house is immaculate or I'm in my pajamas, says one mother. "Instead she'll ask if I'm feeling better than last week, or listen to me when I tell her how I handled one of my baby's crying spells."

Support to first-time mothers is critical for the future of their babies. Calgary home visitor Jayne Forster stresses overwhelming importance of building a healthy attachment between parent and child.

"I can't say enough about how vital it is to explain to moms who maybe didn't feel this for themselves -or any mom- that just to look into their baby's eyes and be able to give that love, is huge."

In the low-income Calgary neighborhood where she works in the Healthy Families program, Jayne sees plenty of mothers who are hurting. It's an unfamiliar journey for them to be able to love their children because they never were.

"We do need to mother the mothers," said Jayne. The goals of Healthy Families programs-to focus on early intervention for babies to five-year-olds-are realized not through strict assessments of the problems but by being the voice of the child for mothers who truly can't hear the call yet.

"I had a young mom whose baby was one week old and she had to learn so much about a baby's needs but already she was picking up on the baby's different cries. I told her that her baby was so lucky to have her as a mom because she understood and loved her newborn baby already. The thing is, we have to build on what these moms can do and they'll do more of it. There's a big difference between saying, 'Can't you hear the baby crying,' and saying, 'Oh, he's crying again what do you think that could be about?' "

One of the primary benefits for new mothers, from the regular, weekly nature of the program, is that home visitors have the appropriate setting and the continuity of relationship to be able to model exactly how mothers can comfort, play with and stimulate their baby. It's a world away from reading about it in books. An overwhelmed new mother can't absorb this information. Instead, home visitors watch the mother with the baby, point out the important things a mother might not realize she is doing right and work on the rest one week at a time. The rewards are in being able to point out the baby's response and see the confidence grow in the mother.

Home visitors might help parents recognize and have healthy interactions with their children by including some of the following during their weekly visits:

  • listen to the baby's cries, watch the baby's behavior and help the mother figure out for herself what the baby is trying to say
  • affirm a mother's healthy response to her baby and encourage her
  • teach healthy ways to play; introduce songs or games
  • give information about child development and point out what developmental steps the baby is taking

With 25 years experience in rehabilitation services for the developmentally disabled, working with troubled teens in schools, as well as raising a blended family of five children, Shelley Logelin jumped at the chance to become a home visitor with the Healthy Families program in the Strathmore-Didsbury area. She has been traveling to meet families with young children in their homes since November 2002.

Shelley thinks of the potential of home visitation practices as the cutting edge-a promising way to help build a healthy society. Having worked with families who have carried heavy burdens for many more years as their children entered the teen years, Shelley is thrilled to have discovered her place in home visitation practice in families with very young children.

"It seemed like a wonderful opportunity to work with families so early. In my experience I saw many negative parenting and behavior problems become ingrained." "I have also been a foster parent and I know that sometimes families can become so defensive when assessments seem to focus on all the deficits in the home and it seems that service providers are sent in to 'fix the problem.' "

"Home visitation is such a positive approach. We ask families, 'What would you like us to help you with?' and then we help them meet the goals they have set." She knows from experience that the time and care taken to build a relationship with a young mother makes a world of difference. One of her clients, a teenage mother, leaves a powerful impression.

"She was a young mom who was abandoned herself as a young child. She had no examples of being a mother and she really did need a lot of support. I worked with her for a few months and she was able to get other in-home support. There were very valid concerns about how she was doing as a mom, even at the outreach school she was attending. But her progress was awesome.

"Then one time when I attended the school with her; the mothers and babes were at a session on play, focused on child development. She saw that another young mother and baby were having problems- the mother was speaking harshly to her baby. So the mom I was working with got up, went over and started playing and talking lovingly to this other baby. She was modeling all this positive behavior and doing the coaching. I was amazed."

Home visitors might be able to help a family fill out forms for subsidized housing, find a good source of gently used clothing or help access a milk fund. Sometimes it's just a matter of letting a young mother talk about keeping her dreams alive in the face of a poverty trap that makes the mountains just too big to climb, especially when you're trailing three children under five years old. In lots of cases, there are no quick fixes but week to week, there's always a positive step to celebrate, no matter how small.

Families can easily be guided to assess the positive outcomes in a program that they choose for themselves, says Jayne Forster.

"It's they who have ownership over their progress and their achievements." The most wonderful benefits are in the positive ripple from parent to child, to family, to community as people become motivated to change what they really want to change.

"That's what makes this work so exciting," Jayne said. She came to what she defines as her dream job with a myriad of experience in daycares, early childhood education, group homes with adolescents and with special needs children- all of which serve her well in a new and exciting way, through the lens of a home visitor.

Her team of seven home visitors meets regularly for on-going training and support. A common baseline of knowledge and training unites home visitors of different backgrounds and experience.

"I help families draw on their own strengths and in fact, I am supervised the same way. That's what keeps me so charged up."

Forster's training, as with all home visitors in Alberta, centers on a shared curriculum developed through research institutes such as Healthy Families America. The immense strengths of the research-based philosophies that direct the structure of home visitation are confirmed for her each time she develops a relationship with a new parent and sees the outcome of that relationship.

Shelley Logelin agrees. "The difference this makes in the lives of families, if you look at the cost of this program, it's nothing compared to the costs of taking children into care. Ultimately, I would love to see the Healthy Families program expanded for home visitation and provide additional parenting programming, especially as outreach in rural areas."

Says Jayne, "What better gift can we give our society than having mothers and all children getting a healthy start?"

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