VIDEOGRAPHER: KAELYN LYNCH
Marisol Trevizo-Carlos wasn’t sure what to expect when she became pregnant with her son in 2017. Although the 24-year-old was married and had a job helping resettle newly-arrived immigrants in Santa Fe, New Mexico, she missed the support of her family, who lived in other parts of the state or in Mexico, and she didn’t have much experience being around children.
So when a colleague directed her to a local nonprofit that provided first-time parents with prenatal classes and home visits, she thought she’d give it a try.
Over the next three years, a home visitor came to her house every month, offering useful lessons on breastfeeding, learning through play and baby-proofing. When her son started walking at 11 months old, Trevizo-Carlos said she was grateful to have a home visitor reassure her that he was developing normally.
“It was really neat having this neutral person who was not going to tell me how to raise my kid, but who was going to be there to support me and give me guidance,” said Trevizo-Carlos, who accessed the services through United Way, now Growing Up New Mexico.
In addition to providing basic prenatal and early childhood development education to parents, home visitors are also trained to screen for violence in the home and connect families to resources if they’re struggling with challenges such as mental illness or financial problems. In New Mexico, a state ranked second to last in terms of overall child well-being based on education, health, family and economic security, home visitation programs can provide additional support to families.
There are 33 state-funded home visitation programs for new parents in New Mexico, with each using one of four models: First Born, Nurse‐Family Partnership, Parents as Teachers and Partners for A Healthy Baby. Programs are free to families and continue until a child is 5 years old.
Trevizo-Carlos said she valued the program so much that, in 2020, she decided to become a home visitor herself. Today, she works for Growing Up New Mexico, which offers home visits, childhood education programs and courses for child care providers in Santa Fe and Rio Arriba counties.
“I appreciate the job, how my home visitor made me feel and the relationship that we developed,” she said. “It was something I wanted to do.”
Creating a model for New Mexico’s challenges
Home visitors served 5,697 families in New Mexico in 2021, according to the New Mexico Early Childhood Education and Care Department, a slight dip from 5,746 in 2020, though the service has steadily grown over the past five years. The majority of families — 60 percent — were Hispanic; 17 percent were white and 10 percent were Native American. Half of New Mexico’s population is Hispanic or Latino, according to the census, with 37 percent white and 11 percent Native American.
About 70 percent of primary caregivers who received services did not have a college education.
In total, 99 percent of these parents sought out prenatal care and roughly 91 percent of children were screened for healthy development, including milestones like sitting up and crawling, and referred for additional support such as speech or physical therapy if needed. Eighty-three percent of families were screened for intimate partner violence.
Each home visitation model follows a curriculum organized by the stages of development in a child’s life from prenatal to five years old. Some lessons offer parents educational activities they can do with their child as they grow. A home visitor may introduce a conversation about childproofing by going room by room, pointing out electrical outlets in the bedroom that need to be covered or making sure knives in the kitchen are out of reach.
Many programs also check on the parents’ mental health through the Edinburgh Depression Scale and review the parent-child relationship with the Piccolo assessment.
“We usually sit on the living room floor, where the baby or toddler is,” Trevizo-Carlos said, describing how she structures her home visits. “We ask them how the week has been and if they’ve had struggles, and then we brainstorm together on why.”
When something good happens, like when a child starts walking or speaking their first words, “we celebrate together,” she added.
Of the four home visitation models used in New Mexico, First Born is the only one that was specially created for New Mexico, while the others are national models. First Born launched in 1997 in Grant County, located in the southwest corner of the state.
The model was created with New Mexico’s specific challenges in mind. Unlike many models, which are only offered to families that meet a certain low-income criteria, First Born is available to everyone. As the state with the third highest percentage of residents living in poverty, according to the census bureau, First Born was built on the premise that the majority of New Mexican families could benefit from home visits.
In 2020, the most recent year for which they have full demographics, First Born reported that 50 percent of their families were on Medicaid and 67 percent were non-white.
When the program first started, it was also common for home visitation models to require visitors to be registered nurses, like the Nurse‐Family Partnership model. New Mexico, though, has seen a decades-long nursing shortage that has only gotten worse. As a solution, First Born allows anyone to become a home visitor if they complete the required training.
Today, the program offers a 36-hour training course through the Santa Fe Community College’s Institute for Innovative Families Program, and receives $2.7 million annually from the state. The course trains home visitors in 29 competencies including communication skills, children’s development, and how to handle situations of domestic abuse or substance use.
After years of successful implementation across the state, the coronavirus pandemic has posed significant challenges to home visitor programs.
Some home visitors were used to driving hours to serve families in rural areas. The shift to telehealth services has been a struggle for many of those families, who are more likely to have slow or no internet access.
“I see our model as being mixed delivery” with in-person and telehealth, said Tekla Johnson, First Born’s program director. “It makes a lot of sense to be able to see families regularly and take away the barriers to that happening.”
Benefits of home visits backed up by data
Across the country, home visitation programs have shown positive outcomes, including increased school readiness and access to healthcare, according to a Department of Health and Human Services review of research on 50 early childhood home visiting programs over 40 years.
Ivan de la Rosa, a social worker and associate professor at New Mexico State University, researched the First Born model in its early days.
In one 2005 study of 109 families in southern New Mexico, he found that parents who received home visitation services were better equipped to seek out emotional and material assistance from family members and their community. They also reported being better caregivers, and were more likely to view their child as a positive aspect of their life instead of a burden.
Rebecca Kilburn, an economist at the University of New Mexico’s School of Medicine who has also studied home visitations, said she was surprised by the impact on parents.
“For a lot of parents, improvements in outcomes take place right away, like completing their education, working more or being less likely to be involved in criminal activity,” she said. “Some of the most immediate payoffs in terms of monetary benefits are actually due to changes we see in the parents.”
Trevizo-Carlos has seen those changes firsthand as both a mom and a professional home visitor.
She said she has met and helped parents with all kinds of problems, from a mother who was having trouble getting her son to sleep alone, to one who needed help leaving an abusive relationship.
“Families have good intentions; sometimes they just don’t have the resources,” she said. “With a home visitor giving information to families and supporting them, children tend to do a lot better.”
