In Lincoln County, Universally Offered Home Visiting Is Already Making an Impact

In Lincoln County, Universally Offered Home Visiting Is Already Making an Impact

The Oregon legislature approved funding earlier this year for Universally offered Home Visiting (UoHV), a program designed to support infants and toddlers and their families while promoting healthy development and early learning from the time a child is born. In August 2019, the Oregon Health Authority (OHA) selected eight areas of the state in which to roll out the program.

UoHV in Oregon will follow the Family Connects model, developed by Duke University and offered throughout North Carolina. We don’t have to go to North Carolina, though, to see the impact of the program. A look at Lincoln County—which has been offering universal home visits using the Family Connects model since 2017—gives a sense of what’s to come for families with newborns across Oregon.

Every Mother Can Benefit

Unlike other home visiting programs that serve specific populations, like first-time mothers, or children with special health care needs, Family Connects visits are available for any mother who wants them. Dr. Meredith Mann has been an obstetrician in Lincoln County for six years. She refers every patient she sees for voluntary home visiting.

“Regardless of your education level, job, or income, pregnancy can be a scary time,” Dr. Mann explains. Programs that target mothers based on risk factors or household income could leave many women without the beneficial support they need.

Amy Lunstedt, a nurse in Lincoln County who has been conducting home visits for the past six years, agrees. “Even families who are economically secure, or who aren’t dealing with trauma of some kind, have needs that a home visitor can address.”

The Family Connects model is an evidence-based approach that makes it easy for nurses to identify a family’s needs during the visit. During visits, nurses focus on twelve different domains.

These domains provide structure for the visits and are used as a tool for nurses to identify additional support or referrals a family might need. Lundstedt emphasized that home visits are not just about running through a checklist. Instead, nurses have in-depth conversations with mothers about a range of issues that fall under these domains. This includes feeding, crying, tummy time, appropriate infant behaviors, maternal nutrition, postpartum depression, birth control, car seats, household safety concerns, and any financial resources the family might need, such as the Supplemental Nutrition Assistance Program (SNAP). The nurse will also conduct a newborn health assessment. Heidi Harrington, another nurse home visitor we spoke with, says the families she visits are “giddy” to get this support.

“Mothers respond positively because nurses are respectful of people’s boundaries,” says Dr. Mann. The flexibility of the Family Connects approach makes that easy. Families can, for example, meet somewhere like a library if they prefer not to have a nurse in their home. Mothers can also choose when to schedule their home visit.

“It’s concierge medicine,” Dr. Mann says. “When I hear from mothers about the visits, they say ‘my nurse came over.’” These relationships between mothers and nurses last.

“Because we talk about so many different topics, mothers know they can call us with questions,” Harrington says. Nurses respond to follow-up calls by answering questions if they can or referring families to other supports, such as a lactation consultant.

Healthy Families, Healthy Communities

Shelley Paeth, the Maternal Child Health Program Manager for Lincoln County Health and Human Services, first heard about Family Connects in 2015. Though there were already several other home visiting programs in Lincoln County, she felt it was important to bring this universal, evidence-based approach to her community. It took roughly 18 months to strengthen relationships between nurses and doctors and hospitals, train nurses, and work with the Early Learning Hub of Linn, Benton & Lincoln Counties to roll out the program.


Paeth explains her rationale for bringing a program that serves every mother to the county.

“Pregnancy and postpartum are vulnerable times for everyone. And they’re a key time when women and new families are open to learning new information and motivated to make changes in their lives if they need to.”

In addition to providing a framework through which all mothers can receive support, the Family Connects model can help communities improve the services they provide. Following each home visit, nurses track the referrals they made for mothers and the services they need. The data helps reveal gaps in services.

From her experience conducting home visits, Amy knows her patients struggle with housing, transportation, and access to medical care. Children with special health needs must often leave the county for health care, and mental health supports are lacking. This reality can be difficult for nurses, knowing how hard it can be for patients to ask for mental health support. “It’s heartbreaking trying to help a patient who has finally decided to call for an appointment, only to be told there are no spaces available,” Amy reports. The data on referrals collected through home visits will help counties determine which programs and services, like mental health care, are most needed by the community.

Moving Forward Across the State

Now that the state has allocated funding for Universally offered Home Visiting, other counties are following Lincoln’s lead. The eight early adopter communities chosen by the Oregon Health Authority will begin delivering home visiting services in July of 2020. 

Families with newborns will benefit from this support and the data from these visits will help the state continue to improve the health supports and other social services available in local communities.

Learn More About Home Visiting


Children’s Institute Policy Brief 2019: Home Visiting 

The Foster Care Fix: Invest in the Services Proven to Keep Kids in Their Homes

The Foster Care Fix: Invest in the Services Proven to Keep Kids in Their Homes

Guest Column by Leslie Brown, Program Director, Children’s Relief Nursery at LifeWorks NW

Oregon’s Child Welfare System needs help. Our system for reporting abuse and neglect can be confusing, we do not have enough foster families or child welfare workers, and there are currently 84 foster children who’ve been sent out of state for care. These issues hit young children hard: according to the Oregon DHS 2017 Child Welfare Data Book, 45 percent of children in the Child Welfare System are under 6. While additional funding to improve this system is important, it is even more critical that we invest in programs that help keep young children out of foster care.

Fortunately, we know what it takes to keep kids in their homes. Relief Nurseries offer tailored, trauma-informed services to support families with children ages birth to 5. As a clinician working in the field of early childhood for 40 years and Program Director for the LifeWorks NW Children’s Relief Nursery, I have seen firsthand the impact Relief Nurseries can have on a family. We provide wrap-around services to families that reduce parental stress and social isolation. We teach parenting skills, strengthen bonds between parents and their children, and provide targeted services that reduce child behavioral problems and improve social-emotional development in very young children. These services include therapeutic classrooms for children, respite care that enables parents to take care of personal or family matters, regular home visiting to help families achieve family goals and build healthier parent-child relationships, and access to family counseling and consultation with an early childhood mental health therapist. Research shows that these types of primary prevention activities build the protective capacity of parents, keeping kids out of foster care.

According to the most recent evaluation conducted by Portland State University, the families Relief Nurseries serve have an average of 16 risk factors associated with abuse and neglect. This same evaluation shows that 98.5 percent of children working with Relief Nurseries between 2008 and 2010 avoided foster care placement. Children already in foster care who work with Relief Nurseries exit the system twice as quickly as those who don’t. Relief Nurseries provide additional benefits to parents and children, including increasing the percentage of parents reading to children, decreasing emergency room visits, and improving family economic stability.

LifeWorks NW is one of 31 Relief Nurseries and satellite sites operating in 17 counties in Oregon. According to a Children’s Institute interview with Cara Copeland, Executive Director of the Oregon Association of Relief Nurseries (OARN), these sites serve roughly 3,000 children in 2,600 families. But there are many more families across the state who could benefit from these services: based on the number of cases of reported abuse and neglect among children ages 0–5, OARN estimates that there are more than 36,000 young children across the state whose families need these programs.

Oregon has an opportunity in 2019 to keep children out of foster care by investing in Relief Nurseries. Governor Kate Brown, supported by a coalition of early childhood advocates, has called for a $5.6 million investment from the state to open two new Relief Nurseries and seven satellite sites, as well as expand the capacity of current programs. This is a smart investment for the state not only because Relief Nurseries have been proven to keep kids out of foster care, but also because for every $1 that the state invests in these programs, Relief Nurseries raise an additional $1.80 in private revenue.

I hope Oregon’s lawmakers will support this common-sense approach to fixing our state’s over-burdened foster care system. We should improve our Child Welfare System so that we no longer need to send foster children out of state for care. The best way we can do that is to provide families with the support they need so that children can remain in their homes receiving the love and care they need.

Advocate for Children in Oregon

Advocate for Children in Oregon

Learn more about the programs and services in Oregon that support young children and families: home visiting, child care, early intervention, early childhood special education, and preschool.

Parenting is hard work, especially with young children. Fortunately, Oregon has great services and programs for families.

These include home visiting, child care, early intervention, early childhood special education, and preschool.

Home visiting improves child health and development, parental confidence, and school readiness. And it reduces maternal depression, child abuse, and low-weight births.

Today, home visiting reaches only 1 in 5 eligible families. What if every family who wanted these services could access them?

Oregon also helps many working families access quality child care by providing subsidies or, in some cases, paying for the full cost.

But many working families don’t have access to child care because there aren’t enough providers or it’s just too expensive. What if we could help more parents?     

Early Intervention and Early Childhood Special Education services support children with developmental delays and disabilities.

They help kids build skills and get ready for school.

But only 1 in 50 kids with high needs get the EI/ECSE supports they need. Where does that leave the rest?

Children who attend high-quality preschool are better prepared for kindergarten and more likely to graduate high school.

And the benefits of preschool last. Adults who attended preschool have better job prospects and better health.

30,000 children in Oregon could benefit from high-quality preschool. Imagine if all of them had that opportunity.   

From birth to age 5, kids grow and develop at an astonishing rate, and they need loving, nurturing environments and relationships.

Parenting young children is challenging, but together we can work to make it easier.   

Join Children’s Institute in advocating to expand home visiting, early intervention, early childhood special education, child care, and preschool so more kids and families have access to these proven supports and services.

You can make a difference.

And we need your voice.


Advocate for Children in Oregon

Learn more about our 2019 Policy Recommendations to support young children and families in Oregon and join our movement to let lawmakers know: Early Childhood Matters!

In Lincoln County, Universally Offered Home Visiting Is Already Making an Impact

Learn More About Voluntary Home Visiting

With a 2019 investment, Oregon could make meaningful progress toward offering universal voluntary home visits to new parents who need and want additional support in their first few months home with a new baby. While expanding home visiting services to all infants and families is a new idea in Oregon, home visiting has a long history in the state. The Oregon Legislature created Healthy Families Oregon (originally Healthy Start) in 1993 to provide home visiting services to first-time parents. Since then, the state has worked to strengthen the program with federal dollars and created the Best Beginnings Committee with a goal of creating a cohesive home visiting system. Home visiting services provided through Healthy Families Oregon and numerous other state- and locally-funded programs currently reach 12,000 families across the state. This is, unfortunately, less than 20 percent of families who could benefit. 

We aren’t the only state who understands the value of Home Visiting services. As part of their ongoing “What’s Working” series, CBS This Morning looked at the impact of Family Connects, a universal home visiting program that has served 30,000 families in Durham, North Carolina. Home visiting has been proven to increase optimal child development and health, the confidence and competence of parents, and school readiness in children. It decreases child abuse and neglect, maternal depression, low-weight births and other preventable childhood health conditions. As the video below highlights, home visiting has also reduced medical costs, ultimately saving the state money.

Now Is the Time for Oregon to Expand Voluntary Home Visiting 

In her Children’s Agenda, Governor Kate Brown proposes funding to provide home visits for all Oregon infants. Speaking with the Beaverton Valley Times, Dr. Alanna Braun of Oregon Health & Science University explained the value of the program:

“Having a new baby at home is stressful for everyone, regardless of income,” she said. “It’s a time of life when most anybody needs some help.” The idea of home visiting being universal throughout Oregon would be good, Braun said, because not everyone has the same easy access to a pediatrician or a hospital.

As Oregon’s population becomes more ethnically and linguistically diverse, culturally specific home visiting has also become increasingly necessary. For families who live in rural communities, the challenge of receiving vital home visiting services is further complicated by the lack of access to home visitors and increased driving time and costs.

Bill Co-Sponsor Sen. Steiner Hayward, In Her Own Words

In this interview on Think Out Loud, State Senator Elizabeth Steiner Hayward explains why she’s co-sponsored the bill that would make voluntary home visiting services available to all parents of newborns. 

Steiner Hayward said her own personal experience with postpartum depression, in addition to her professional background as a family physician, has been a motivating factor in her support for this bill.

“I was married. I was a physician. It was a planned pregnancy. My husband was a successful father already. I had everything going for me, and yet I still had this completely common biologic occurrence of having this depression, and it would have been incredibly helpful to have a trained nurse come in and help me,” she said.

Learn More About Voluntary Home Visiting

Hear from a Family Who’s Benefited from Voluntary Home Visiting Services

In this podcast, we visited Ha Mi Da and her family at her apartment in Southeast Portland. Ha Mi Da came to the United States from a Burmese refugee camp several years ago and we wanted to learn more about her story, her involvement with home visiting services provided by IRCO, the Immigrant and Refugee Community Organization, and her hopes and dreams for the future. Many thanks to Mihaela Vladescu, the family’s home visitor with IRCO and Healthy Families Oregon, and Min Sein who provided interpretation services during the visit.

Read Our Policy Brief on Voluntary Home Visiting in Oregon

Our policy brief on home visiting focuses on promoting loving, nurturing relationships between parents and children and the role of home visiting programs across Oregon.

Our 2019 policy recommendations for the state include offering universal home visits for all families and further investing in programs that strengthen parent-child bonds.

Read and download the policy brief

New Research: Impacts of Voluntary Home Visiting on Families

The Administration for Children and Families and the Health Resources and Services Administration within the U.S. Department of Health and Human Services recently released the results of a multi-year study of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which confirms lessons learned for states and communities working to continually improve the outcomes of vital, federally-funded voluntary home visiting programs.

This study looks at the crucial work being done in communities nationwide to identify family needs and implement and improve home visiting programs to make a difference in the lives of families with young children.

Among other findings, the study documented the following outcomes from voluntary home visiting:

  • Improved home environments: Families participating in home visiting provided more cognitive stimulation and emotional support to their children.
  • Reduced frequency of psychological aggression towards the child: Parents participating in home visiting were less likely to yell, scream, or swear at the child, or call the child names.
  • Fewer child emergency department visits: Children whose families participated in home visiting were less likely to go to the ER for injury or illness, perhaps due to improved preventive care, reduced incidence of child maltreatment, or a better understanding of when an ER visit is needed.
  • Fewer child behavior problems: Children whose families were enrolled in home visiting were less likely to show aggression, act out, or demonstrate hyperactivity; they were also less likely to present with anxiety, sadness, and social withdrawal.
  • Gentler guidance: Parents enrolled in home visiting were more likely to motivate and encourage their children in a positive manner than to assert power over children to accomplish a task.
  • Reductions in experience of intimate partner violence: Mothers enrolled in home visiting were less likely to experience physical or sexual violence or battering.
  • Reductions in parental depression: Parents enrolled in home visiting were less likely to exhibit symptoms of depression.
  • Reductions in parental stress: Parents participating in home visiting were less likely to exhibit parenting distress or dysfunctional parent-child interactions.
Other Trusted Sources Discuss Voluntary Home Visiting

Education Week: Home Visiting Successes Explored in New Reports

The New York Times: How Home Visits From Nurses Help Mothers and Children, Especially Boys

National Home Visiting Resource Center: Oregon Profile

Health Resources & Services Administration: Home Visiting Overview


Oregon’s Relief Nurseries Support Families and Keep Kids Out of Foster Care

Oregon’s Relief Nurseries Support Families and Keep Kids Out of Foster Care

Oregon’s nationally recognized Relief Nursery model serves families with children ages 0–5 who are most at-risk for abuse and neglect. In 2019, Children’s Institute is joining a coalition of early childhood advocates to request an additional $5.6 million in funding for Relief Nurseries to strengthen parent-child bonds and decrease abuse. We spoke with the Association of Oregon Relief Nurseries Executive Director Cara Copeland to learn more the need for additional investments in these critical programs.

All photos in this story were taken at the Chelsea’s Place Family Building Blocks Relief Nursery in Salem.

Children’s Institute: Can you explain how Relief Nurseries, which are unique to Oregon, use a multidisciplinary approach to serve children and families?

Cara Copeland: Relief Nurseries have been in Oregon for just over 40 years. The core model relies on three things: a therapeutic classroom for children, home visiting for parents, and parent education. A lot of our children are behind developmentally, so we work one-on-one to make sure they’re ready for kindergarten, focusing on the social emotional development of kids ages 0­–5. The home visiting and parent education provide tools and emotional support. Many Relief Nurseries also have other supports: they might have food and diapers available, or mental health, drug and alcohol counseling, or peer services.

CI: Why do you think the ages birth to 5 are such a critical time for kids and families?

Cara Copeland: Research shows that a child’s brain is 80 percent developed by age 3. The first 1,000 days are the most critical. We know that if you don’t invest in that child in the first three years, you’re compromising that child���s future capacity.


There’s no wrong door.

Cara Copeland explains how families can connect with a Relief Nursery. 

“When a new Relief Nursery starts in a community, typically families come to us via referral. The idea is that there’s no wrong door, and there’s one piece of paper that a pediatrician could fill out, a DHS worker, a self-sufficiency worker, an employment office, or a WIC provider. The Early Learning Hubs have been integral in helping communities, either partnering alongside what communities are already doing to coordinate referrals, or to instigate that process. Over time, what we’ve seen across virtually every Relief Nursery is that within a couple of years, most referrals are self-referrals: families in the program refer their friends. We build trust within a community, and that’s what’s really important.”

This is also an important time for a family to establish healthy patterns, especially for a first birth. Forty-five percent of children reported to be abused or neglected are under age 6, and 12 percent of children who suffer abuse are under age 1, according to the Oregon DHS 2017 Child Welfare Data Book. Many of our families are products of abuse, generational neglect, substance abuse, and incarceration. In those first few years when they are becoming a family, if we can establish some patterns of interaction and parent-child attachment, that’s going to serve that family for the long haul.

CI: How do Relief Nurseries help establish those healthy patterns for families?

Cara Copeland: Sometimes people think of Relief Nurseries as child care or preschool. We do serve families that are raising children of preschool age, and we do care for their children, but we are neither child care nor a preschool program. We’re focused on building the five protective factors in families: concrete supports, social supports, understanding of child development, social-emotional competence of children, and parental resilience. When parents have something traumatic happen to them—homelessness, food insecurity, domestic violence—that’s where relief nurseries step in, to build parental resilience along with these other supports. We can’t guarantee that life is going to get easier, but we can help give parents tools to stand up when life is hard.

CI: What kind of impact have Relief Nurseries had in Oregon?

Cara Copeland: Across the state Relief Nurseries serve about 3,000 children, and about 2,600 families. Forty percent of the families coming to us are already involved in child welfare. Statewide our families have an average of 16 risk factors associated with a higher likelihood of abuse and neglect, which often lead to foster care. Across the state, our most recent independent evaluation showed that 98 percent of our children required no further foster care placement after they entered Relief Nursery services. Parents love their children and they really want to parent, and we’re often their last chance at keeping their kids.

We need a strong foster system. We need quality foster parents, and we need to support our foster parents. But my goal would be that at some point we have no need for foster care. Can you even imagine? I think that’s a worthy goal to fight for.

The Impact of Adverse Childhood Experiences

Cara Copeland explains why trauma-informed care is critical to preventing child abuse and supporting families. 

Children’s Institute and many other early childhood advocacy groups from across the state recognize the value of Relief Nurseries and have joined together to request a $5.6 million investment in Relief Nurseries that help prevent child abuse and strengthen parent-child bonds. 

Learn more about our 2019 Policy Recommendations and add your voice in support of programs that support healthy and intact families. 

Home Visiting Programs Support Young Children and Families

Home Visiting Programs Support Young Children and Families

In this segment, I visited Ha Mi Da and her family at her apartment in Southeast Portland. Ha Mi Da came to the United States from a Burmese refugee camp several years ago and I wanted to learn more about her story, her involvement with home visiting services provided by IRCO, the Immigrant and Refugee Community Organization, and her hopes and dreams for the future. Many thanks to Mihaela Vladescu, the family’s home visitor with IRCO and Healthy Families Oregon, and Min Sein who provided interpretation services during the visit.



Pin It on Pinterest