Oregon Must Choose Early Childhood Investments for a Better Future

by Dana Hepper | Dec 4, 2024 | Child Care, Home Visiting, Oregon Policy, Parents and Families

Governor Kotek released her Recommended Budget for 2025-27 on Monday, December 2. While it makes some notable needed investments in young children, more is needed to ensure Oregon lives up to our values of supporting young children and families furthest from opportunity. These investments help families overcome generational poverty, put working families on a path to success, and strengthen the state’s economy.

The Governor’s Recommended Budget recognizes the need to start early with some small but important investments.

Existing Early Childhood Investments

$12.7 million to provide early childhood mental health consultation support to child care providers experiencing challenging behaviors in their classrooms. This is a $4.4 million increase from 2023-25.
$19.6 million to continue the work of the Birth to 5 Early Literacy Fund for the 2025-27 biennium, and $2.2 million for Imagination Library.
$4.7 million investment in the new Tribal Early Learning Fund.

We are calling on the legislature to go further with three targeted investments for young children and families living in poverty that strengthen both our early childhood and economic ecosystems across this state, especially in rural areas.

Strategic Investments for 2025-2027

Employment Related Day Care: $500 million is needed to reach unconnected and waitlisted families. More than 8,000 families are on a waitlist to access help to pay for child care. This means parents can’t work and provide for their families. Child care shortages hinder our economy and the ability of employers to recruit and retain workers.
Momnibus Package: Pass needed legislation and allocate at least $20 million. Rep. Lisa Reynolds has spent months working with partners to develop a Momnibus package of investments focused on stabilizing families during pregnancy and the first year of a child’s life. Prioritize the passage of the Momnibus package and approximately $20 million needed for implementation.
Home Visiting: $26 million investment. Breaking intergenerational cycles of trauma requires investments that support families. Home visiting programs strengthen healthy child development and school readiness while helping prevent child abuse and maternal depression. These are crucial services for families raising our youngest Oregonians.

Early childhood investments yield some of the best returns for any public funding and have broad public support. We call on Governor Kotek and the Oregon Legislature to make these choices today for a much brighter and stronger future for the state.

We Need You!

While you’re here, please sign our petition to help elevate the importance of early childhood investments in the legislature in 2025. It takes 10 seconds and your name makes a difference!

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Home Visiting Provides Personalized Care to New Parents & Strengthens Families

by Rafael Otto | Dec 14, 2022 | Podcast, Health and Development, Home Visiting, Parents and Families

Guest

On this episode of The Early Link Podcast, our host Rafael Otto speaks with Jennifer Gould who currently works as a Nurse Home Visitor for the Nurse Family Partnership program with the Multnomah County Health Department. Gould has been in this role for more than 15 years, is a Registered Nurse, and is also an International Board Certified Lactation Consultant.

The Nurse Family Partnership is a community based, public health program with 45 years of research showing evidence of significant improvements in the health and lives of first-time moms and their children affected by social and economic inequality.

Summary

Gould kicks off the episode with the history and meaning behind the Nurse Family Partnership program, what brought her into the work, and how she became a home visitor.

She also explains how families are connected to the program, shares about what it looks like to work with families and discusses how services have changed because of the pandemic. Gould shares some of the experiences she’s had while supporting new parents, with the hope that more people will be aware of how impactful and important these programs are to so many young children and families.

Children's Institute · Home Visiting Provides Personalized Care to New Parents & Strengthens Families

Transcript

[00:00:00] Rafael Otto: Hello everyone. This is the Early Link Podcast. I’m Rafael Otto. Thanks for tuning in. As always, appreciate your ears on our segments. You can catch us on 99.1 FM in the Portland Metro on Sundays at 4:30 PM or tune in at your convenience wherever you find your podcasts. That includes Spotify, Amazon Music, Apple Podcasts, and as always, you can listen on our website at childinst.org.

I’m talking today with Jennifer Gould, who currently works as a nurse home visitor for the Nurse Family Partnership Program with the Multnomah County Health Department here in Oregon. She has been in this role for more than 15 years and is trained as a registered nurse and also an international board certified lactation consultant.

That program, the Nurse Family Partnership is community based public health program with more than 45 years of research. Showing evidence of significant improvements in the health and lives of first time moms and their children affected by social and economic inequality.

Jennifer, it’s great to have you on the podcast today. Thanks for joining me.

[00:01:11] Jennifer Gould: Great. Thank you, Rafael. It’s nice to be here.

[00:01:13] Rafael Otto: I wanted to just start, if you could tell me a little bit about the program Nurse Family Partnership, and then what drew you to the work? How did you become a home visitor?

[00:01:26] Jennifer Gould: Yeah, thank you. You know, the program was originally called The Olds Model. Based on the, the. NAN researcher that actually developed the program, who was Dr. David Olds, who is still involved. And the story I always kind of have heard from him and that I tell is when he finished his first kind of round of studies, I believe he’s a, you know, sociologist, psychologist, that kind of realm of world, was working in a daycare center kind of similar to like a head start. And he said, you know what I realized is that at age three or four, some of these families were doing great. These families all had to qualify by income to come in. Some of them were doing great and their kids are thriving, and other families by age three or four really needed some support for a couple of years before their kids showed up at our center.

And so he really started to look at what programs already existed that potentially supporting families before they hit school age. And how he could really not just replicate, but also really… I mean, what to me was fascinating about him is that he was one of the first people to really kind of started to say, how can we…? We need to actually do some kind of studies and do some research to really see is it just the information or is it the program?

And so he and his teams and teams of people at this point have done a few really long term trials, and they can really quantify a little bit the positive outcomes that we see by this kind of a relationship, this based program. The basic idea is that a especially trained home visiting nurse is matched with a family during pregnancy. We do prioritize first time parents and we prioritize families before the last trimester of pregnancy. He really found that it was a true window of opportunity where people were really open for support and really thinking about change.

Please download the full transcript below.

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

by Melissa Duclos | Oct 28, 2019 | Home Visiting, Oregon Policy

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

5 Things to Know About Infant and Early Childhood Mental Health

by Helen Shum | Sep 19, 2019 | Health and Development, Health and Kindergarten Readiness, Parents and Families

Advocates for children’s mental health envision a comprehensive network of supports for children and families that begins with mothers at the prenatal stage and continues throughout an individual’s lifetime. That’s reflective of continuing research which demonstrates that children who enjoy good health—including mental health—are better prepared for school and life.

Yet, general understanding of infant and early childhood health is still at an emergent stage. That’s partly because diagnostic classification of mental health and developmental disorders in children under 5 did not exist until 1996. While treatment and payment protocols have been established in Oregon since then, more work is needed to integrate infant and early childhood mental health into the larger array of available services and supports for families and children.

Here are five answers to questions about infant and early childhood mental health in Oregon:

What does mental health in an infant or toddler look like?

Social and emotional health in the youngest children develops within safe, stable, and attached relationships with caregivers. Children who have positive and engaging interactions in their earliest years are more likely to enjoy good physical and mental health over their lifetimes. They are also better able to experience, regulate, and manage their emotions—key skills for later school readiness.

What types of mental health issues and disorders do young children suffer from?

Children who suffer from abuse, neglect or trauma—especially those facing additional barriers such as living in poverty—are more susceptible to mental health issues, including attachment and emotional regulation disorders and other developmental or psychological disorders.

Laurie Theodorou, Early Childhood Mental Health Specialist at the Oregon Health Authority (OHA), says very young children can also suffer from the same disorders that affect older children.

“Depression and anxiety can be seen even at the pre-verbal level. Though they can be harder to diagnose, young children respond well to therapy that includes their parent,” she said.

She’s also careful to note that mental health issues and disorders are not limited to situations related to maltreatment. “It’s important to de-stigmatize mental health and mental health treatment… Parents can be doing everything right and still need additional help for their child’s social emotional or behavioral problems.”

How are infant and early childhood mental health issues treated?

Proper screening and assessment are key to identifying and treating young children who are at risk for or suffering from mental health issues or disorders.

Treatment for mental health issues and disorders can be provided in a variety of home and clinical settings. Evidence-based treatments are family-centered and use attachment-focused approaches, including infant-parent psychotherapy, Parent Child Interaction Therapy, and psychoeducation.

Source: The Oregon Children’s System Advisory Council (CSAC) 2015; Early Childhood Workgroup. Adapted from TACSEI, www.challengingbehavior.org and http://csefel.vanderbilt.edu/ April 2015

What policy strategies can help improve outcomes for young children?

Researchers Joy D. Osofsky of Louisiana State University, and Alicia F. Lieberman of the University of California, San Francisco, recommend four actions to improve awareness and action on early childhood mental health issues:

Expand early screening for infants and toddlers to detect mental health issues.
Train professionals in mental health, pediatrics, early childhood education, child welfare, and other related professions to recognize risk factors; and ensure that undergraduate, graduate, and continuing professional education include content on infant mental health.
Integrate infant mental health consultations into programs for parents, child care, early education, well-child health services, and home-based services.
Address insurance and Medicaid payment policies to provide coverage for prevention and treatment of mental health issues for infants and toddlers.

How is Oregon working to improve public policy and practice for infant and early childhood mental health?

Oregon’s efforts to build a system of care for infant and early childhood mental health have been steadily building. For example, Oregon’s adoption of developmental screening as an incentive metric for Coordinated Care Organizations has increased the numbers of children identified for further assessment. The creation of a diagnostic crosswalk—a guide that aligns multiple diagnostic classification manuals—has also made it easier for providers to be reimbursed for mental health treatment.

More recent and upcoming developments include the planned roll-out of universally offered, voluntary home visiting in Oregon, and Project Nurture, an integrated model of maternity care and addiction treatment for pregnant women with substance use disorders.

A number of workforce-related efforts have strengthened the existing network of support for Oregon’s youngest children. OHA and the Oregon Infant Mental Health Association have partnered to offer an infant and early childhood mental health endorsement for early care and education and mental health professionals. An infant/toddler mental health graduate certification is available at Portland State University and the school has also introduced a new, two-year scholarship program to study rural infant mental health with funding from The Ford Family Foundation.

Raise Up Oregon, the state’s early learning systems plan, and the passage of the Student Success Act also promise to bring more attention and resources to the ultimate goal: a network of support for all children beginning at the prenatal stage which sets children up for future academic and lifetime success.

2019 Legislative Recap

by Rafael Otto | Jul 3, 2019 | Podcast, Oregon Policy, Policy Trends

Dana Hepper from Children’s Institute and James Barta from Children First for Oregon provide a legislative recap to close out the 2019 session. In this segment, they discuss the final days that resulted in passage of nearly 150 bills, including all remaining bills from the Early Childhood Coalition legislative agenda. Among the highlights are bills that fund universally available voluntary home visiting and create a task force on child care. Oregon also passed HB 2005 which creates a paid family and medical leave insurance program by 2023.

While the 2019 legislative session resulted in historic investments in children and families, Dana and James reflect on the work ahead. That includes advocacy efforts to support the Student Success Act. The way in which this bill is funded will likely be referred to voters in January 2020. It also includes the work of implementing new programs, a focus on ensuring program quality, and continued advocacy in the months and years ahead.

Listen here: