Susanna, 22 years old, enters the exam room bringing her five-week-old son, Daniel, for his well-baby check. During the visit, everything appears on track. Daniel’s physical exam is normal, there are no major medical problems, and Mom looks fine. Then you ask Susanna if she has any concerns. Somewhat hesitantly she begins to ask a few questions, and soon the words and tears come pouring out. The baby won’t sleep at night; there are fights with her husband about Daniel’s sleeping arrangements; her in-laws are telling her not to breastfeed so often; and she feels anxious, isolated, and insecure in her new role.

These aren’t really medical issues, but Susanna and Daniel clearly need help to get on the right track. Wouldn’t it be wonderful if there was someone you could direct them to, someone who could sit down with Susanna, support her in her new parenting role, and direct her to helpful resources in the community? 

Fortunately, there is! Every day, Families First Home Visiting nurses, educators, and child development specialists visit homes throughout Sonoma County, meeting with new parents to provide the best start possible for their babies and to strengthen the health and well-being of the family. During these home visits, parents have in-depth conversations with Families First experts about common parenting issues—issues that are more appropriately addressed outside a busy medical office. 

Dr. Danny Toub, a Santa Rosa family physician, is a strong advocate for Families First. “As a physician,” he says, “it is very helpful to have someone else on the health care team who is available to provide patients with emotional support, common-sense health and safety information, information about their baby’s development, and resources … and even better that it is someone who can make home visits and has time to spend with new parents.”

Since the program began in 2002, Families First personnel have made more than 15,000 visits to about 7,000 families in Sonoma County. All new families are eligible for three free visits, including patients of physicians and midwives in private practice, the Family Medicine residency, Kaiser Permanente, and community clinics. These patients are diverse in language, ethnicity, socioeconomic status, education, and insurance coverage. What they have in common is the experience of parenting their first newborn in Sonoma County. 

The initial Families First visit occurs soon after birth, the second visit between three and six months, and the third between six months and a year. Families First customizes each visit to the needs and interests of the individual family by offering a full menu of conversation topics. These may include baby’s growth and development, feeding and sleeping, maintaining health insurance and well-baby care, breastfeeding support, parenting classes, safety tips and car seats, secondhand smoke, preventing baby-bottle tooth decay, childcare options, and adjustments to becoming a parent. 

At the first visit, parents receive a Kit for New Parents, which includes educational materials, gifts for the baby, and a DVD with expert guidance for parenting. (These free kits are also available for physicians or clinics to give directly to patients; see below for details.) One mother, originally from another country, appreciated that her Families First visitor used the kit to suggest methods of disciplining other than hitting. The mother was glad to learn that her children could grow up without being afraid of their parents, as she had been. 

The Families First visitor also brings gifts to reinforce baby’s development and to deliver health and safety messages. Gifts include baby books that parents can read to their infant, electrical outlet covers, hand puppets to encourage play and conversation, and a “Keep me tobacco free” T-shirt.

Access to health care is an important focus of the Families First visits. If necessary, the visitor provides parents with health insurance assistance and makes sure they have a physician to call if their baby gets sick. The visitor also makes sure the child is receiving well-baby care and explains why that is so important. One mother was unable to take her baby in for immunizations because she was waiting for the insurance that would begin when her husband started his new job. The visitor helped the mother obtain additional coverage, and the baby received the immunizations. 

Families First visitors often notice medical problems, such as unusual rashes, thrush, or feeding and digestive problems. However, because home visits are not medical visits, the visitor always directs parents to contact their baby’s physician for medical issues. 

At the third appointment, the Families First visitor helps parents fill out the Ages and Stages 
Questionnaire. This screening tool encourages parents to observe and understand milestones that are typical for their baby’s age. In some cases, the questionnaire may signal a need for further screening or assessment. 

Fathers are strongly encouraged to participate in the home visits. As Dr. Toub recalls, “Even though I trained in family medicine, have delivered over a hundred babies, and have experience in taking care of newborns, I did not have a credential to be a father. As a nervous ‘first-time dad,’ I found the visit from my Families First home visitor reassuring. I received valuable information and support that I would not have gotten otherwise.” 

Even when one parent has other children, the family may still be eligible for visits as long as the first-time mom or dad is present at the visit. One father was overwhelmed when he found himself the primary caregiver after his wife unexpectedly left home for an extended period of time. Imagine his surprise and delight to receive home visits from a Families First nurse offering support in his new role!

Families First Home Visiting is a program of First 5 Sonoma County, a local government commission that promotes, supports, and improves child development from the prenatal stage through age five. The First 5 Commission initiated Families First to promote the health and well-being of babies and families in Sonoma County.

Earlier this year, an independent consulting group, LaFrance Associates of San Francisco, evaluated the initial four years of results from Families First. Among other topics, they measured the impact of home visits on parents’ skills, knowledge, and confidence in parenting. They also evaluated length of breastfeeding, child safety in the home, and knowledge of health and social services for children and families among the parents served.

Some of the key findings were:

• Eighty percent of parents reported learning something new from their home visitor about how babies develop, and 98% learned “some” or “a lot” about what they can do to help their child learn and develop.
  
  
• Parents reported making changes in the way they take care of their child, using practices they learned from Families First, such as tummy time, feeding and dental care techniques, responding to the child with less stress and greater confidence, and being more able to respond to their child’s needs. 
  
  
• Mothers in the program said they benefited from support with breastfeeding and from learning where to get additional support. Eighty-six percent of new mothers reported breastfeeding at the first visit, 66% at the second, and 51% at the third, exceeding the national Healthy People 2010 objectives for breastfeeding.
  
  
• Eighty-six percent of parents reported learning how to access local services, including parenting classes, parent support groups, breastfeeding resources, car seat assistance, help to access medical insurance and medical care, and referral to WIC for nutritional assistance.
  
  
• Almost all parents reported learning how to make their homes safer for their child. They covered electrical outlets, installed safety locks and baby gates, and kept babies away from tobacco smoke.

Many parents said that Families First provided them with support and information they had not found anywhere else. They were particularly appreciative of parent-child activities that help stimulate healthy development, tips on handling colicky babies, and information about developmental milestones and what to expect at baby’s different stages. In the words of one mother, “I learned so much. Being a new parent is scary and having this support was so helpful for me and my husband too.”

All first-time parents of newborns in Sonoma County can receive three free Families First visits, but many are not aware of the program. Most referrals come directly from hospitals, with permission from the parents. 

Referrals are accepted by phone, fax, and website, from all sources, including health providers, community agencies, and self-referrals. Physicians can play an important role by encouraging their patients to participate in the program. As one mother noted, “I didn’t know about the program. Neither my obstetrician nor pediatrician ever mentioned it. I happened to see the brochure in the packet from the hospital, so I called. If I hadn’t pursued it myself, I never would have received the visits. If there was just a way that doctors could mention it.”

Here’s how:

• To receive FREE Families First brochures, referral forms, or additional information, call 565-4507 or visit www.sonoma-county.org/familiesfirst. 
  
  
• To receive FREE First 5 Parent Kits for your patients, contact First 5 Sonoma County at 565-6680.

The Sonoma County Department of Health Services is the lead agency for Families First. Additional partners include Alliance Medical Center, California Parenting Institute, Early Learning Institute, Public Health Nursing, Sonoma Valley Health Care District Home Care, Southwest Community Health Center, St. Joseph Home Care Network, Teen Parent Connections, West County Community Services, and the Women’s Health and Birth Center.