OK. We get it. The budget of the state of New York is out of control and cuts — deep cuts — will have to be made. Not only do we get it, but we agree. What Gov. Andrew Cuomo is proposing is simply responsible good governance.
It is also clear that cuts amounting to billions of dollars cannot be made with delicacy or at the margin. The cuts needed and the changes that follow will be seismic, disruptive and difficult. Think bulldozers, not shovels. Bulldozers are as effective as they are indiscriminate. Everything is at risk to become rubble and dust. This is where our grave concern arises.
Program in peril
Facing the blade of the ’dozers is Healthy Families New York, a $23 million home-visiting program for vulnerable moms and their infants. Support workers go into the home and help these high-risk New Yorkers learn about caring for themselves and their infants. They coach these new families as they inch their way through the system.
Care and attention begins before the babies arrive. The young mothers-to-be are encouraged to take their vitamins, watch their weight, stop smoking and leave alcohol alone — keys to a successful full-term pregnancy. The admonitions and teaching work — low birthweight deliveries in the Healthy Families New York program are reduced by 50 percent, with estimated savings to Medicaid and state-sponsored health insurance plans of $2.4 million in one year.
Many of the moms are single and were lost in the education system. Beyond pregnancy, their educational status and social standing puts them and their children at risk for illness, crime and loss of hope.
Mothers in the program are assisted and then coached to stand up for themselves. The mothers make the calls to the pediatricians and social workers. Immunization, lead screening and appropriate medical care services are increased. Home-visited parents’ depression frequency is reduced, as is their use of alcohol, cigarettes and drugs. Family home-visiting programs work.
Mothers are further encouraged to finish their educations and direct their future focus toward independence and work. One study found an 83 percent increase in employment by mothers who took part in the program. Fifty percent of families receiving Temporary Assistance to Needy Families benefits when they entered the program successfully get off those services as they progress. Discussions about family size and stability are visited and revisited.
Parents are taught to read to these children, increasing the probability their school years will be successful.
The program managers insist on results. Programs must report staffing and process milestones, difficulties and outcomes; the good and bad.
Carefully done research by HFNY demonstrates that the results are positive and consistently achieved.
But don’t take their word for the results. Two highly respected external bodies have reviewed Healthy Families New York and attest to its beneficial results. According to the RAND Corporation’s Promising Practices Network on Children, Families and Communities, HFNY is designated a “Proven Program.”
This means the program has demonstrated effectiveness using extremely rigorous scientific standards. The Pew Foundation reported that home-visiting programs can cut child abuse and neglect by 50 percent. For infants at age 2, one program showed a 35 percent reduction in emergency room use and a 40 percent reduction in injuries. These reductions amount to very real dollar savings and, not inconsequentially, healthier, happier infants.
Make no mistake; this is not a feel-good program. Not only do these programs get the job done but they are the right thing to do.
Many newly pregnant, low-income (often no income) single young women have had lackluster school experiences. They feel isolated, frightened and overwhelmed. Worried about themselves and their babies, sitting in drafty, drab apartments — their outlook is bleak.
Enter their home visitor. For perhaps the first time in their lives the new moms are the center of someone’s attention. The support worker respectfully addresses them, showing concern and empathy. The visiting program confers dignity even as it raises expectations for the clients. Here is the opposite of the “subtle discrimination of low expectations” described by President George W. Bush.
In the Affordable Care Act, there is a $90 million provision to bolster these programs all across the United States. In order to qualify for ambitious matching dollars, states must have a program.
Under the governor’s current proposed budget, no program exists — hence New York would not qualify for these important funds. It is crucial that this program be restored in the budget and expanded with federal help.
Sustaining this program is an investment. It is a hand up, not a handout.
Finally, there is a haunting lose-lose feel to all of this. Failure to restore the program forgoes the plump federal match and deprives the most vulnerable of a program that really does work. If this puzzles you, it puzzles us too.
Failure to restore these dollars for this proven, effective program would be throwing the babies and their mothers out with the bath water. It seems to us the bulldozers stop here.
Raymond Schimmer is chief executive officer of Parsons Child and Family Center.
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