The state health department is starting a broad initiative with targeted home visits for high-risk families to reduce the number of child deaths, as well as abuse and neglect in Montana.
The program is called the First Years Initiative and comes out of the review and analysis of child deaths reported to the Department of Justice’s Child and Family Ombudsman. Ten of the 14 deaths over a 16-month period were children under the age of 1. All had come into contact with the state’s Child and Family Services child protection division.
“That is just not acceptable, so how do we help fix that?” Department of Public Health and Human Services Director Sheila Hogan said Thursday. “That’s what this is about.”
As a first step, the health department is starting a pilot project in five regions of the state where a home visitor will work exclusively with high-risk children and their parents. They will focus on families who have come into contact with Child and Family Services and equip parents to better care for their children.
The home visit collaboration will involve the Child and Family Services division, as well as the Family and Community Health Bureau, which is a part of the state health department's Public Health and Safety Division.
Through a federal grant, the state health department has funding for five new full-time equivalent positions for the home visitors.
Communities around the state already have home visiting services for children and families that need the assistance, whether they are involved in the child protection system or not. These services are typically contracted through organizations.
The new positions will work exclusively with high-risk children and families in the child protection system. The new positions will carry a caseload of about 25 child/family groups, meaning statewide about 125 child/family groups will be in the pilot program.
Home visiting pairs families with trained nurses, social workers, child development specialists or trained para-professionals with various degrees.
Home visitors can help pregnant women get prenatal care, teach home safety, promote child-parent bonding, coach parents on activities that foster a child’s development and do screenings to identify health and developmental issues, among other services.
“It’s about the child, but it’s also about the parent,” Hogan said. “We would help the parent get the skills they need to parent kids so they become self-reliant, healthy.”
Home visitors are also mandated reporters of child abuse and neglect.
Hogan said the dedicated home visit workers will be another resource for Child and Family Services child protection specialists, who have in recent years told legislators that they deal with high caseloads that make their already difficult jobs even harder.
The Child and Family Services division of the health department has been under intense scrutiny from the public and lawmakers in recent years over the number of child deaths and children removed from their homes.
Since 2015, the state has been required to report child deaths to the Child and Family Ombudsman, who works in the Department of Justice.
The first report, released a year ago, found 14 child deaths between July 1, 2015 and Nov. 8, 2016. A little over four months ago, a representative of the Child and Family Services division told an interim legislative committee eight children who had been involved in child protection services died in 2017. None of the children was in out-of-home care at the time.
The 2017 ombudsman's report has not been released.
Hogan said the new initiative will be a “first line of defense” to help the most at-risk children.
“If there are safety issues, (the dedicated home visitors) would work to help that family,” Hogan said.
Home visits have a track record of success, Hogan said. A study commissioned by Congress in 2016 found that home visits had the most promise in preventing child fatalities.
Montana will use four models for home visits.
The first model works with families from pregnancy through when a child enters kindergarten and teaches parents how to help their children develop.
The second model partners nurses with pregnant women who are assessed as high risk and sticks with the family until the child is 2.
The third model is for parents of children from birth to age 5. It provides 18 visits that teach parents about child-parent interaction, home safety and child health.
The final program is specific to Native American communities and works with newborns to children age 3. It focuses on helping parents work with their children to develop physical, cognitive, social, emotional and language skills over 63 individualized lessons.
Over time, Hogan's goal is to focus the department's existing resources and local programs on working with families from pre-birth through a child’s first years to prevent abuse and neglect.
Hogan said the approach is essential in a time of budget cuts when resources are limited.
Part of Hogan’s goal is to also bring in outside services, such as Healthy Mothers Healthy Babies, to work with families during pregnancy and after to help prevent abuse and neglect.
“The department has great resources, and we need to bring in our partners,” Hogan said.