Home Visiting


The Idea

Include military families as a targeted population in state-sponsored home-visiting programs, which provide pregnant and new parents with important information, support, and connections to community-based services.

The Issue

A full 42 percent of the 1.9 million children of military families are under the age of 5. The cycle of frequent moves, deployments, and reintegration puts stress on these young families, who are often isolated from traditional family supports.

Emerging data shows that parental stress in military families is associated with child maltreatment. Research shows that child abuse and neglect rates in military families are increasing — especially when families are preparing for deployment or adjusting to a service member’s return. In addition, military children are vulnerable to abuse or neglect during deployment, especially when the stay-at-home parent is a young civilian. Finally, the Pentagon reports that the number of soldiers found to have committed spousal abuse or child maltreatment has been increasing significantly in recent years.

At one time, the Pentagon funded Heroes at Home, a program developed by the national organization Parents as Teachers specifically for military families. The program, which served more than 1,000 families and 1,500 children across 36 U.S. military installations, was designed to help families with everyday challenges of the military lifestyle and used home-visiting models to bring professional parenting support and child development information to military homes. The program was discontinued because of funding problems.

The Pentagon continues to offer a program called the New Parent Support Program to help active duty, on-base families with young children deal with challenges common to new parents and to military parents specifically. As of May 2012, the program had reached over 4,100 families with intensive home visitation – as well as many other on-base families through parenting classes, playgroups, written information, and other means. Families may self refer, or can be referred by unit commanders, doctors, and youth program directors; information about the program is distributed on bases and through new and traditional media. But the program does not reach the approximate 75 percent of military families who live off-base.

A provision of the Patient Protection and Affordable Care Act of 2010 provides an alternative source of support for Reserve, Guard, and active duty families. The law established a $1.5 billion, five-year federal grant program to fund voluntary, evidence-based home visiting programs for “at-risk” families.

The law specifically includes families who have — or have had — a parent serving in the Armed Forces. Mary “Tib” Campise, a licensed social worker in the Office of the Undersecretary of Defense military Community and Family Policy’s Family Advocacy Program, says the Department of Defense “welcomes the partnership with states” to fill in the gaps and reach families the military cannot.  Campise helps coordinate services and cross-refer clients between New Parent Support and states’ home visiting programs; she also hosts conference calls and information sessions to “facilitate and massage connections” and encourage states to use their home-visiting money to help military families.

According to research by the Pew Center on the States and the RAND Corporation, home-visiting and early intervention programs have been proven to: decrease the low-birthweight births by nearly half, which saves between $28,000 and $40,000 per child in medical and other expenses; cut child abuse and neglect cases by nearly half; and improve children’s school achievement. In total, home visiting can save between $1,400 per child to nearly $240,000 per child over the course of the child’s lifetime.

What States are Doing

All 50 states, the District of Columbia, and other six jurisdictions received federal grants for the Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program through the Health Resources and Services Administration (HRSA), a part of Health and Human Services (HHS). States were asked to identify which regions they plan to target and which at-risk populations they plan to serve. States may choose from among eight approved home-visiting models or blend several choices to suit their target populations.  

As of mid-2011, seven states had chosen to include military families in their plans: Florida, Georgia, Kentucky, North Carolina, Ohio, South Carolina, and Tennessee.

Georgia

Georgia officials were well aware of the effects that repeated deployments have had on military families, including increases in rates of post traumatic stress disorder, substance abuse, and domestic violence cases.

Georgia’s process of initiating military-focused home visiting was a lengthy one: of 159 counties in the state, officials narrowed their search to 72 communities with identifiable at-risk populations. Next, they narrowed the list to 25 by evaluating the communities’ capacity to implement home-visiting programs. One of six counties finally selected was Muscogee County, home to Fort Benning. Two factors governed the state’s decision. First, Muscogee County has high infant mortality rates and low birthweights. Second, local organizations have established good working relationships with military families who live off base in the community.

Georgia has elected to use three home-visiting programs: Parents as Teachers, Healthy Families America, and the Nurse-Family Partnership.  Because Georgia already provides universal hospital-based parent support through its First Steps program, the HRSA grant will help expand parent support to homes and communities.

Carol Wilson, project manager, says that going forward, state officials hope to enroll families who live on the base at Fort Benning. But that task, she said, will take longer because “the military community has a traditional of taking care of itself — we have not conquered that yet.”

Contact

  • Carol Wilson, project manager
    Governor’s Office of Children and Families
    404-921-0338
    [email protected]

Tennessee

Tennessee’s story is similar. Although the largest military base in the state — Fort Campbell — is actually in Kentucky, most Fort Campbell families live in Tennessee. And Fort Campbell, home of the 101st Airborne Division, has experienced unprecedented baby booms linked to the unit’s returns from overseas duty, including one month in which 800 births were recorded.

Cathy Taylor, assistant commissioner for the Tennessee Department of Health, noted that while state officials had looked for ways to expand services for young families, the state historically lacked resources. The HRSA grant, however, presented an opportunity.

But there was still another obstacle: cracking the shell of a traditionally self-reliant military base. Taylor explained that a real turning point occurred when she coincidentally befriended some military personnel who helped her advocate on behalf of home visiting in the Fort Campbell area. With some resistance broken down, Taylor and her colleagues invited Fort Campbell officials to the table and emphasized cooperation and support over competition.

In 2011, Tennessee planned to enroll its first 25 families. And while the military continues to provide services for high-risk families through its New Parent Support Program, the HRSA grant will allow the state to reach out to lower-risk families. The state will use the Healthy Families America model for military families — a model that Fort Campbell officials approved.

Tennessee is also seeking federal funds to help military families without straining state budgets. In 2011, for example, state officials were looking into a Centers for Disease Control and Prevention (CDC) “community transformation grant.” This grant would affect military families by raising standards for child care off-base care to the already high standards of Department of Defense childcare.

Additionally, the U.S. Department of Agriculture (USDA) released funds through its Women, Infants, and Children (WIC) program. WIC provides grants to states for “supplemental food, health care referral, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk,” according to USDA. This money will help Tennessee improve its screening and referral capacity.

By combining HRSA, CDC, and USDA funds, Tennessee can continue to expand its outreach to military families in need. “These are just a couple of projects whose time has come,” said Taylor.

Contact

  • Cathy Taylor, DrPH, MSN, RN
    Assistant Commissioner, Tennessee Department of Health, Bureau of Health Services
    615-741-2970
    [email protected]
  • Dr. Michael D. Warren, program director
    Tennessee Home Visiting
    615-741-0305
    [email protected]

Federal Contacts


  • Jessie Buerlein, MSW
    Division of Child, Adolescent, and Family Health
    Maternal and Child Health Bureau
    HRSA
    301-443-8931
    [email protected]
  • Marilyn Stephenson
    HRSA
    [email protected]
  • Mary E. (Tib) Campise, LICSW
    OUSD Military Community and Family Policy
    Family Advocacy Program
    703-602-5001
    [email protected]

Resources