Nurturing children by nurturing their families

New Haven — When Imari Troche’s son Nathan was born three years ago, she knew how to change his diaper and feed him. But much beyond that was a struggle.

Shortly after Nathan’s birth, Marta Santana began visiting Troche and Nathan in their home nearly every week. Those visits have changed everything in the young mother’s life.

“She taught me a lot about how [kids] grow, how to take care of the kids and understand them,” Troche said recently as she sat on the couch of her second-floor apartment. She lives there with her mom, Nathan and several of her siblings.

As Santana puts it, when Nathan was born: “Yeah, she knew how to change a diaper. But she didn’t know why kids do what they do.” Now, the soft-voiced Troche viewed her son with a kind of fascination as she watched Santana play word games with him.

“I think sometimes they come out smart already,” she said, grinning. “They’re born baby geniuses.”

Santana works for the Nurturing Families Network, which is run by the Children’s Trust Fund, a division of the state Department of Social Services.

Every week, Nurturing Families Network sends hundreds of employees like Santana to the homes of parents who are considered to be at risk of having poor parenting skills. Sixty-two percent of the mothers visited were abused themselves as children, and about half, like Troche, are teenagers.

Data collected by the Children’s Trust Fund suggests the weekly visits help reduce this risk.

After just one year of participating, more mothers are employed and living on their own. According to surveys, the moms say they feel less socially isolated and are less likely to have what are labeled as “rigid parenting attitudes.” And the rate of child abuse and neglect among families helped by the Nurturing Families Network is about 2 percent, while a rate of about 20 percent has been documented in at-risk populations that don’t get home visits.

Multiple goals

Santana was just a few minutes away from Troche’s house when her cell phone rang. She didn’t need to answer.

“That must be my Imari calling,” she said, laughing. “It’s been three years, and she hasn’t changed.”

The mom wasn’t the only one anticipating the visit. As soon as Santana opened the front door, Nathan bounded down the stairs in his new white sneakers, yelling “Marta!” and offering to help her carry her box of toys to the second floor.

Santana was there that week to focus on Nathan’s “gross motor skills,” -– or how he uses his “big muscles,” as she put it for Troche. The three did jumping and balancing exercises together, and they played word games. But Santana had another goal for that week’s visit: Talk to Troche about getting back to school.

While Nathan went into another room to play video games with his uncle, the two discussed Troche’s long-term plans: Once he was in school, she’d enroll in adult education and get her GED. She was starting to look for an apartment so she could live in her own place. And she had finally managed to get Nathan’s father -– who was intermittently involved in his son’s life –- to pay monthly child support. Santana had a hand in all of this, talking it through with Troche during their weekly visits or over the phone.

“When I have problems with my son’s father, if I need help with an apartment, I can call her. She’ll talk to me about how to deal with the situation. She helps me with a lot,” Troche said.

These conversations are invaluable for Santana in evaluating how Troche is doing -– and none of them could conceivably happen in a busy doctor’s office.

These sentiments are echoed by Michelle Afanador, another home visitor in New Haven. Like Santana, Afanador visits 15-17 families every 1-2 weeks, and most of the moms she sees are teens. She used to be a medical assistant, but she finds this job more fulfilling. You can find out a lot more about someone in their home, she said, than at a doctor’s office.

“Some people might not tell you they don’t have food. Because they feel ashamed. But if you’re in their home and the kid’s asking for milk and she’s like ‘I don’t have nothing,’ you know she doesn’t have milk.”

Expanding to include fathers

Since the Nurturing Families Network began in 1995, home visitors have focused on helping the moms -– especially since only about a third of them live with the fathers of their children.

Dads are often “a little resistant to open up, to talking, and just sharing with another person outside of the family,” said Evelyn Flamm, who directs the network’s Fair Haven Community Health Center site in New Haven.

But Flamm is hoping this changes when the New Haven site soon hires a male home visitor specifically targeted towards dads. Many of the other 40-some Nurturing Families Network sites across the state have hired male home visitors in the past year.

This expansion of the network comes amid a growing national interest in home visiting programs. The federal health care law created an initiative around such programs specifically for maternal and child health services, dedicating more than $1 billion to the effort through 2014. The idea is to eliminate barriers to reaching at-risk populations –- and to deliver care more effectively.

“Once you walk into someone’s home you are in their lives in a way that’s very different than if they come to see you in the office,” said Karen Foley-Schain, who is executive director of the Connecticut Children’s Trust Fund. “You’ve got people coming in and out, you’ve got family, you’re working with Grandma, you’re involved in a very different way. It’s very effective.”

Ideally, the state would reach every family who might need a home visitor to help with parenting, Foley-Schain said. For now, they’ll settle for 42 sites serving 2,000 families a year with a budget of $10 million, and some opportunities to expand under the federal health care law. And while other programs run by the Children’s Trust Fund have suffered funding cuts in recent years, the Nurturing Families Network has remained intact partly because the families it serves, and its employees, have aggressively advocated for the program.

Troche has traveled to Hartford in recent years to testify in support of maintaining funding, because she knows what a difference it’s made in her and Nathan’s lives, and the lives of her extended family. When Santana first arrived at the house after Nathan was born, the atmosphere was chaotic and tense.

Santana quickly insisted on regular “family conferences” where the whole household got together with a therapist. Things have changed a lot since then.

“I see the difference in Nathan,” Santana said. “Nathan is using polite words when he speaks. Socially, he gets along with everyone … he’s doing wonderfully.”

Troche and her mom used to constantly be at odds; now they laugh about the tantrums Nathan used to have and how Santana helped his mom and grandmother to understand them.

“If he takes something he don’t need, replace it,” Troche recalled: That’s one thing Santana taught her about how to deal with Nathan. “I thought you just take it. But you replace it so he don’t have to throw a fit. And that worked pretty good.”