Two years ago, a new family—a young mother and her six kids—arrived at the Primo Center for Women and Children, a homeless shelter on the west side of Chicago. Mom had only a sixth grade education and the youngest child, a two-year-old girl, was hardly speaking.
“She was really limited in her ability to parent,” Christine Achre, the CEO at the Primo Center, told The Daily Beast.
Because her youngest was only two, the mother was eligible for a new program within the Primo Center: regular meetings with a home visitor, a type of parent coach who would help her build stronger parenting skills.
The program made a huge difference, Achre said. “Over these two years, we’ve really seen her blossom.” The two-year-old, now four, is smart and talkative—the staff at the Primo Center say that she’s going to be a lawyer.
She’s not the only one benefitting from home visits. Each year, tens of thousands of at-risk new mothers and children benefit from home visiting programs, which send trained professionals to meet with families where they live. These can be as frequent as weekly home visits; the visits can last as long as three years.
Home visiting can take different forms, but the overall goal is the same: to improve maternal and child health, strengthen family relationships, and help ensure kids meet developmental milestones.
But homeless families are often not enrolled in these programs, even though they might be eligible. Logistical barriers often stand in the way, such as the fact that the services are meant to be provided in a home.
But in Chicago, a nonprofit called the Ounce of Prevention Fund, which runs early education programing for poor families, is trying to address those problems. Through their Home Visiting for Homeless Families Demonstration Project, the Ounce is partnering with home visiting providers and shelters like the Primo Center to expand home visiting to reach homeless families.
“The goal is the same, and the services are the same, but we’re tracking and documenting what it takes to provide them to homeless families,” Shawanda Jennings, a program specialist at the Ounce of Prevention Fund, told The Daily Beast.
Families with children make up around 35 percent of the homeless population in the United States, and children in those families are particularly vulnerable to health problems: They miss vaccinations, they’re more likely to be exposed to lead, they underachieve academically, they have developmental delays.
They also often don’t have access to early intervention services.
“Home visiting would seem like almost an ideal intervention for them,” Carie Bires, policy manager at the Ounce of Prevention Fund, told The Daily Beast. A combination of federal, state and non-profit dollars fund the evidence-based programs, which exist in every state in the country. Studies show that they help improve health outcomes, reduce maltreatment of children, promote positive parenting, and help with school readiness, among other outcomes.
In the fall of 2013, the Ounce started recruiting home visiting providers and homeless shelters to engage homeless families with these services. The home visiting providers would dedicate some of their staffers to working with those families, and the shelters would start to provide that programming in-house.
Home visiting is typically done by jurisdiction, and different providers are responsible for different swaths of cities. When families don’t have stable housing, and are moving through shelters, or couchsurfing, they often move in and out of the individual regions. “They’d have to change home visitors, and they would need to be building and rebuilding those relationships all the time,” Bires said.
To navigate around that problem, the Ounce worked with their partner providers to bend the typical rules. “The programs were allowed to follow families all over the city,” Bires said. They also reduced the caseload for the visitors, giving them more time to track down and commute to their families.
That element is key, said Melanie Garrett, chief program officer at New Moms, a home visiting provider participating in the demonstration project.
“The needs of both case management and coaching were going to be higher, especially with travel time,” she told The Daily Beast. “We have this relentless outreach approach, and the visitors would get really creative — using texts, email, Facebook to find their families. Sometimes, they would lose contact, but then could find them and re-engage because of the flexibility.”
The definition of home also had to change. “Home is wherever families say home is,” Garrett said. “That might be the public library, that might be a car.”
Home visitors also aren’t constrained by their usual targets, Bires said. “They don’t need to meet a particular set of outcomes. We told them, if you don’t meet your benchmark on the number of completed visits, that’s ok. The only outcome is that you stayed connected.”
Since 2013, the demonstration project has provided services to about 160 families, Jennings said. Because of funding problems, the project did not run consistently through the past five years, so the Ounce is only now reaching the volume of data that they need to conduct an analysis and report on the outcomes of the project compared with typical home visiting benchmarks.
But anecdotally, Bires said, families say that they’re benefiting from home visiting.
“We’ve learned that using these services for homeless families absolutely can be done, it just takes intention and support,” Bires said. “It’s asking people to move away from business as usual.”
At the Primo Center, staffers have offered services to any eligible family, defined as one with a child under the age of three. Nearly all eligible families have enrolled in the program since it started in Chicago, Achre said.
For moms struggling with homelessness, home visiting is a great way to help shift focus towards children, LaTanya Gray, senior director of early childhood at the Primo Center, told The Daily Beast.
“When you have so many other stressors, and your basic needs aren’t being met, it can be difficult to think, ‘Is my child’s language on target? Are their fine motor skills where they need to be? Is there concern about their growth?’” Gray said. “It’s not on their radar, because they’re contending with food, or places to sleep, or domestic violence.”
They key, Gray said, is showing families that it’s not an all-or-nothing issue, and small, teachable moments can go a long way. “We want to show that it doesn’t take a lot of money or toys to create these learning opportunities with children,” she said.
The lessons learned through the Ounce of Prevention Fund’s demonstration project in Chicago could help home visiting providers across the country, many of whom have indicated an interest in working with homeless families.
There’s also attention from the federal level. In 2015, the Division of Home Visiting and Early Childhood Systems sent a letter to programs nationwide that received funding from the Maternal, Infant, Early Childhood Home Visiting Program encouraging them to identify ways to serve these families.
The federal Health Resources and Services Administration started collecting data on the number of homeless families served by the Maternal, Infant, and Early Childhood Home Visiting Program in 2017. That year, about 3 percent of the adult participants in the program were homeless, said Cindy Phillips, the acting director of the Division of Home Visiting and Early Childhood Systems.
In Florida, for example, though home visiting programs are not formally targeting the homeless, they often work with families deal with housing insecurity. “When you’re dealing with high-need families, homelessness and housing instability are part of the package,” Carol Brady, project director of the Florida Maternal, Infant and Early Childhood Home Visiting Initiative, told The Daily Beast.
Home visitors might work with homeless families incidentally, and end up struggling to overcome problems like the once identified by the Ounce’s project.
“If the family moves within a distance that they can continue to provide services, they do, but the home visitor can be constrained by distance,” Brady said. It’s difficult for home visitors to build a strong relationship with a family if they’re moving around a lot, she said. “A big part of the evidence for home visiting to work well has to do with the intensity and duration of the relationship, and with housing instability that can be a challenge.”
In 2015, New York City started offering three total home visits to mothers with newborns in select shelters. The service is an extension of the city’s Newborn Home Visiting Program, which provides two visits to mothers in Central Brooklyn, South Bronx, and East and Central Harlem. The shelter-based program is largely the same, but adds on a maternal depression screening, Ericka Moore, Director of the Maternal and Child Health Unit in the New York City Health Department, told The Daily Beast.
“We’ve engaged over 3,000 families,” she said. “We have been able to provide maternal and infant health education and support, as well as connect families to resources.”
The ages between birth and five years are crucial for healthy childhood development, Achre said, and that’s one reason she thinks home visiting is a key investment area for homeless families — it can helps mitigate some of the negative effects of homelessness, and set kids up for a healthier future.
And the programs are important for moms, as well, Garrett says. “Homelessness is stressful, and these moms already feel like they’re not doing enough,” she said. “Despite their circumstances, they’re really motivated to be good moms. Having a coach to say, you’re doing a good job — that matters.”
Additional support for this article was provided by RiseLocal, a project of the New America National Network.