First Born home visiting program is strengthening maternal and child health care among Native Americans

Program expanded to Navajo Nation to support stronger maternal and child health care among Native Americans

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RoShanna Francisco | W.K. Kellogg Foundation
First Born’s Toby Lee goes over a list of what to expect during the first six months of development at a home visit with new mother RoShanna Francisco. RoShanna moved back home when she found out she was pregnant.
Calleigh Mae
First Born’s Toby Lee holds a toy to assess Calleigh Mae’s development during a visit with new mother RoShanna Francisco. The First Born curriculum guides first time parents in child rearing best practices.
RoShanna Francisco | W.K. Kellogg Foundation
New mother RoShanna Francisco holds her 3-month-old child Calleigh Mae in her home. RoShanna said First Born has taught her to identify cues with her child.
Toby Lee | w.K. Kellogg Foundation
First Born’s Toby Lee makes notes in her car following a home visit with new mother RoShanna Francisco in Standing Rock, New Mexico. Lee visits with 18 families a week.
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RoShanna Francisco | W.K. Kellogg Foundation
Calleigh Mae
RoShanna Francisco | W.K. Kellogg Foundation
Toby Lee | w.K. Kellogg Foundation

As a family therapist in Michigan, Vicki Johnson regularly met families struggling to address problems with their young children—­­ from not adjusting to preschool to conflict between siblings and behavioral concerns.

It soon became clear to Johnson that many of the common problems these families faced could have been prevented with earlier support and education.

During graduate school, Johnson focused her thesis on home visiting, a model where trained health professionals provide one-on-one coaching to help new and expectant parents learn skills to help their children grow up healthier.  The curriculum she proposed, called First Born, would support any first-time mother through weekly home visits, starting at pregnancy and through the first three years after birth. If the family had more children, they could apply what they learned in the program to those children, Johnson reasoned.

Toby Lee | W.K. Kellogg Foundation

“Why should we wait until families get in trouble before we provide service? We need to invest our dollars and our resources at the beginning, at conception, with a woman’s first pregnancy,” Johnson said. “The best return on investment is through prevention.”

After moving to New Mexico in 1996, Johnson used the First Born model to launch a pilot project with 12 teenagers raising newborns. The results were encouraging. Girls who went through First Born took their babies for regular check-ups and were aware of their child’s developmental stages, among other positive outcomes. On the heels of the pilot’s success, First Born expanded to surrounding Grant County.

First Born eventually drew the interest of the Los Alamos National Laboratory (LANL) Foundation, a New Mexico-based foundation committed to promoting early childhood education. In 2008, the LANL Foundation expanded the program sites to three additional counties in New Mexico.

Given the size and needs of New Mexico’s tribal communities, LANL explored extending First Born into the Navajo Nation to support stronger maternal health care there. Nearly half of all Native American women in New Mexico were reportedly receiving late or no prenatal care as of 2010, according to the Annie E. Casey Foundation KIDS COUNT report.

However, extending the program had its challenges. Tribal and community leaders were hesitant to accept the program because of past experiences with other grant–funded programs that were not sustainable.

“The Navajo Nation has a rich culture and some are wary of accepting money from outsiders who believe they know what’s best for them,” said Anna Marie Garcia, early childhood director at the LANL Foundation.  “When we first started meeting, we were told that many people on the Navajo Nation were tired of having people coming in, telling them what to do and how to do it, and then leaving.”

After meetings with local leaders over the course of a year, communities supported the program and North West New Mexico (NWNM) First Born launched in San Juan and McKinley counties on the Navajo Nation in 2012.

North West New Mexico | W.K. Kellogg Foundation

Supported by the W.K. Kellogg Foundation and other funders, North West First Born continues to grow. The program, which recently acquired 501c3 status, serves about 150 families in an area slightly larger than the size of New Jersey. It may reach more in the future with recent support from the The Navajo Nation’s Growing in Beauty program and New Mexico Children Youth and Families Department, totaling $1.3 million over a two to three-year period.

In home visits, First Born staff coach families on topics such as infant and toddler growth, what to expect during labor and how to develop positive relationships with their child.

For new mom RoShanna Francisco, a 25-year-old living in Standing Rock, a rural area in McKinley County about 150 miles from Albuquerque, her weekly visits with home visitor Toby Lee help her stay calm. Still, she says, raising a baby has taught her to expect the unexpected— like managing a cesarean section when she had planned for a natural birth.

“I had never cared for an infant before. I had never babysat anyone’s kid. Everything with the baby is new… and every day is a learning experience,” said Francisco. “First Born has taught me what cues to look out for and what to do and not to do. It has helped me through everything.”

While all First Born sites address similar issues among first time parents, the North West New Mexico sites have some unique challenges.

Many parts of these counties, like where Francisco lives, are rural and remote, which can mean home visitors must travel as long as an hour or more one way to reach some families. And while First Born serves all families regardless of circumstances and background, North West chapter participants are more likely to be low-income. The organization plans to open two new offices in rural locations that may address the distance challenges.

The impact of First Born is evident, according to the data. In all 12 licensed First Born locations, programs are evaluated against 32 sets of criteria and the sites were found to have lower rates of emergency room visits, domestic violence and child abuse, and nearly 100 percent rates of immunizations and check-ups, according to last year’s annual report.

Furthermore, new research conducted by the RAND Corporation documenting the program’s impact will determine whether First Born is the first home visiting program in New Mexico to achieve evidence-based status. Being designated as such may help First Born get additional funding in the future.

The full impact of First Born cannot be completely quantified though, according to North West First Born staff, who feel the program ultimately is about giving parents confidence and a foundation in parenting that leads to lifelong success for their children.

“The larger purpose of our program is to build resiliency in families,” said Su Hodgman, executive director of North West New Mexico First Born. “When families are tightly bonded and children know that they belong and are cared for, then we can build stronger families and stronger communities.”

Grant Details

Los Alamos National Laboratory Foundation

Espanola, New Mexico, United States

Improve the health and well-being of young children by strengthening capacity of home visitation programs through developing a community of practice and increasing collaboration

Thriving Children
June 1, 2015 - May 31, 2016

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“Empleen el dinero del modo en que crean conveniente, siempre y cuando promueva la salud, la felicidad y el bienestar de los niños.” - Will Keith Kellogg

“Sèvi ak lajan an jan w vle depi se sante timoun, byennèt timoun ak kè kontan pou timoun w ap ankouraje.” - W.K. Kelòg