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A Healthy Start Begins at Home

A home-visitation program that gives teen moms advice on new-baby care and education goals has had success and will get an $18.7-million boost

May 15, 2000|SHARI ROAN | TIMES HEALTH WRITER

At 20 months, Eddy Duarte is a whirlwind of energy and opposition.

His mother, 18-year-old Jessica Duarte, tries to busy him with crayons and paper during a recent afternoon in the cramped apartment Duarte shares with her child and mother on West 93rd Street. Eddy scribbles for a few seconds, then tosses the paper and crayons aside. Duarte sighs.

So when Monica Nunez walks through the door, cheerful and carrying a bulging briefcase, Duarte appears grateful and a little relieved. Nunez, a public health nurse employed by the county, has been Duarte's friend and supporter since the unmarried teenager walked into the maternal health clinic at California Medical Center in 1998, five months pregnant, poor, alone and afraid.

On that day, Duarte was paired with Nunez in a small home-visitation program designed to help first-time pregnant teens have healthy babies and develop skills to keep their families thriving. Today, Eddy is healthy and happy in a calm and loving home while Duarte closes in on her goal of graduating from high school and getting a job.

The success of Duarte and other teens in the home-visitation pilot program, called the Esperanza Project, recently helped convince Los Angeles County to spend $18.7 million to expand the project. Over the next year, 1,000 pregnant teens will be enrolled countywide--up from 100 in the 1998 project. The expansion is being financed, in part, from funds that the county has accrued since welfare rolls began to decline.

"We know this program works," says Dr. Jonathan E. Fielding, director of public health and health officer for the county, who has championed the expansion. "A young mother has to have hope and see herself as a productive person who can provide for herself and her child."

Home-visitation programs in which a nurse or trained professional has regular contact with a young mother have been touted by health experts for almost two decades as a tool to improve infant health and give babies in disadvantaged homes a healthy start in life.

However, the specific program adopted by Los Angeles County has distinguished itself as the most effective among home-visitation models, some of which have not produced evidence of lasting benefits, according to several studies published over the past decade. The program, called Prenatal and Infancy Nurse Home Visitation, was developed by University of Colorado pediatrics professor David L. Olds, and was first tested in Elmira, N.Y., and Memphis, Tenn.

Based on 15 years of studies on a group of 400 white teenage girls in Elmira, Olds' program was found to improve infant health, reduce child abuse and lessen the mothers' dependence on welfare.

And, last month, Olds published a study in the Journal of the American Medical Assn. attesting to similar effectiveness when the program was offered to black urban teenagers.

'She Was There When

I Needed Someone'

The experts' opinions, however, are of little interest to Jessica Duarte. She knows only that Monica Nunez is a godsend.

"It was only me and my mom at first, and we were alone," says Duarte, handing a picture book to Eddy. "My mom had just found out I was pregnant and I was scared about whether she would help me out. Monica helped me a lot. She was there when I needed someone to talk to. She understood me."

Nunez provided such practical support as bringing the young mother some baby clothes and a thermometer to check Eddy's temperature when he was sick, Duarte says. And, during the baby's infancy, Nunez taught her techniques for dealing with Eddy's severe colic, which resulted in hours of fussing.

"Sometimes, he throws himself on the ground crying, and it ticks me off," says Duarte. "I ask Monica what I should do, and she tells me some things I can try."

According to the program's protocol, the nurse visits weekly for six weeks after the birth, biweekly through the baby's 21st month and then monthly until the program concludes when the child is 2.

During pregnancy, the nurse encourages the teen to keep her prenatal visits, adopt a healthy diet, and stop smoking, if necessary, according to Olds' protocol. After the birth, the visits concentrate on encouraging breast-feeding and teaching practical infant care techniques, such as diapering, bathing and swaddling the baby. A schedule is kept to ensure that all routine pediatrician visits are maintained.

The nurse and teen mom also complete program questionnaires designed to ensure a safe home for the baby (such as covering electrical outlets with safety plugs), and that effective and appropriate techniques are used for disciplining a toddler. Considerable time is also spent discussing the mother's goals for herself.

"What made it easy with Jessica is that she was receptive," says Nunez. "She was eager to learn."

That is not always the case, say Nunez and other public health nurses working in the Esperanza Project.

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