While studying to become a paralegal and working as a temp, Symphonie Dawson kept feeling sick. She found out it was because she was pregnant.
Living with her mom and two siblings near Dallas, Dawson, then 23, worried about what to expect during pregnancy and what giving birth would be like. She also didn't know how she would juggle having a baby with being in school.
At a prenatal visit she learned about a group that offers help for first-time mothers-to-be called the Nurse-Family Partnership. A registered nurse named Ashley Bradley began to visit Dawson at home every week to talk with her about her hopes and fears about pregnancy and parenthood.
Bradley helped Dawson sign up for the Women, Infants and Children Program, which provides nutritional assistance to low-income pregnant women and children. They talked about what to expect every month during pregnancy and watched videos about giving birth. After her son Andrew was born in December 2013, Bradley helped Dawson figure out how to manage her time so she wouldn't fall behind at school.
Dawson graduated with a bachelor's degree in early May. She's looking forward to spending time with Andrew and finding a paralegal job. She and Andrew's father recently became engaged.
Ashley Bradley will keep visiting Dawson until Andrew turns 2.
"Ashley's always been such a great help," Dawson says. "Whenever I have a question like what he should be doing at this age, she has the answers."
Home-visiting programs that help low-income, first-time mothers have been around for decades. Lately, however, they're attracting new fans. They appeal to people of all political stripes because the good ones manage to help families improve their lives and reduce government spending at the same time.
In 2010, the Affordable Care Act created the Maternal, Infant and Early Childhood Home Visiting program and provided $1.5 billion in funding for evidence-based home visits. As a result, there are now 17 home visiting models approved by the Department of Health and Human Services, and Congress reauthorized the program in April with $800 million for the next two years.
The Nurse-Family Partnership that helped Dawson is one of the largest and best-studied programs. Decades of research into how families fare after participating in it have documented reductions in the use of social programs such as Medicaid and food stamps, reductions in child abuse and neglect, better pregnancy outcomes for mothers and better language development and academic performance by their children.
"Seeing follow-up studies 15 years out with enduring outcomes, that's what really gave policymakers comfort," says Karen Howard, vice president for early childhood policy at First Focus, an advocacy group.
But others say the requirements for evidence-based programs are too lenient, and that only a handful of the approved models have as strong a track record as that of the Nurse-Family Partnership.
"If the evidence requirement stays as it is, almost any program will be able to qualify," says Jon Baron, vice president for of evidence-based policy at the Laura and John Arnold Foundation, which supports initiatives that encourage policymakers to make decisions based on data and other reliable evidence. "It threatens to derail the program."
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