Hfi Newsletter Spring 2009

Primary Prevention Perspectives | Spring 2009

HEALTHY Family Initiatives

Healthy Family Initiatives leads communities in developing solutions to eradicate child abuse and neglect.

HEALTHY With A Baby At Home, Young Couples Add Work To Their Homework

Alan Nava and Adriana Rojas snuggle on the couch. Holding hands, touching knees, they look like a million other teenaged couples. They might at any moment burst out in “When You Look Me in the Eyes.” Except that Alan and Adriana also have eyes for Alan, their 3-month-old son. Alan and Adriana have come to the comfortable parlor on the second floor at Lee High School to attend the HFI Young Couples Group for student-parents. Each meets with a group of other teen moms or dads as well. Those couples in which both partners are enrolled at Lee attend the couples group also.

On another couch, facing Alan and Adriana across a coffee table, sit Emerson Mejicana and Tahys Diaz. A bit less demonstrative, they nonetheless look equally committed. However, they are teenagers, and introducing a child into a high-school romance does not guarantee a future together. In fact, it may make it less likely. Statistics indicate that 80 percent of unmarried teen couples are together when their child is born and 15 to 20 percent remain in the relationship on the baby’s first birthday. Doula Program Director Marisa Pena Alfaro says that in her experience, something less than 80 percent remain committed to each other at the birth, but that the 15-to-20 percent range rings true at one year. HFI’s program directors guide the young moms through their pregnancy and childbirth classes, and the young expectant dads break out into their own D.A.D.’s program classes. They team up again for the couples group. Here, the lessons learned in the company of other moms or dads — where questions flow more freely — are examined in a context in which the partners can interact and explore personal approaches. They have been given a worksheet for homework that instructs them to list “his core concerns” and “her core concerns” followed by “Our general agreement that meets BOTH our core concerns.” Then comes a chart asking for more detail, with boxes for “who” “will do what” “when” “where” and “how.” The program leaders guide their young charges through examples of couples who have preceded them, and elicit responses

family initiatives

HEALTHY family initiatives

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family initiatives

on how the moms and dads are putting their lessons into practice every day. Adriana confesses that distilling life into a series of routines strikes her as boring, but she concedes the need for organization. She and Alan discuss how they’re balancing the demands of child care, jobs and homework, and describe a spat they had when communication broke down. Different techniques are discussed to point out the discipline and organization so needed as a working parent. One technique used by program directors is illustrating expectations through interestrelated examples, like sports. Parents often have to visualize several outcomes in advance much like a soccer or basketball player does during a game. The class is also guided to adjust expectations when unforeseen circumstances interfere as well as to set realistic goals and prioritize. For example, Emerson says he’s learning to budget his time: More diapers means fewer video games. One specific program model is never enough; one size never fits all. There are many forms fatherhood can take, which an effective program must take into account. Needs for teen fathers differ from those of their twenty-something counterparts, or a divorced weekend dad, or a step father. The lessons appear to sink in — and a record of success says they do. Healthy families are intact families. And families remain together when the partners put in the practice to build and maintain healthy relationships. HFI

Healthy Family Initiatives

2009 HFI Board of Directors The Honorable Geert C. Visser, Ing. Chairman Consul of The Netherlands President Global Marine Transport

John F. Chirichigno Treasurer Financial Advisor Assistant Vice President Investments Wachovia Securities, LLC

Elaine S. Mcanelly, J.D. Secretary Vice President Assistant General Counsel JP Morgan Chase Bank, N.A.

Patrick J. Kiley Past Chairman Principal Kiley Advisors

Sheshe Taylor Evans, J.D. Legge, Farrow, Kimmitt, McGrath & Brown

MARJORIE FOWLER Community Volunteer Principal Proclaim Public Relations Ashley T. Harlan Community Volunteer

W. Robert Houston, Ph.D. Executive Director and Professor Institute of Urban Education College of Education University of Houston

Steve Moriarty Assistant Director Projects Business Unit Wilson-Mohr, Inc.

The Honorable Linda Motheral Community Volunteer Retired Family Law Judge, District 257

Susan Sample, J.D. Liaison, Junior League of Houston

ROSIE VALADEZ MCSTAY, MPH Director, Government & Community Relations Texas Children's Hospital

Advisory Board of Directors Rosanne Dickson Community Volunteer

W. David Hanks HFI Campaign Chairman Retired, President & CEO Riviana Foods, Inc.

Patrick Leung, Ph.D. Professor Graduate School of Social Work University of Houston

Michelle V. Anderson Lyn, M.D. Pediatric Emergency Medicine Texas Children's Hospital

Kenneth Spalding Community Volunteer Retired, Shell Oil Company

President’s Letter The 111th Congress and the 81st Texas legislative sessions are in progress. With the economic downturn, we should all be wondering how children are being affected by our public policy processes. The American Academy of Pediatrics notes that “It is clear that the current situation is having a major impact on adults throughout the United States and abroad. The effect that it may have on children and adolescents is less obvious, but it is something that parents and pediatricians can address.” According to a January (2009) COUNTRY Family Finances survey, compiled by Rasmussen Reports, LLC and based on a national telephone survey of nearly 1,200 Americans who currently have children at home, three in four Americans admit the economic downturn is heaping more stress on their family and one-third say it has sparked more arguments with their spouse or children. Children’s mental health, chronic medical conditions, access to health and child care should all be of concern to our society. Voices for America’s Children, the national advocacy group indicates that “Budgets are the single-best indicator of a government’s priorities. Large increases or drastic cuts in funding for programs or other services for kids are clear indicators of what policymakers value. All states depend on federal funding to provide vital children services from education to child care to nutrition assistance, which means that budget decisions made at the federal level can have a big impact on state and local programs.” Texas has already lived through one recent cut in funding for activities that prevent poor child outcomes several sessions ago. The Children’s Leadership Council is a coalition of child advocates representing 36 leading national policy and advocacy organizations who are working to improve the health, education and well-being of children and youth in order to prepare

them for school, work and life. It bases its current public policy agenda on the premise that “…investing in children and youth is investing in America. By making all of our children— from birth to young adulthood — a priority, we strengthen our country and secure everyone’s future.” A recent editorial in the Miami Herald makes the point that, “While policymakers on both sides of the political aisle debate a potential economic stimulus package that throws lifelines to major industries and employs legions of citizens to build bridges, repair roads and develop alternative sources of energy, they also must invest in programs and services that put people to work safeguarding, educating and developing our children and youth. Investing in children provides short-term economic stimulus with lasting impact….” “…on average, a $1 investment in quality early care and education provides between $4 and $8 in reduced costs associated with such social outcomes as lower rates of grade retention, special education placement, adolescent pregnancy, drug use and criminal activity — at the high end this is a 17-percent return on investment.” In these tough times, let’s not pull the rug out from under our future. Let’s make sure we let our legislators know that we value our children, and that an ounce of prevention is the stimulus we really need. HFI Marianne L. Ehrlich President & CEO Poverty and financial stress. The two leading causes of child abuse and neglect are more widespread during a recession. No job, no health care. Uninsured parents are more likely to delay medical care for their children, which can result in being accused of medical neglect. Reduced supervision. Financially unstable parents often have less time to watch their children, leading to more reports of inadequate guardianship. Government’s role. Fiscal woes often result in cuts to child abuse prevention programs.1 1 Some Attribute Child Abuse Spike To Recession, by Michael Amon, [email protected]

www.hfihouston.org Abuse Cases Highlight Need For Action The case of Baby Grace in Galveston grabbed the headlines, and little wonder. In a four-hour videotaped statement, the 2-year-old girl’s mother admitted to whipping her with a belt and helping to dunk her head repeatedly in a bathtub of cold water. The three skull fractures that resulted in death occurred, she said, when the stepfather threw the child across the room because she wasn’t minding.

to a charge of injury to a child.

>>In Gainesville, the boyfriend of a woman whose four children were burned with sulfuric acid turned himself in at the Cooke County Sheriff’s Office. This partial list notably leaves out cases of neglect that resulted in a child’s injury or illness. As Child Abuse Prevention Month arrives, we pause to reflect that while we cannot make definitive judgments on individual cases, much damage caused by abuse and neglect is preventable. Most

April is Child Abuse Prevention Month. Make a difference in a child’s life by supporting the efforts of Healthy Family Initiatives.

Other Texas cases may seem less sensational but they are no less horrible for the victims. In recent days: >>A Tyler mother and her boyfriend were charged with manslaughter after the woman’s 9-month-old son drowned when he was left unattended in a bathtub. >>In Dallas, the mother of a 9-year-old diabetic who died as she lay beside a bag of candy was accused of helping cause her death by failing to help the girl manage the disease, including giving her high-glucose foods. >>P rosecutors said an 8-year-old Gonzales girl who weighed 45 pounds starved to death in the hands of her adoptive parents when she could no longer get enough food by stealing from classmates and eating out of trash cans. A medical examiner testified that the girl could have died from malnutrition, blunt force trauma to the head or a combination of the two. >>A n Alvin man told Philadelphia police he stomped his 3-month-old son to death to stop him from crying. >>A Brownsville woman whose newborn daughter was found dead and stuffed in a suitcase pleaded guilty

instances of child abuse are not caused by inherently violent or evil people, but by parents who are unable to cope with their temper in a time of crisis. The best way to prevent child abuse and neglect is to support families and provide parents with the skills and resources they need. Research demonstrates that intervention before abuse ever occurs works in measurable ways. Supporting families to learn to find and access resources helps them become more self-sufficient. Guiding them in effective parenting and teaching parents to understand child development and then to adopt reasonable expectations for children’s behavior produces long term positive results. The key is to address the needs of the entire family unit. For example, while not an exclusive condition for occurrence, research has demonstrated that poverty is directly related to child abuse and neglect. Sixty percent of the nearly 29,000 children in foster care in Texas in 2007 came from families with annual earnings of $10,000 or less. Intensive home visitation programs not only improve parenting, but help parents to establish and achieve personal goals. In the Healthy Families Houston program, families improved their economic situation as well as their parenting skills, moving over the course of our intensive,

long-term interactions with them from annual incomes of about $13,000 to an average of $32,000 in annual income. Education for parents matters. Almost one-third of U.S. parents have a surprisingly low-level knowledge of infant development and unrealistic expectations for their child’s physical, social and emotional growth. “An astonishing number of parents are unsure of what to anticipate as their child develops,” said Dr. Heather Paradis, a pediatric fellow at the University of Rochester Medical Center, which conducted a study on parental knowledge. “Some parents expect too much of babies too soon and grow frustrated.” Among the causes and risk factors for parents are immaturity and unrealistic expectations, unmet emotional needs, the stresses of child care, economic crisis, domestic violence, lack of parenting knowledge, difficulty in relationships, depression or other mental health problems and drug or alcohol problems. Proven intervention solutions are available. With the coming of Child Abuse Prevention Month, isn’t it time to redouble our efforts to create the resources? Precious lives are at stake, as much so in cases that don’t make headlines. HFI

Stop Child Abuse specialty license plate now on sale at www.texasonline.com. A percentage of each plate sale will go to the Texas Council of Child Welfare Boards and to the child welfare board in the county of sale.

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Healthy Family Initiatives

Around HFI’s Board Table Geert C. Visser, ing, president of Houstonbased Global Marine Transport Inc. , has been elected chairman of the board of directors of Healthy Family Initiatives. Geert joined the board in January 2007. The father of three boys, now grown, Geert has long had an interest in children’s issues. “I feel a personal commitment to kids, and to making positive change in our community. I came to know HFI, and I know it to be an organization that works hard, is well run, and has tested outcome programs with great impact on children’s lives. Kids who otherwise likely don’t have a safe environment and a foundation that allows them to shine. At HFI we call it Prevention — the power of prevention and what it can do for families. I am proud to be connected to it and now, to be its chairman. I hope to further the mission by

Heartbeat Of A Healthy Family Major Gifts Campaign Uncertain times, with grave national and global economic concerns, have prompted Healthy Family Initiatives to considerable deliberation about our Major Gifts Campaign. In light of this deliberation, the HFI board has decided to continue cultivation with sensitivity to the general philanthropic environment. When the economy is down, it is a known fact that the rate of child abuse and neglect often goes up. The additional stresses, especially in vulnerable families, become an insurmountable challenge. The need for family support and prevention programs becomes even greater. The first good news is that during these difficult times HFI can continue to make

Past HFI Board Chairm

an Pat Kiley (right) wel

comes incoming Chairm

an Geert C. Visser (left).

doing a good job leading and growing this well respected board.” At the January annual meeting, Geert expressed his deep appreciation to Pat Kiley, outgoing chairman, for his dedicated service to HFI and wisdom of leadership over the past three years.

A native of The Netherlands who has lived in the Houston area 30 years, Visser was appointed Consul of The Netherlands for Texas, Oklahoma and Arkansas in 2003. He is a member of the American Society of Petroleum Engineers. He and his wife live in The Woodlands. HFI

a difference in the lives of children and their families with your continued support. The second good news is that to date, our Heartbeat of a Healthy Family Major Gifts Campaign has already raised almost one-fourth of our goal to support awareness about the challenges of abuse and neglect through your pledges and gifts. We are experiencing that people of generous hearts will still want to invest in a worthy cause. We know we cannot hesitate to ask for your help, for the proceeds of our campaign support proven and vital components that will change the community’s understanding about the value of prevention, will facilitate broad dissemination of early prevention programs and will help focus efforts on improving child protective public policy. And so we encourage you to please consider making that gift or filling out

a pledge card, helping us move forward toward our goal of $1 million. The impact we can make together, the success your gifts bring to the long term life outcomes of a greater number of families at risk lead us to feel confident in extending our ask to you. Please remember us and help support this first campaign — a campaign that will help protect the children in our community. Your gift lasts a lifetime for our children! Thank you for your support of our campaign. If you have questions, please contact our development office at 713-270-8849 ext. 226. HFI

It’s here! Visit HFI’s new website at www.hfihouston.org.

www.hfihouston.org In HFI’s Family...

Tamera Stark, Ph.D., Named Vice President, Programs Having long worked with children, Dr. Tamera Stark says she has seen children struggle once they reach school age (5-years-old) because their parents didn’t prepare them to be “school-ready” early on.

Helping First-Time Mothers A Joy For Delores Hamilton Who better to coordinate the Texas Nurse Family Partnership program in Houston than an experienced women’s health nurse? Delores Hamilton, RN, BSN, begins her job as project coordinator with her eyes wide open. “Some of the moms see this baby as ruining their lives and some see it like having a doll to play with,” she says. Still others are angry and often the young woman is living with a grandparent, a sister or a boyfriend because the parents

“It can affect them throughout their entire school career,” she says. “This shows the importance of starting at the beginning.” As the new vice president-programs, Dr. Stark will develop and administer HFI’s programs, including Building Strong Families, Community Doula, Dads Make A Difference and all HFI family support programs. Dr. Stark was previously director of community programs for Bastrop Independent School District, where she developed and administered an array of programs for students and adults in the district’s 16 campus and community locations. She also provided oversight of the Community Education, 21st Century Community Learning Centers, STARS After School, District Daycare, Pregnancy Related Services and Life Skills programs. Dr. Stark holds certifications from the Learning Resources Network, the Association of Professionals in Business Manage-

ment and the Society for Human Resources Management. She holds a BBA from the University of Texas in Austin, an MA from the University of South Dakota and an MA

have turned her out of their home. Delores saw all the problems while working in a hospital. Now she sees reason for hope. “The teen moms and young single mothers coming into the hospital to have their babies knew absolutely nothing,” she says. “We had a lot of teaching to pack into the two days they would be in the hospital! When I learned about this program, I thought, ‘Wow! A program that will teach these young women beforehand!” NFP nurses will work with a lowincome, first-time mother for two years, beginning before birth. In addition to teaching parenting skills, they will help the young moms and dads with finding resources. “It will be important for the nurses to let the moms do the work and not ‘fix’ a problem or do the work for them,” Delores says. “The moms will feel better about themselves, particularly when the baby comes, “ Delores says. She adds that the nurse home visitors will be good role models for the girls. “The nurses working with these teens and young single mothers need lots of skills and abilities. The goal is to build

trust and strong relationships with the moms,” Delores explains. “They need to have compassion and help these young women believe they can do this.” A mom herself and a grandmother of a 2-year-old, Delores knows the ups and downs of parenting. She also brings to HFI a broad background of clinical, management and educational skills. Delores is responsible for general oversight of the program and coordinating with the national and state NFP program leaders as well as with the consortium partners, particularly the three service providers: Baylor College of Medicine Teen Clinics, Texas Children’s Health Plan and The City of Houston Department of Health and Human Services. Each of the service providers has four nurses providing home visitation services. Service providers began seeing mothers in December 2008. The Nurse Home Visitors and Nursing Supervisors are registered professional nurses with a minimum of a Baccalaureate degree in nursing. HFI is the lead agency, serving as fiscal agent and coordinating services. HFI

I like the fact that HFI isn’t just a service provider, but is here to trail-blaze new programming as well.

and PhD from Louisiana Baptist University. She and her husband, Scott O’Beirne, live in Sugar Land. HFI

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Healthy Family Initiatives

Two Countries, 5,000 Miles And A Cup Of Coffee A simple cup of coffee brought two women together from countries 5,000 miles apart, but it was the challenges that they faced in their two cities that reunited them in Houston months later. Over a three day sojourn this past summer, Healthy Family Initiatives hosted a delegation of four Birmingham, England, health services representatives to share knowledge about best practices in home visitation, pregnancy and prenatal education and prevention of child abuse and neglect, and to gain better understanding about how our two countries’ very different health and human services systems are responding to very similar human needs and challenges. The exchange originated through a chance meeting in Palo Alto, CA of our president and CEO, Marianne Ehrlich, at the Stanford Social Innovations conference, with Vicki Fitzgerald, Gateway Community Interest Co. chief executive. Over coffee, the two realized the extraordinary similarities of their work and determined to expand their dialogue through a visit to Houston. Together during the exchange visit in Houston, we looked at our health care systems, demographics, work force issues, infant mortality, family structures and cultural and ethnic issues in serving high risk populations. Our British colleagues shared their own programs and approaches to strengthening families and were introduced to the HFI Building Strong Families program model and staff, our doula and fathering programs, and to members of our board of directors. HFI arranged a series of collaborative visits, including The Children’s Defense Fund and with members of the current American Leadership Forum class to learn about its Cradle to Prison Pipeline project. Houston Area Women’s Center members discussed violence prevention programs

and approaches and United Way representatives shared insight about how it has developed and is tracking human services program outcomes. The ladies also met with the local consortium group working with HFI to plan and implement the state funded Nurse Family Partnership program pilot. As well as being implemented in the United States, this program is in a second phase of expansion in Great Britain, offering ongoing opportunities to compare outcome data and study the process and progress in the two different health care systems. After the Houston visit, HFI arranged a visit in Birmingham for the Texas Health and Human Services Commission NFP contract administrator to see firsthand how the NFP program is being rolled out. Gaining greater understanding that problems confronted by families are very similar

across cultures and that we can improve our own approaches by learning how other countries find solutions to such challenges was an eye-opening experience. Through further exchanges, this budding international relationship will likely become even more fruitful. All from a cup of coffee. HFI

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It’s here! Visit HFI’s new website at www.hfihouston.org.

www.hfihouston.org

Doula Program Expands Due To Popular Demand Beatriz was 14 years old, married and three months pregnant when she left her family and moved to her husband’s home in Houston. Her husband-to-be had come to her village in Guerrero, Mexico, after they met over the phone. Two weeks later they were married. Right away, she was pregnant. As soon as she arrived in Houston, her sister-in-law mentioned the childbirth education classes offered by HFI’s Community Doula Program at the Magnolia Multi-Service Center clinic in Houston’s East End.

aro, ena-Alf arisa P M s to r, e u to c iq chn Dire rogram mfort te l Doula P irthing and co e High Schoo sb t Le explain moms a nt teen expecta

Beatriz completed the course of eight sessions but attended an additional 10 classes because, she says, “I learned so much about pregnancy and found out that all the myths people had told me weren’t true. “ Although the word “doula” — literally, “servant” — is an old one, the concept is relatively new. In the greater Houston area, Marisa Pena-Alfaro is one of only 14 women certified as doulas through DONA International, the oldest and largest doula association. At HFI, she and Karla Tapia work with at-risk pregnant teens and

other young mothers, helping them to develop and maintain a healthy lifestyle during pregnancy and after. The program fills an essential need for education and support of low-income expectant mothers. In Harris County in 2004, 18 percent of pregnant women received either late prenatal care (after the first trimester) or none at all. Eight percent of all births in the county were low birthweight, making these babies 25 times more likely than healthy babies to die before their first birthday. At the Magnolia Center, a heavily Hispanic area, 19 percent of children are born to teen mothers; 60 percent do not have a high school diploma. The doula program works. In 2008, 96.8 percent of the mothers carried their pregnancy full term, compared to 87.5 percent nationally; 80 percent had natural births compared to 68.9 percent nationally; 97 percent of mothers had healthy weight infants, compared to 92 percent nationally, and 81 percent breastfed their children for at least six months compared to 13 percent nationally. The demand for these services is increasing — HFI added a program at the Spring Branch Family Development Center in Houston in February 2009 to the existing locations at Lee High School, LBJ Teen Clinic and the Magnolia Center, and provided advisory services to organizations as far

Full-term pregnancy Healthy weight infant Cesarean section Breastfed 6+ months

away as the United Kingdom. “Karla was so supportive for my husband and me,” Beatriz said. “She stayed with me during all my labor. Karla taught me the way to breastfeed my little Merlina. That’s why I could breastfeed her for one year. “Having Karla was just like having my own mom.” HFI

You can help prepare our mothers-to-be by donating layette items for our monthly baby showers. For more information, or to make a donation, please contact Marisa Pena-Alfaro at 713-270-8849 x234 or at [email protected]

National (%)

Doula Program (%)

Estimated cost savings per birth ($)

87.5

96.8

N/A

92

97

41,985

31.1

20

8,000

13

81

810

*National statistics from National Center for Health Statistics, March of Dimes, American Academy of Pediatrics and CDC

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HEALTHY BABIES HFI’s doula program for low-income mothers outperforms national averages in the births of healthy, full-term babies by natural childbirth. Demand for the program is growing. Read one young mother‘s experience on page seven and learn how you can help.

HEALTHY FAMILY INITIATIVES STAFF LEADERSHIP MARIANNE L. EHRLICH President & CEO ELISABETH RUEB FEERICK Senior Vice President Ellison “Rick” Dyson, CPA Vice President Finance & Administration TAMERA L. STARK, Ph.D. Vice President Program Operations

Primary Prevention Perspectives is published by Healthy Family Initiatives.

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7500 Beechnut | Suite 366 Houston, TX 77074 P: 713.270.8849 F: 713.270.9532 www.hfihouston.org HFI is a Better Business Bureau accredited 501(c)(3)

Please help us strengthen families and prevent child abuse this year.