CHICAGO--Her first baby, a boy she planned to call Jaidan, arrived stillborn on June 25, 2009, the same day Michael Jackson died. More than three years later, when a second chance at motherhood finally came her way, Dwana Harris was determined to do everything right.
So last fall, Harris was intrigued when she unexpectedly met a woman bearing information about healthy child development in the living room of a cousin with a newborn. Soon the woman was visiting her, too, in the meticulously clean one-bedroom apartment that she and her boyfriend share in a South Side public housing tower near Lake Michigan.
Harris, 28, had questions about what to ask at doctors' appointments, what to eat and generally what to do to keep her unborn daughter on track. Her home visitor, Tammie Haltom, and a birthing coach named Sonia Collins had answers. They got her into a high-risk prenatal clinic at the University of Chicago, where Collins attended appointments with her. They persuaded her to cut back--way back--on the amount of Wild Cherry Pepsi she drank. They gave her children's books like "Shades of People" and "The Itsy Bitsy Spider," which she began reading to her belly.
The women work for the Ounce of Prevention Fund, a Chicago nonprofit that strives to stop the achievement gap for children in poverty from ever starting. That means beginning assistance at the first possible moment--in other words, before birth.
In recent months, President Obama has reignited the national conversation about early childhood education by proposing universal preschool for 4-year-olds from low- and moderate-income families. But with much of a child's brain development occurring in the first three years of life, advocates at the Ounce and elsewhere say even that is too late, thrilled though they are by the preschool proposal. Poor babies as young as 9 months show a gap in cognitive development compared with wealthier peers, a gap that triples by the time they are 2 years old.
A less publicized part of the president's plan would provide $15 billion over a decade for home visiting. The federal government has already provided $1.5 billion for home visitation under the 2010 Affordable Care Act, and states are funding the service for hundreds of thousands of families nationwide. But still only a small fraction of babies born into poverty receive this earliest intervention.
"We can remediate 3-year-olds and 4-year-olds, or we can get them right from the beginning," said Diana Rauner, president of the Ounce, a $48.5 million organization that provides training and funnels public funding to 32 home visiting and doula (birth coaching) programs around Illinois, among numerous initiatives. "The remediation doesn't work so well, even at that age."
So how to get it right from the start? The crux of home visiting work is relationship building with a mother and, by extension, an entire family. To begin to alleviate poverty's devastating effects on a child's development, the thinking goes, a family needs a positive frame of reference for relationships. Provide a young mother whose life may be filled with chaos and drama with the opportunity to be heard and valued. Arm her with the information she needs to speak up in institutional settings, whether a hospital delivery room or a kindergarten class, and in personal relationships. Show her how to develop a baby's vocabulary through reading, singing and stimulating conversation--starting in utero. Guide her to nurture her child and herself.
The result, if the strategy is successful, is that mothers in underserved communities are empowered to advocate for themselves and their children--and children grow up in more grounded, affectionate, engaging environments. Compare the school involvement of low-income parents versus affluent ones, and the differences lie in confidence levels and institutional knowledge. Look at children's academic performance and life outcomes in general, and the emotional stability and cognitive stimulation they get at home are undeniably enormous factors.
But as with all relationships, the terrain is delicate and messy. It challenges families' values and cultural norms. Result can't be measured immediately, and many forces compete to undermine success. This is, after all, Chicago, where the potential horrific consequences of an unstable childhood are painfully evidenced in the city's violent crime statistics, including a murder rate now declining after a surge in 2012 but still impacting youth disproportionately.
"If it were cheap or easy, we would have done it already at a great scale," said Rauner, whose husband is a Republican candidate for Illinois governor. "But clearly, we think it's the beginning of this great opportunity to really affect parent behavior, which really, in the long run, is the answer for children's school success... If there's another way to do this, I don't know what it is."
The Ounce helped to pioneer the idea of using doulas, or coaches in birthing and newborn care, as an intervention for impoverished teen mothers in Chicago nearly two decades ago. Two of three pilot sites in the mid-1990s are still in operation.
A few years ago, the Ounce began operating the Healthy Parents and Babies program in which Dwana Harris now takes part. It is funded by a $543,025 Early Head Start grant.
The program, similar to others the Ounce supports around the state, relies on two people with distinct roles to form relationships with a family. A doula supports the mother before, during and after delivery, promoting the initial parent-child bonding in the context of a longer-term home visitation program. A home visitor is a parent resource who works with the family through other formative experiences that can be equally trying, from sleep training to potty training to temper tantrums. "It's a journey where even the most highly degreed and highly resourced of us feel like we don't know, we're just barely getting by," Rauner said. Participants are also invited to join parent support groups.