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BOZEMAN — In the last couple of weeks, 11-month-old Eva Ball started occasionally covering one of her eyes, something that would make any parent who doesn't happen to be an optometrist wonder.

“Is that normal for a kid?” asked her mom, Michelle Helvik, as she sat in her Bozeman home last month.

Mary Schwämmlein, a social worker with the county health department, was there to answer. Eva should get her eyes checked at her 12-month appointment, and, if needed, Schwämmlein could also bring a vision screening machine the next time she came to the home.

Schwämmlein and Helvik got connected through Gallatin County's Home Visiting Program. The free and voluntary program connects pregnant women, as well as families with infants and children under the age of 6, with social workers and nurses.

Since starting in 2011, the 27 Home Visiting Programs around the state — some run by county health departments, others by local service providers — have helped more than 6,000 Montana families through more than 45,000 visits.

The state started the program because providing family-centered services in homes to pregnant women and families with young kids supports healthy pregnancy outcomes, as well as good child health and development and strong child-parent relationships, said Jon Ebelt, a spokesman for the state health department.

The list of benefits is long: reductions in child maltreatment and domestic violence, less postpartum depression, higher breastfeeding rates, children more ready for school and more, according to data collected from the Montana program.

Half of families who participate reduced the number of emergency room visits they make due to injury or illness. Nearly all families have either gotten or kept health insurance coverage while in the program, and 86% of kids get screenings to check their developmental progression.

Helvik and Schwämmlein meet about every two weeks, often in Helvik’s home but sometimes at the neighborhood park. Every visit is different, but generally they check in on what they talked about in the prior visit — it could be anything from watching Eva progress with crawling to tracking how 3-year-old Marie is doing learning to use children's scissors. The women talk about Helvik’s goals, too, including developing a plan to go back to college.

Home visitors do developmental screenings to assess how kids are progressing, testing for fine and gross motor skills, social-emotional speech and language and problem-solving. That identifies strengths and, if any weaknesses are found, home visitors can recommend activities to help improve.

The visits look and feel much less like an appointment between a person accessing services from the health department and a social worker, and more like two friends talking openly, honestly and without judgement about the highs and lows of parenting and sharing advice and ideas, not mandates, to navigate it.

“Our job is to not be judgmental,” Schwämmlein said. “Our job is not to come in and know everything and say you know nothing. That’s not our role, because that’s not true. The program is not me telling you what to do, it’s about what you need: 'How can I be of help to you? Where do you want support?'”

Sometimes people don’t have a great example of parents to learn from. Sometimes they do, but still want some extra help with a new baby.

“Parenting is hard. Kids don't come with a playbook. Nobody really knows what they're doing," Schwämmlein said. "Myself included. I'm a mom, and it’s really scary to have this little person whose life you’re responsible for."

While it can be intimidating to have a stranger come into your home, Helvik said it was also convenient and something she grew comfortable with quickly.

“At first I was definitely apprehensive. You think, ‘The health department is calling? What did I do wrong?’” Helvik said. But she agreed after someone reached out following the birth of her second child, Eva. She said it's been an incredible resource to help her understand phases her children go through, tackle any problems and have an ear to listen when that's what she needs.

Watching their relationship makes it clear that it's a two-way street. Both women are mothers to children around the same age, who hit the same developmental milestones —  and woes — around the same time, and can bounce ideas and concerns off each other.

“You feel really alone, you feel like you don’t know what you’re doing and everybody else knows. And the mom sitting next to you is also thinking the same thing, and the mom sitting next to her is thinking the same thing, but nobody’s saying, 'Actually, none of us really know, and this is kind of scary and hard,'" Schwämmlein said.

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In addition to social workers like Schwämmlein, the Gallatin County Home Visiting Program has nurses who can visit infants and families in their homes to help with medical concerns. For example, a baby with a low birth weight might need to be weighed every day for the first few weeks of their life, and a nurse can come to the family's house to do that instead of parents having to drive a newborn to the hospital every day.

Gallatin County’s program has six nurses, two social workers and two father-engagement specialists, said Amie Gatterdam, the maternal child health program manager with the health department.

Gatterdam has worked to grow Bozeman’s program through reaching out to all the places pregnant women and families might be, and breaking down stereotypes.

The majority of referrals come from the hospital, where people from the health department visit a few times each week and staff try to refer families they think might need a bit of extra support. They’ve also partnered with obstetrician offices, which have started universally telling first-time moms about the program.

In 2017 the program had 207 referrals. That grew to nearly 700 in 2018, Gatterdam said. By June this year, Gatterdam said they'd already had 438 referrals and could be on target to reach 1,000.

In some parts of the state, the Home Visiting Program also includes the First Years Initiative, a collaboration with Child and Family Services. Helvik did not enter the Home Visiting Program through CFS.

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Across Montana, there are 14 home visitors that work with CFS in 15 counties, including locations in Butte-Silver Bow, Madison, Beaverhead, Big Horn, Cascade, Custer, Dawson, Flathead, Gallatin, Hill, Lewis and Clark, Mineral, Missoula, Park and Yellowstone. So far they've helped 217 families, who have had 1,800 home visits.

The First Years Initiative has helped stabilize what had been a record-high number of children entering the state foster care system, Ebelt said, meaning more kids stay home with their parents. In the first half of the most recent fiscal year, the number of children entering care rose about 1.4%, according to Montana Public Radio. That's down from 12.5% the year prior and 19% the year before.

Erin Clements, who works with Child and Family Services in Gallatin, Park, Sweetgrass and Madison counties, said the First Years Initiative has been a huge help for families that come into contact with CFS.

"They're able to build relationships, and families understand that is a neutral person," Clements said. "We always present it as, 'They're not here to rat you out, they're here to help people and build you up and talk about those barriers to safety or reunification and how to overcome those barriers together.'"

The First Years Initiative has also helped bring up the number of families using Home Visiting Programs around the state. That's important because some locations that were not operating at a minimum of 85% capacity will see their budgets reduced this year by about 15%.

Twelve providers statewide were not meeting capacity, and will have their combined budgets cut $305,513 in the upcoming fiscal year. 

Providers that will see cuts include AWARE Inc. in Butte and Helena, Bighorn Valley Health Center, Butte 4-Cs, Cascade City-County Health Department, Flathead City-County Health Department, Florence Crittenton Home in Helena, Lewis and Clark County Health Department, Mineral County Health Department, Custer County, RiverStone Health Department in Billings and Roosevelt County Health Department.

Several factors could lead to sites not being at capacity, Ebelt said. That could include turnover, travel times, inability to hire nurses or keep them on staff, housing issues, families worried about any stigma attached to using the program or misunderstandings of what home visiting is.

Breaking down stereotypes about the program has been a focus for Gatterdam.

"People sometimes think it's only for 'those kind of families,' people with troubles, people who are low-income, people who have issues. And now my goal is to really prove that anybody can use extra support and there's nothing to be embarrassed of," Gatterdam said.

She even used the program herself with her first child.

"I thought I'd just kill it as a parent, and oh my gosh, in two weeks I called my director and said, 'Send in a home visiting nurse,'" Gatterdam said.

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