Child First May Be The Most Effective Anti-Poverty Program In America

Jonathan Cohn

NEW BRITAIN, Connecticut -- Luisa Cintron, 25, is sitting up as straight as she can, perched on the edge of the neatly made bed that doubles as a couch inside her dimly lit apartment. She is wearing a sweater and slacks, talking about the government program that she says changed her life, and trying -- without much success -- not to get distracted by the 4-year-old talking loudly about Batman in the next room.

The 4-year-old is Luisa’s son, Maliek. And not so long ago, Luisa explains, Maliek wouldn’t have been talking about superheroes -- or anything else for that matter. At 18 months, well past the time that babies usually start forming words, Maliek was still “non-verbal” and communicating almost exclusively through gestures. “It was always pointing at this, crying at that,” Luisa says.

Delayed speech wasn’t Maliek’s only problem. He also had a severe case of eczema that caused him to bleed into his clothing and sleep fitfully, if at all. It further impaired his ability to learn, and made for yet more tension at home.

At the time, Luisa was working at a Mexican fast food restaurant. Childcare was a constant struggle, and so was housing. While Luisa’s daughter, three years older than Maliek, didn’t have the same issues, Luisa says the combined financial and emotional strain of raising the two kids on her own was “overwhelming.”

“I was young, the [kids] would be in my face and acting crazy, and I would just want them to please go away and play,” she says. She thinks she was “in denial” about Maliek’s speech problems. Sometimes, she recalls, she felt like "giving up."

These are the sorts of situations that scholars agree put young children at grave risk of trouble later in life. Raised in environments full of economic, emotional and psychological turmoil, these kids are less likely to succeed in school or at the workplace, and are more likely to run afoul of the law or experience a variety of mental and physical health problems. But Luisa didn't give up. Acting on advice she got from her sister, she instead reached out to Child First -- a Connecticut-based organization that seeks to help distressed families, particularly those in low-income communities.

Child First is a “home visiting” program, which means staff members work with families mostly in their homes rather than in office settings, sometimes meeting as frequently as three or four times a week. The first priority is addressing tangible problems like poor housing or lack of medical care, which sometimes means connecting families with public programs. But the main focus is improving relationships within the family, particularly between the parents and children, through a combination of advice and therapy.

“People are most comfortable and most themselves at home,” says Flora Murphy, a Child First mental health clinician who worked with Luisa. “It’s most effective too for working with children. You bring children into an office setting, they’re nervous and they’re really not themselves. And it’s really not an [ideal] place to do what we need to do, which is work with families.”

The visits with Luisa’s family lasted about 18 months and ended last year. Today, signs of improvement are evident. Maliek’s eczema is under control, thanks to a program that Child First found through the University of Connecticut. He’s also enrolled in a special education program and sounds more and more like a typical 4-year-old -- still relatively behind in his speech development, but with a rapidly increasing vocabulary. Luisa works as a nanny for her sister’s kids, and that has helped her to stabilize both her financial and housing situations. "I’m paying rent, I’m paying my bills, my household needs are getting taken care of," she says.

Luisa's also learned a lot about being a parent, starting with the importance of patience and making sure her kids know that she loves them. “My patience was extremely low, dealing with the kids, and we worked on that,” Luisa explains. “I’m just this brand new person ... I understand them.”

A New Way To Fight Poverty

Nobody can know how Luisa and her kids will be doing in a few years, or precisely what effect Child First had on their lives. But many researchers believe that such early, tenative signs of progress are emblematic of what a new federal anti-poverty initiative can ultimately achieve with enough time and money -- and maybe some more judicious management from Washington.

That initiative is the Maternal, Infant, and Early Childhood Home Visiting Program, through which Child First gets funding. MIECHV, which officials refer to as “mick-vee,” began as a pilot initiative during the Bush administration and became a full-fledged program in 2010, when the Obama administration tucked funding for a massive expansion into the Affordable Care Act. The program is popular on Capitol Hill, with prominent supporters in both parties, and Congress just renewed it for another two years.

Very few people noticed that vote, because the appropriation was part of the high-profile, controversial bill that permanently adjusted Medicare payments for physicians. But if home visiting is successful on a large scale, it could prove transformative. While paying trained nurses and social workers to visit homes can get expensive, at least in the beginning, it can also yield large returns later on -- in the form of a more productive workforce, as well as taxpayer dollars not spent on treatment for mental and physical health problems, public assistance and the criminal justice system.

“Investing early is going to be a lot better than investing late,” says Ezekiel Emanuel, a vice provost at the University of Pennsylvania who championed home visiting while he was an official in the Obama White House. It's an argument the president himself has made on many occasions, frequently citing the work of James Heckman, the Nobel-winning economist at the University of Chicago.  To read more click here.