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Baby Brexley was born in the hospital with the highest share of women enrolled in Medicaid in Tulsa, Okla. But she and her mother, Cortny Reddell, are receiving in-home postpartum visits from a nurse who will weigh the newborn, remind mom to sing to the baby, and screen Ms. Reddell for her own mental and physical health. The visits are part of a strategy to build a more robust social safety net in Tulsa, in a state where public services have suffered repeated deep cuts. Anchored to a broad literacy and parenting initiative, the goal is to uplift a generation born on the wrong side of the social and racial divide. Home visits also connect families to services from contraceptives to childcare and nutrition. But what also makes a difference, says George Kaiser, whose foundation is funding the effort, is an “offensive” approach that trains low-income moms in nurturing, language-rich interactions with infants. “If you can generate that [early learning], then you can eliminate the differential,” he says. “You won’t make everyone successful, of course. But it won’t be determined by the accident of birth.”
It’s mid-afternoon when the nurse arrives at the ranch house outside town. Inside, Cortny Reddell rests in a reclining chair cradling Brexley, her daughter, who was born premature a month earlier and spent her first three weeks in intensive care.
The nurse, Courtney McMahon, rests her portable scale on the coffee table and peeks at the swaddled baby. “Her color looks good,” she tells Ms. Reddell, lifting Brexley into her arms. “I’m going to weigh her and see how much she’s grown.”
This is Ms. McMahon’s second visit to check on Brexley, who it turns out has gained 9 ounces in a week. The nurse also wants to know how mom is doing so while she holds Brexley, Reddell fills out a survey that covers mental and physical health as well as relationships and housing. Before she goes, McMahon leaves a gift bag of diapers on the table.
Postpartum visits by registered nurses are routine in most European countries. Not so in the United States, and especially not in conservative Oklahoma, which infuses a frontier spirit into its limited government. More practically, it’s a social service that costs money and isn’t covered by health insurance.
That Reddell is receiving this service is a function of where she gave birth, at Hillcrest Medical Center in Tulsa. Since last year, nurses have been offering free home visits to mothers from Hillcrest, whose maternity ward has the city’s highest share of women enrolled in Medicaid.
These visits are just one strand in a privately funded, multi-year strategy to build a more robust social safety net in Tulsa. Anchored to a broad literacy and parenting initiative, the ultimate goal is to uplift a generation of children born on the wrong side of the city’s social and racial divide.
Home visits offer a way to help new mothers while connecting them with other services, from contraceptives to childcare and nutrition. Part of the challenge of tackling poverty, says George Kaiser, an oil-and-banking billionaire whose foundation is underwriting the Birth through Eight Strategy for Tulsa (BEST), is ensuring families don’t fall between the cracks of various social services, and that they stay connected to nurses and other advocates.
“I visualize it as being a whole series of repetitive family connections through trusted sources,” says Mr. Kaiser, who has spent more than $1 billion of his fortune on philanthropic ventures in Tulsa, including early-childhood education. “I put them all in one continuum.”
Overcoming resistance to services
Still, such services can only be effective if families chose to accept them. Some have had past experiences with child welfare services and as a result may be wary of what could happen to their own children.
As director of nursing for the Parent Child Center of Tulsa, Jenny Fairchild has had to find creative ways, from gift bags to text reminders, to persuade moms to sign up for and accept postpartum visits. She understands their hesitancy. “The idea of someone coming into the home … I think it’s a concept that’s taking some time for people to get comfortable with,” she says.
Ms. Fairchild and her team will visit moms up to three times in the first 12 weeks after they bring their baby home. More than 800 women have received home visits since October 2017.
The program is modeled on Durham Connects, an initiative in Durham, N.C. In a randomized trial of nearly 5,000 families it found that of those who received home visits, fewer infants had medical emergencies. It also reported improved quality of parenting and mother well-being. The cost of visits averaged $700 per family; each dollar spent saved more than three times that amount in infant medical care.
In addition to the nurse’s expertise, families in Durham benefited from referrals to community resources that they might not otherwise have accessed, says Kenneth Dodge, who as the former director of the Center for Child and Family Policy at Duke University, where he’s a professor of psychology and public policy, helped develop the nationally recognized program.
“It’s a match maker. You’re trying to match families with community resources,” he says.
Improving infant health is essential to fighting poverty, as is supporting vulnerable mothers, says Kaiser. Blending a home-visiting program with social service referrals is also important. But even this, to him, is still a “defensive” approach when it comes to giving an infant plenty of mental stimulation. “The social services safety net is fine but it’s not going to make enough of a difference by itself,” he says.
The skill of talking to baby
What makes a difference, he believes, is an “offensive” approach that trains low-income moms in nurturing, language-rich interactions with infants. This is what most wealthy parents already do, which is why studies have found a cognitive development gap from as early as nine months.
All parents want the best for their children, reasons Kaiser, and should want to learn these skills and put them into practice, whatever their economic constraints. “If you can generate that [early learning] then you can eliminate the differential. You won’t make everyone successful of course. But it won’t be determined by the accident of birth,” he says.
Catrice Brantley is a former nurse and director at the George Kaiser Family Foundation (GKFF) who oversees navigation services for BEST. She meets regularly with Kaiser and other foundation staff to review strategy and says he frequently brings the meeting back to the topics of brain science and early learning.
“He’s always thinking about the children’s interest and their early brain development, and that this is what sets us apart,” she says.
This emphasis is reflected in McMahon’s visits. She checks if new mothers still have their literacy-focused gift bag from the hospital (another GKFF initiative). She asks moms, do you know where the nearest library is? Have you begun singing to your baby?
Reddell, who also has a 6-year-old son, tells McMahon she is singing to Brexley. But she admits reading to her children can be hard because she’s dyslexic, which held her back at school (she has a GED diploma). She plans to go back to work as a housecleaner and dog groomer; her husband, a truck driver, is the main breadwinner. For now her biggest challenge is running the household with a baby at home. “It’s so hard to get stuff done,” she says.
On her last visit, McMahon signed Reddell up for ConnectFirst, the navigation service that Ms. Brantley oversees. This means her information can be shared with a family advocate who will call back to check on Brexley’s progress and refer her to other public and private services.
Decades of cuts
Not everyone is convinced that navigation is the answer to Tulsa’s grinding poverty and its effect on child cognition. Steven Dow, the executive director of CAP Tulsa, which runs a network of GKFF-funded preschools for low-income families, says he has a waiting list of 1,300 children. “The big problem isn’t a referral problem but a shortage of services,” he says.
Social spending in low-tax Oklahoma lags behind most states. In April, its Republican-run legislature passed a tax-raising bill, its first in decades, to restore $480 million in education funding after a mass walkout by teachers. But analysts say most state public services have suffered repeated deep cuts, including mental health and cash welfare.
Nor would a basic safety net necessarily resolve Tulsa’s lack of quality jobs or stable housing. The daily stresses that low-income families face make it hard for them to find bandwidth for parenting advice, even if they do want it. “We know that life is hard, and it’s pretty amazing that your kids come to school every day,” says Mr. Dow, who has run CAP since 1992.
Kaiser concedes this point. “There’s not a lot of extra leisure ... [for a mother] to be able to deliver the kinds of upper-middle-class reinforcement and [parent-child] interactions, even if she knew what it looked like,” he says.
To Kaiser, that means supporting these mothers with intense wraparound services that can ease some, if not all, of their acute burdens. That, in turn, should free moms up to pay more attention to child development, what he calls the “offensive” reed of his strategy.
First, though, his team needs to recruit more mothers and other caregivers. Brantley has hired three full-time family advocates who have begun cold-calling hundreds of expectant and new moms enrolled in Oklahoma’s Medicaid program. She also wants staff to go out and drum up interest.
On a recent afternoon, Shawna Fariyike stood at a covered table inside a gym inside a public-housing facility in West Tulsa. ConnectFirst was one of 20 nonprofits taking part in the family event, which drew a stream of kids who lined up for face painting and candy. The housing project is one of the oldest and most deprived in the city, but it had just gotten good news: a $30 million federal grant to rebuild it and regenerate the neighborhood.
As a family advocate, Ms. Fariyike’s goal is to sign up new mothers and mothers-to-be. “We’re just getting out into the community now,” she says, scanning the crowd of mostly older caregivers and school-age kids. Working mothers are probably still at work, she reasons.
Eventually Fariyike spots a woman with a telltale bump and hurries over to make her pitch. She returns smiling with a completed form and drops it in a safe box. Another name to call. Another child to follow.