I'm proud to be able to say that while not all of our visitors are
nurses, the State of Nevada is providing a program which offers home
visits at the parent's requests for any family with an infant birth to
twelve months.  Called "Family to Family Connection" it is funded as a
part of the MCH block grant appropriation, was originally funded for
only two years, and has been implemented in our area of the state for
only the last 8 months.  It comes up for review and refunding this
January when our legislators meet, so the scramble to prove our worth is
already in fast forward.

Participation in the program is totally voluntary.  Our conservative and
independent Western US citizens would certainly rise up in arms at the
thought that anyone __had to have__ a home visitor.  We recently
analyzed our third quarter statistics.  We believe we are contacting at
least 80-85% of the families who give birth each month in our service
area, so that they are aware of the program's availability.  We are
having telephone "visits" with at least 60% of the new parents within a
month of delivery, and between 20-30% of all new parents are actually
requesting at least one home visit.

We have two other components to the program, our New Baby Centers (what
an inane name), where we hold classes, workshops and "baby play
groups".  The classes generally focus on some aspect of child
development or parenting issues, children under one year are always
welcome, the setting is very informal and conversational with a goal
that families might become "connected".  Workshops are usually one time
presentations on a topic, with hands on exercises or activities for
parents to participate in with their child.  One really popular workshop
has been one called "Thinking While I Play" for moms with 8-12 month
olds.  The idea here is to show moms how various things like object
permanence, communication ability, etc are developing in this age group
and that the play activities that baby and parent engage in can
contribute to the child's development.

I'm very much enjoying my work as visitation supervisor for the "infant
support district" or ISD, which serves our capitol, Carson City, a
nearby community to the east, Dayton, and the entire Douglas County area
which borders on the southeastern quarter of beautiful Lake Tahoe.

We deal with a lot of new parent adjustment issues during home visits
and have become painfully aware of the lack of support breastfeeding
mothers experience once they leave the hospital setting.  It is my
personal goal, and I'm really happy to report one shared by key staff
members at our only hospital, to make an impact on the breastfeeding
duration/continuation rate here in the area.  At present we don't really
know what that is, but will be doing a survey soon to attempt to
determine it.  If we only had another 18 months before we have to
demonstrate our impact! instead of 18 weeks or less.

The third component is a resource lending center with videos, books,
developmental toys and children's books.

Many of the 13 ISD's have hired child development or early childhood
education people to be visitation staff.  At least two others are also
using nurses as the supervisors.  We are also supposed to be helping
families connect with other state programs already having ongoing
funding, so that the family resource centers, domestic violence
prevention programs, Healthy Kids programs through Medicaid, WIC, Nevada
Check-up (the insurance access program for uninsured lower income, not
poverty level kids), early intervention programs, etc.

The local hospital has a one time "courtesy" home health nurse visit for
new moms.  It's very medical model focused, ie, blood pressure checks,
questions about lochia, looking at infant for jaundice, etc.  There are
several nurses who make these visits and the degree of accuracy in
breastfeeding info is ok, although the info given is very scant.  At
least they don't steer them too far off course.