Why early childhood home visits are cause for celebration in R.I.
Elizabeth Garganese, RN, is a nurse in the First Connections program at Children's Friend, helped connect Maryam and her son Eli with a pediatrician and ongoing education and support. Only the first names for the family are used here to protect their privacy. (Photo by Rise To It Productions, Courtesy of Children's Friend)
I am a nurse in the First Connections program at Children's Friend. I recently spoke at Home Visiting Day at the Rhode Island State House and joined Rep. Joshua Giraldo, a Central Falls Democrat, on the floor of the House for the reading of a resolution commemorating May 8 as Home Visiting Day. Home visiting programs are designed to support families during the crucial early days and years of a child's life. Nurses like me, along with social workers and family support specialists, bring our expertise directly into a client's home — making home visiting one of the most accessible forms of support available to new parents.
Unfortunately, most new parents don't even know this kind of help exists.
Last year, the Rhode Island Legislature included updated rates for First Connections in the fiscal year 2025 budget, which effectively saved the program. I am incredibly grateful for this investment. However, significant challenges remain.
Uncertainty at the federal level, combined with Rhode Island's shift to a new fee-for-service Medicaid model, continues to strain our ability to deliver services. That's why passing the RI Home Visiting Act (H6073/S677) is more critical than ever. This legislation would require the state to invest enough to qualify for the maximum federal match. The federal government contributes $3 for every $1 contributed by the state. If the state allocates $356,000 for family home visiting in the fiscal year 2026 budget, that would generate $1.1 million in federal funding. Right now, Rhode Island is one of just three states leaving that money on the table. The other two states are North Dakota and Tennessee.
I believe the lack of investment is simply a lack of awareness. More people need to understand just how vital these programs are. First Connections provides peace of mind and essential support to new parents across the socioeconomic spectrum. This includes addressing the mental and physical health needs of postpartum mothers.
Through First Connections, I've visited families who needed help with the basics: safe sleep, breastfeeding, diapering. I've also walked into homes where mothers or babies were in acute medical crisis: dangerously high blood pressure, infant dehydration, undiagnosed postpartum mood disorders, infected C-section incisions. In those cases, serious illness — or even death — could have been the outcome. But it wasn't, because First Connections was there. Being able to guide and intervene at such a critical moment in a family's life is deeply fulfilling.
I believe the lack of investment is simply a lack of awareness. More people need to understand just how vital these programs are.
First Connections is a short-term program, which covers up to three visits. It's crisis management and an essential connection to longer-term resources for many families. At Children's Friend, nearly 40% of the families we serve through First Connections are referred to longer-term home visiting programs, like Healthy Families America and Early Head Start. In some cases, we also refer older siblings for Early Intervention services after observing developmental challenges in their home environment.
Take Maryam's story for example:
We visited Maryam and her family just days after she gave birth to her son, Eli. Our priority was making sure both mom and baby were safe and healthy. For Maryam, that meant helping her get to a doctor to refill a critical medication for a pre-existing condition. For Eli, we secured a pediatrician and helped resolve a health insurance issue caused by an error on his birth certificate. We also made sure the older children were safe by installing locks and screens on windows and doors.
Without First Connections, Maryam's health and Eli's development could have been seriously at risk. For Maryam and Eli, three visits weren't enough, so we connected the family with Early Head Start, a longer-term home visiting program at Children's Friend. Now, the entire family receives ongoing education and support alongside other families with young children.
According to a report by the Department of Health, we are only reaching a quarter of the most vulnerable children in our state through home visiting programs. My hope is that awareness will improve participation in these life-changing programs.
I consider nursing my life's calling. Through home visiting, I'm not only helping to ensure the immediate health of moms and babies, but I'm working to build stronger, healthier futures for entire families.
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