Traile Easland provided her first home nurse visit with Welcome Every Baby nearly 20 years ago.
At first, she said she didn’t know what she was getting into as it felt like there wasn’t much of a plan when nurses approached new families.
“I went back to my supervisor and said, ‘If I’m going to work for this program, I’m going to make it uniform,’” Easland said. “I’ve worked hard to make sure we all follow the same protocol, but I wanted every family to know a WEB [Welcome Every Baby] nurse was coming, and by the end of this program that was what we became. We all provided quality service and the golden standard of what a nurse home visit should be.”
WEB was a free postpartum nurse home visitation program for all Santa Barbara County families not already enrolled in a program, usually serving families who delivered at Cottage Hospital in both Santa Barbara and the Santa Ynez Valley and at Lompoc Valley Medical Center.
“Every visit is going to be different in a way because every family is different. We are trying to help identify and provide support and education for each family’s unique needs,” Easland said.
Nurses did a head-to-toe assessment on the baby, and checked vitals, blood pressure, temperature, and heart rate. They asked the mother how her labor and delivery experience went, how her parenting was going so far, and about her adverse childhood experiences and screened her for prenatal mood and anxiety disorders.
“We are all international board certified lactation consultants, so we do a lot of lactation support and education,” she said. “We get families connected to any resources they might need.”
WEB opened in 2001 and served more than 18,000 families. Although families praise the program and many people believe it’s essential to the community, unsustainable funding models caused the program to shut its doors on June 30—with Easland providing WEB’s last postpartum home visit.
“I thought one of my other nurses was going to do the last visit, but I got two calls last week and I couldn’t not go,” Easland told the Sun on July 6. “Doing the last home visit was kind of like putting a tidy bow on everything. It broke my heart because it … cemented the fact that we need to have this service in the community.”
While Planned Parenthood and other stakeholders are looking at how to set up another universal postpartum visitation program in the county, Easland said she worries about the gap in services and the new program’s quality of service.
“We identify concerns of infection, dehydration levels, jaundice, and many areas of health concern anyone less [than] a nurse would not be able to identify right then and there, which would then prolong getting help,” she said. “Whatever and whoever steps up to the plate, I hope that it is following a nurse model.”
WEB fell under the Santa Barbara County Education Office (SBCEO) and wasn’t considered a health care provider so it couldn’t bill private insurance for its service and relied on First 5 Santa Barbara County and other private philanthropic organizations for funding, Easland said. Throughout the years, WEB tried to partner with other home health entities or become its own health care agency, but neither worked out.
“It was never really meant to stay at the Santa Barbara County Education Office; it was always meant to move under a medical provider to figure out the reimbursement billing,” said Michelle Robertson, assistant director of First 5 Santa Barbara County.
First 5 Santa Barbara County provided funding for WEB as part of a program supporting infant immunizations, which consisted of a nurse home visit, she said.
First 5 contributed about $1 million a year to WEB in the early 2000s. At that time, First 5’s annual budget was $6.5 million per year, Robertson said, but the nonprofit’s funding stems from tobacco products’ sales tax. As consumption has decreased so has the organization’s budget, which is now about $2.9 million per year.
“Proposition 30 passed in California, which is a ban on flavored tobacco—which are in vape products—which is again a good thing because we don’t want teen smoking, but it severely affects all of the funding across First 5 in all California, and there’s nothing to replace that revenue that’s been lost at this time,” Robertson said.
As a result, First 5 had to re-create its strategic plan to stretch fewer dollars further, she said. Now, it solely focuses on kindergarten readiness and making sure that children are transferring from early childhood into the K-12 learning system. The organization mainly works with school districts to help them with early learning plans now that universal transitional kindergarten is coming online in California, she said.
“[WEB’s] a really wonderful program … it’s just we are looking countywide for moving the needle,” Robertson said. “The outcomes and indicators in our new strategic plan didn’t align any longer. We had invested in the program for 20 years, and it was time to move on and have the health care industry fix that.”
Hosting a program like WEB under a health care provider that could bill for insurance would greatly impact its long-term sustainability, said Jon Clark, president of The James S. Bower Foundation.
The local, private, independent foundation funds end-of-life care, environmental work, and youth and early childhood development. Because of the foundation’s emphasis on childhood development, it invested in WEB starting in 2007 and provided at least $850,000 total, he said.
WEB’s been on the financial edge more than once, with initial concerns rising five or six years ago, Clark said. When WEB expressed financial concerns again this year, the foundation conducted a study to see why.
“WEB, or whatever it evolves into, needs a new home that has the capacity to bill medically and fundraise, including from families served by WEB,” Clark said. “This hole of private insurance coverage … it’s an issue for sure. That’s been a big miss for a long time and a head-scratcher for a long time.”
WEB also served predominantly affluent families, and while the study reported that many families loved WEB, Clark said there weren’t a lot of efforts to ask for donations.
“This is understandable, especially since SBCEO is a government agency. Many philanthropic donors resist the idea of funding the government, and likewise, government agencies are understandably not well equipped to fundraise,” the foundation’s study states.
The study also reached out to several local health care providers who could potentially take on WEB or develop a similar program, and only one organization responded, Clark said—Planned Parenthood.
“The theme was, ‘Why would I adopt a program that’s in financial trouble again?’ I think organizations need to be able to see a mechanism for billing for some of it and see that the fundraising part fits into what they are doing,” Clark said.
Planned Parenthood stepped up because WEB’s services aligned with the organization’s mission to improve reproductive health outcomes, said Jenna Tosh, president and CEO of Planned Parenthood of the California Central Coast.
“Health data shows nationally that trends are going in the wrong direction for maternal health,” Tosh said. “Improving infant and maternal health is an important part of reproductive health, and programs like Welcome Every Baby are a really important strategy to improving disparities.”
Tosh said that Planned Parenthood is beginning to create its postpartum nurse visitation program that will be available to all families and will be very similar to WEB’s program, but it will be led by its chief medical officer and the medical team.
As a licensed and certified health care provider, Planned Parenthood also has the infrastructure in place to bill private insurance companies, establish medical records, and collect data needed in order to get additional funding.
“There will be a gap in the community as a result of WEB ending its services. We are developing the program model, hiring staff, and establishing partnerships in order to have this in the community as soon as possible. Our goal is to have services about a year from now,” Tosh said. “This is an opportunity for us to engage more deeply in reproductive and health equity and … to improve community health.”
Reach Staff Writer Taylor O’Connor at toconnor@santamariasun.com.
This article appears in Jul 13-23, 2023.