First Born Program Overview

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First Born Program

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To learn more about implementing a First Born Program in your community, contact Jennifer Sallee at firstborn@sfcc.edu



First Born Program Overview

  • Introduction
  • Essential Program Elements
  • Home Visiting
  • Outcomes
  • Evaluation
  • Annual Report

The First Born® Program (FBP) has its roots in Michigan and was established in l997 in Grant County, New Mexico through a comprehensive community-based collaborative process. The program's central office is located at Santa Fe Community College in Santa Fe, New Mexico.

The Program's mission is to increase the health and wellness of women pregnant for the first time, families parenting for the first time, and families adopting their first baby. FBP provides mothers, fathers and primary caregivers with education, support and service coordination. FBP is curriculum-based and relationship-centered. FBP was named one of the nation's 10 most innovative and exemplary prevention programs in 2002 by the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Prevention and several other collaborating national agencies.

Through weekly home visits, families identify their personal goals and learn to build upon their strengths, recognize challenges and opportunities for growth, and establish healthy relationships whose effects will last a lifetime. At the core of the program is the conviction that a healthy pregnancy and healthy baby are not only critical to the immediate well being of mother and child but are also basic to the long-term health and success of family and community. The most effective and efficient unit for building a competent society is a bonded, resilient and competent family.

The expanding knowledge of human growth and development in the earliest years teaches us that children are born learning. We know that children’s success in preschool and beyond is built on the foundation of relationships, experiences, and skills they develop in their first three years of life. With exposure to the First Born Program, infants and toddlers grow into preschoolers with solid social, emotional, language and literacy skills that provide the foundation for later academic success. By investing in newborns at birth, when they begin learning, we believe that we can change the lives of individual children today and for years to come.

The First Born® Program (FBP) is a unique home visiting program designed to meet the needs of first-time families. All services are free, voluntary and offered to all women pregnant for the first time and first-time families within the program service area regardless of economic or health status.   Services may begin at any time during pregnancy or at the birth of the baby and may continue until the child is 36 months.

The FBP approach to promoting health is a paradigm shift from the way that healthcare services are typically delivered in New Mexico and in the rest of the U.S. The FBP represents a reorientation of child and human services toward early investment and prevention away from attempting to “treat” poor outcomes later in the life cycle.  Research suggests that shifting resources towards investment early in children’s lives produces better outcomes, save taxpayers’ money, and improves the quality of life.
The success of the First Born Program is based on the following Best Practices program characteristics:  

1.  Relationship-based approach
At the core of any successful home visiting program are relationships because all human development occurs both through and within relationships.  This approach supports and respects each family’s unique abilities as well as their ethnic, financial, cultural, and linguistic diversity.  All goals are family-driven. 

2.  Screening and assessments
Because infancy and early childhood are times of rapid growth and development, the First Born Program completes assessments and/or screenings at regular intervals to ensure that children and their caregivers are integrated into each community's continuum of care.

3.  Inclusion of parents/other family members
Because infants and toddlers are profoundly influenced by their parents, other family members, and their community, services are integrated with their families and community.

4.  Staff/family ratios
Caseload size allows home visitors to devote adequate time to plan and build strong relationships with children, families and community.

5.  Staff knowledgeable about very young children
The First Born staff is knowledgeable about infant and toddler development and is experienced in working with children and their families.  The First Born training protocols are comprehensive.

6.  Staff supervision and training
First Born staff receives weekly one-on-one supervision and on-going training opportunities and continuing education. 

7.  Core Curricula
The First Born Program has comprehensive and flexible core curricula written specifically for FBP.  The scope of the curricula includes the prenatal period, the first year of life, and the toddler years. The curricula are copyrighted, updated frequently, and are based on current prenatal and early childhood research.

8.   Multidisciplinary Coordination
For families involved with more than one service provider, services are provided in a coordinated fashion.  

9.   Intensity of services
Services are offered initially on a weekly basis to meet the needs of families.  Service intensity may increase or decrease to meet the changing needs of families.

10.  Transition planning
Transitions from hospital to home, from FBP into a more intensive intervention program or from FBP into a program designed for three-to-five year olds are carefully planned to ensure continuity of services for the child and family.

11. Strong evaluation component
Independent, external program evaluation has been a priority and key component of the First Born® Program since its inception.   The Program has been evaluated by New Mexico State University’s School of Social Work; the RAND Corporation is currently conducting an outcomes evaluation of the Santa Fe County First Born Program.

First Born® Program Home Visits (FBP) are designed to increase knowledge, skills, and insights during the prenatal period and the first three years of a child’s life.

Families learn about:

  • Physical and emotional changes during pregnancy
  • Expectations of childbirth
  • Breastfeeding
  • Encouraging infant growth and development
  • Nurturing positive relationships
  • Creating safe and stimulating environments
  • Selecting toys and books that teach
  • Discovering community resources
  • Working toward solutions for family challenges
  • Opportunities for continuing education and on-going learning


Services are delivered by a well-trained professional staff that is diverse in age, culture, ethnicity, language, education, experience and economics. The staff is an effective combination of degreed professionals (e.g., registered nurses, clinical counselors) and non-degreed professionals who provide support, education, assessment, referral and advocacy for participating families.

While there are many home visiting components that may be offered, the most effective delivery of information occurs when services are matched to the individual family's needs through the planning process. FBP services are carefully chosen and occur within the context of a trusting relationship where learning and behavioral change can occur. Families are linked to the community’s systems of care and all services are coordinated.  Strict confidentiality is maintained throughout the family’s participation with the Program.

Building strong relationships is at the center of the home visits -- strong relationships between the family and their child, strong relationships between the family and their home visitor, and strong relationships between the family and their community.  A healthy pregnancy and childhood are not only critical to the immediate well being of the child but are also basic to building a resilient family and healthy community.

A major appeal of the First Born® Program (FBP) is its promise of effectiveness and its ability to enhance the lives of children and their families who receive program services. First Born will continue to have these effects only if it is implemented according to the original program design.  Staying true to the original program design is what assures program fidelity.

It is expected that each community will put its own "spin" on First Born -- some adaptation to accommodate differences in each community is to be expected. While adaptations may be justified, changes to the content, duration, frequency, and delivery style of the program may diminish First Born's effects.

Communities that implement the FBP with fidelity can expect the following outcomes:

An increase in the number of resilient pregnant women who:
  • Do not use alcohol, tobacco or other harmful drugs during pregnancy;
  • Receive consistent prenatal care;
  • Participate in childbirth classes; and
  • Deliver healthy, full-term babies.

An increase in the number of resilient infants who:
  • Are born full-term and healthy;
  • Do not experience Adverse Childhood Experiences (ACEs), including abuse and neglect;
  • Are exclusively breastfed for six months;
  • Are immunized and receiving well baby checks with a medical provider;
  • Ride in safe car seats;
  • Live in a safe and nurturing environment that promotes school readiness and a lifelong joy of learning;       
  • Are achieving normal infant growth and development or are referred for assessment; and
  • Are bonded with and have positive relationships with their parents and caregivers.
  An increase in the number of resilient parents who:
  • Are bonding with their infant and have positive interactions with their infant;
  • Are creating a safe and nurturing environment for their infant that is free of domestic violence;
  • Are increasing their knowledge, skills and insights into the parenting process;
  • Are experiencing pleasure in parenting;
  • Are screened for Post Partum Depression and referred accordingly;
  • Are continuing their education;
  • Space their second births; and
  • Know what formal and informal community resources are available and how to access those services.

A resilient community that:
  • Is active in the community health improvement process;
  • Participates in collaborative efforts; and
  • Forms broad-based community coalitions and alliances that support collaboration.

Independent, external program evaluation has been a priority and key component of the First Born® Program since its inception in 1997.   It is through responding to assessment data that the program is able to improve and evolve.

The program has been evaluated by Ivan de la Rosa, Ph.D., School of Social Work, New Mexico State University. The results of those evaluations appear in two peer-reviewed journal articles.

In 2002, the First Born Program was named one of the nation's 10 Most Innovative and Exemplary Prevention Programs by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP) and other collaborative national agencies.

The RAND Corporation is currently conducting an evaluation of the First Born Program model.  When results are available, the findings will be disseminated to policymakers and the research communities in New Mexico and across the country. Dissemination of findings will focus on publishing journal articles in addition to presentations at professional meetings. The RAND Corporation will produce a series of articles on different aspects of the findings, such as lessons learned from implementation in all FBP sites, birth outcomes, outcomes for one- and two-year-old children, and cost effectiveness.