Santiago Concepcion Tocado rattled off vocabulary words as he identified various pictures on the cards in front of him at his Lexington home last week.
The 22-month-old is ahead of his peers — his vocabulary is far-reaching, he can count to 10 and he understands concepts like same and different. A fan of music like his musician parents, he turns to Ada Hildago to sign her a song in Spanish.
"He is so smart," Hildago said. "He will sit and have a full conversation with you."
His parents, Legna Tocado Concepcion and Yoiseh Concepcion, say part of the credit goes to Hildago, a home visitor with Health Access Nurturing Development Services, or HANDS, a state program that works with first-time parents who may need additional support.
Hildago first visited Tocado Concepcion when she was pregnant with Santiago more than two years ago. As a HANDS home visitor, Hildago has worked with the family to help them encourage Santiago's educational and social development.
Tocado Conception, a Cuban immigrant with few family members in Lexington, said Hildago was there for her when she needed advice.
"She's like our grandmother," she said. "I would recommend it to anyone."
It's that one-on-one connection that HANDS provides its clients that makes the program so successful, studies and supporters say. Originally started as a pilot program in 1998 as a way to combat child abuse, the home visitation program for first-time parents has proven to be so beneficial to parents and children that it has recently been expanded to non-first-time parents in Kentucky's neediest areas.
The program is in all 120 Kentucky counties and has served more than 60,000 families since 2000, including 10,113 families in the last year, according to statistics provided by the program. It is the largest home visitation program of its kind in the country and is funded with money from a settlement with the largest tobacco companies and the federal government. No state tax dollars are used.
The economic and health benefits for HANDS participants are impressive, according to recent studies.
Participants in HANDS have 32 percent fewer pre-term births than comparable populations, 70 percent lower overall infant mortality and 50 percent fewer emergency room visits, according to research conducted by the University of Kentucky and the University of Louisville.
Babies in the program have fewer developmental delays.
Mothers who participate in HANDS are also more likely to complete or further their education and breast-feed their babies, according to the research.
A recent study by UK showed that certain health outcomes — such a premature birth — improve after just one visit from a HANDS worker.
"The fact that we show positive outcomes with just one or more visits is a strength in itself," said Dr. Ruth Ann Shepherd, director of Maternal and Child Health for the Cabinet for Health and Family Services.
The overall goal is "to have a healthy, safe and nurturing environment," Shepherd said. "This is the most critical time in a child's life, and it will set the stage for the rest of that child's life."
Research shows that the brain's pathways are mostly developed by the time a child is 5 years old. If a parent does not work with a child before they enter school, the child will likely be behind, Shepherd said. Research also shows that children who grow up in stressed and toxic environments struggle throughout their lives.
New parents are referred to the program through a variety of sources: local health departments, medical providers and other social service agencies. There are no income requirements to participate in the program. A mother fills out a questionnaire that determines whether there are additional stresses in her life — such as past history of mental illness, drug abuse or little or no family support.
If accepted into the program, a HANDS worker visits the family once a week until the child is 1 year old, said Brenda English, director of the HANDS program. After the child turns 1, the HANDS worker visits once or twice a month until the child is 2. It is a voluntary program and costs parents nothing.
"The first 1,000 days lays the foundation for their life," English said. "We talk about everything from prenatal care, to care after the baby's born, feeding, nutrition, home safety and attachment and bonding, which is one of the most critical things for a parent and a child."
Moni Shields, a team leader with HANDS for the Lexington-Fayette County Health Department, said the program follows a national early-childhood development curriculum. But HANDS home visitors can be called on to help a family with an assortment of issues: finding appropriate child care, buying or renting car seats and cribs or accessing other needed social services.
"What we say is that every parent needs a second set of hands and that really is true," Shields said. "We act as a support."