Know A Good Doctor? We Do.


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Becoming a parent can be a life changing experience. There is no way to know just how challenging, rewarding, and frustrating parenthood will be. Kentucky’s Health Access Nurturing Development Services (HANDS) is a free, voluntary program that pairs parents with skilled and trained professionals. Starting before the baby arrives these trained professionals – nurses and family support workers – visit parents at critical prenatal and early childhood development points, where they provide health information, training in problem solving techniques, and parenting skills development. HANDS visitor’s also help new parents fulfill their basic needs such as food and housing. Visits cover healthy eating habits, baby-proofing the home, bedtime routines, importance of well-child visits and immunizations, and community resources.

HANDS, which began in 2000 under Kentucky’s Department for Public Health, remains one of the largest early childhood home visitation programs in the nation, making over 16,000 home visits each month. Close to 11,000 families participate in the program each year. The program is offered at no-cost to parents. The program serves all 120 Kentucky counties for first time parents and is now serving families with more than one child in 78 Kentucky counties. HANDS services must begin during pregnancy or before the newborn reaches three months old.

Families at risk for a range of negative outcomes, such as low birth weight, preterm infants, financial difficulties, poor parenting skills, child neglect, substance abuse, and domestic violence, begin the family intervention prior to birth and continue through the first two years of the child’s life, when brain development is occurring most rapidly. Home visits begin intensely then taper as important milestones are reached, parenting skills improve, and self-sufficiency is established. HANDS promotes positive health-related behavior and infant care-giving, in addition to providing social support and access to community resources and medical care. Quality of parent-child interaction and parental sensitivity to the growing infant’s needs, in addition to general knowledge about child development, are additional features of the program.

Karen L. Hacker, MSW, CSW, supervisor and coordinator of the Fayette County HANDS Program, says that “HANDS is a fabulous resource for obstetricians, midwives, pediatricians, and related health care professionals to refer their patients to.

“We review with parent’s baby milestones and nutrition, health promotion, the importance of immunizations schedules, regular doctor visits, breastfeeding, and even make interactive toys to stimulate brain development.”

Some first time parents feel overwhelmed with uncertainty. “We have helped pediatricians with first time parents who call the office frequently with questions. We can act as a go-between for the physicians and parents, providing assurance that some things are normal and sometimes they need to see the doctor,” says Hacker. “We have the advantage of seeing the baby in its home environment, something that physicians rarely get to see. This lets us give practical, hands on information.”

The HANDS program continues to produce excellent maternal and child outcomes. Evaluations conducted by the University of Kentucky Research Foundation examined HANDS with comparable families and noted HANDS families are 46 percent less likely to have a low birth weight baby and 26 percent less likely to experience a premature birth. Pregnancy-induced hypertension is 49 percent less likely in an expectant mother participating in HANDS and maternal complications during pregnancy are 40 percent less than comparable families. Substantiated reports of child maltreatment are 47 percent less.

“Decades of neuroscience and behavioral research indicate that the brain is constructed through a process that begins before birth and reaches a rapid pace in the first few years of life, reaching 80–90 percent of its adult size by age three.” Hacker added “responsive, caring, and supportive relationships that start at home are critical to healthy brain development. We know the first 1000 days lay the foundation for life. HANDS is there to help parents build the best foundation possible.”