YAKIMA, Wash. — “What are some things that worry you about your baby?” “What’s something you enjoy with your baby?” “When you speak to your baby, does she look at you and smile?”

Nurse Ana Laura Castilla went through the checklist with Cruz Pacheco, while Pacheco’s husband, Rafael Ortiz, bounced their baby, Amelia, on his lap next to her. One of Pacheco’s older children passed through the living room, stopping to say hello to Castilla and shake her hand politely in greeting.

As part of the Partnering with Families for Early Learning (PFEL) program, Castilla has been visiting with Pacheco’s family at least twice a month for the past year and a half, starting when Pacheco was pregnant with Amelia. She coaches them on building a strong bond with the baby, setting boundaries, even the importance of a healthy relationship between Pacheco and Ortiz.

“I’ve learned so much that I never knew before,” Pacheco said in Spanish. “It’s much better than before.”

PFEL is one of three home-based early learning programs that wrapped up a five-year funding period from the Bill and Melinda Gates Foundation and nonprofit Thrive by Five Washington in June, which allowed them to focus services on high-risk families. Thrive by Five is the state’s public-private partnership for early learning.

The three programs are now looking for grants to continue to expand services because of the positive results they’ve seen from home visits.

“Home visiting works because you are meeting the family where they are,” said Marilyn VanOostrum, nursing supervisor of the Nurse-Family Partnership, a program that works solely with first-time moms and has been in Yakima County for a decade.

“In the office visit, a provider might have 15 minutes, might have 20 minutes; you’re in the provider’s environment,” she said. “But in the home, we are a guest in their home; we are coming where they are and spending an hour, an hour and a half with them, and understanding how those behavior changes (are) playing out in their daily life.”

Three home-visit programs received the funding. Nurse-Family Partnership, a collaboration between Yakima Valley Memorial Hospital and Yakima Valley Farm Workers Clinic; Parents as Teachers, offered by Catholic Family and Child Service; and PFEL, which is operated by Memorial, Farm Workers and Yakima Neighborhood Health Services.

Nurses and parent educators meet with every family twice a month — more frequently at certain points of child development — and take them through specific curriculum designed to pinpoint parenting strengths and areas that need improvement.

The project targeted a few neighborhoods in east Yakima with high rates of poverty and at-risk pregnancies. Families have to be Medicaid-eligible to enter the programs. Federal poverty level is currently $23,550 annual income for a family of four.

In the last five years, Nurse-Family Partnership served 65 families in that target area, Parents as Teachers served 194 and PFEL served 293.

Total, the Gates Foundation and Thrive by Five invested about $15 million in Yakima. The money went toward nurse and parent educator salaries, as well as improvements in local child care centers.

All three aim to give parents better techniques to care for and teach their children, with the goal of preparing kids to enter school at age 5. Parents as Teachers has a particular focus on brain development and gives out thousands of children’s books for families to keep.

Parents are encouraged to read with their kids, spend quality time together, be consistent with discipline and let their kids know they’re there for them.

For some new moms, nurses say, this is the first time they learn to truly love their child.

“Children who have a secure attachment with their parents are sure of themselves and able to explore because they’ve got a safe base in their parent, and they become kids able to open up and trust and get excited and interested in things,” said Mary Hart, program coordinator for the group of home-based early learning services in Yakima.

By kindergarten, she said, kids have already been molded.

Research shows the first three years are most crucial in establishing positive behaviors, so home visits start with moms before the child is born and follow them until the child is at least 2.

In completing these programs, Hart said, “The parents have gotten the message to work with them and interact with them and talk with them, not watch television. You’re going to have kids that go in (to school) with bright brains ready to take it in.”

Besides encouraging strong parenting skills, all three programs help the parents navigate education and work opportunities, whether it’s getting a high school diploma, GED or job interview.

The programs also teach families when to take their children to a primary care doctor instead of the emergency room, which helps save medical costs to the taxpayer too, nurses say.

The 552 families who received services during the past five years show promising results beyond establishing strong relationships between mother and child.

In Nurse Family Partnership, where the average age of the mother is 17, half the clients have completed high school or gotten their GED, while another nine are still in school.

Nurse Family Partnership and PFEL also saw high rates of breast feeding and of kids with up-to-date immunizations. Most clients quit or reduced smoking and reported lower stress levels than before entering the program.

Many were able to find jobs or go back to school.

Castilla, the PFEL nurse, said that in working with their new babies, mothers are also improving their relationships with older children.

“We are seeing ... what people would have thought is something people can’t change,” she said. “It’s really hard, but it’s making a world of difference for these families.”

Castilla hopes the program will continue to have funding, because those changes create an impact beyond the individual families.

The programs are funded through a combination of state, federal and private money, but PFEL, at least, is only funded through this fall.

Nurse Family Partnership has obtained other grants to continue at its expanded capacity, but those funding streams are not necessarily permanent.

“Like it or not, these kids are going to grow up and they’re going to be our future,” Castilla said. “If we don’t care about it, it’s going to look pretty sad and poor, but if we take time to invest in it more, we’re going to be looking at, thriving children who are going to be successful, stable adults.”

• Molly Rosbach can be reached at 509-577-7728 or mrosbach@yakimaherald.com.