One of R.I.’s most critical programs for newborns is at risk of folding

Family Service of Rhode Island’s First Connections program helps new mothers and babies facing a wide variety of infant mortality risks. But despite growing need, state funding has been stagnant for more than two decades.

Debra Quinton (left), the nurse supervisor and director of First Connections at Family Service of Rhode Island, worked with Jackie Mallette, an early intervention occupational therapist, on a CPR course for infants.David L. Ryan/Globe Staff

PROVIDENCE — For two years, Steffy Molina had traveled to doctor’s appointments, school meetings, and connected social support services for dozens of families in Rhode Island. In many cases, while working for Family Service of Rhode Island, she served as an interpreter for those who did not speak English but also as an advocate for these newborns and young children.

It was a rewarding job for her as a new college graduate and as someone who didn’t speak any English herself when she moved to the United States with her family at 17.

But she was making $16 an hour, and it was hard to keep up with her bills. She left Family Service in 2019 for another local nonprofit where she could still work with families and receive a significant pay bump. This past year, she joined a for-profit health care technology company. She likes her new job, but she misses being able to work with families in need.

“I realized that the further away I got from working with families directly, the more money I could make,” said Molina, whose Guatemalan father and Bolivian mother do not speak English. “But to me, it’s heartbreaking that I even had to leave. The impact I was making on those families, for me, was personal.”

But the price of living made it impossible to survive.

When Steffy Molina graduated college in 2017, she found a job that would be able to help families like hers when she first immigrated to the United States. She was hired at Family Service of Rhode Island, where she was an interpreter for Spanish-speaking families and first-time moms at doctor's appointments and school meetings.David L. Ryan/Globe Staff

Molina had helped as an early intervention specialist with FSRI. Both the early intervention programs and First Connections program help new mothers and babies facing a wide variety of infant mortality risk factors. Hospitals identify the families that could be vulnerable — whether they are young moms, first-time moms over 35, are housing insecure, jobless, have state health insurance, or have substance abuse issues, among several other “risks” — and First Connections is the program that helps screen these families. Throughout the pandemic, case managers and workers went into people’s homes to service their clients.

It’s a critical service, and it’s reached a point where it’s so severely underfunded it’s at risk of folding. Despite the exponential need for support services that many of the state’s nonprofit organizations — like First Connections — provide, their leaders also are up against for-profit companies offering their skilled workers more “livable wages.”

State reimbursements cover two registered nurses, but First Connections employs four, “which is still short by about two or four” based on demand, according to executives. While some states frequently adjust reimbursement rates to reflect changing wages or use federal aid money, Rhode Island has not adjusted reimbursement rates for the program in 22 years. Margaret Holland McDuff, the chief executive of FSRI, said it is paying for additional community health workers for this program from donor dollars and grants because the need is so great.

And because of this, FSRI is running a “well over $300,000″ deficit this year, McDuff said.

“And it makes it really difficult when we keep having to go back to the same donors all the time, asking for more money because the state isn’t providing it,” McDuff said.

Donated clothes for families sat piled on desks in the Family Service of Rhode Island office.David L. Ryan/Globe Staff

McDuff said she asked Governor Dan McKee to fill the 2022 funding gap immediately, raise rates for 2023, and establish a rate-setting process to prevent this workforce crisis from happening again. McKee unveiled his budget on Thursday but did not include increases for First Connections. A spokesperson from the governor’s office did not respond to Globe inquiries.

“It is devastating, and we will be working with the Legislature to help these vulnerable infants and families,” McDuff said.

It’s not just the Family Service of Rhode Island that is feeling the pressure.

Other nonprofit human service organizations have reported experiencing an “unprecedented workforce crisis” that’s directly negatively impacting the lives of vulnerable children and families in Rhode Island. McKee’s RI Rebounds allocates federal funds to invest $119 million into the state’s housing plans and small businesses, among other items as a “downpayment,” but it doesn’t include First Connections.

In 2021, First Connections received more than 2,500 referrals and has responded to all of them with a team of eight direct-service providers. So each First Connections provider is dealing with an annual caseload of about 315 referrals.

Debra Quinton is a registered nurse, certified lactation counselor, and director of the program. She’s been with FSRI’s First Connections program for the last 12 years and said “everything has changed” since she started.

Quinton said the program went from checking in on first-time moms with breastfeeding to making sure kids have had their lead screenings, that a toddler went to the dentist, that babies had their hearing screenings (and if not, to help schedule an appointment), asking about smoke detectors in the home, checking on a mom’s mental health, providing resources about where to get food, connecting parents to WIC to prevent them from watering down their formula, and ensuring babies have their own cribs to prevent unsafe sleeping practices.

Debra Quinton is the nurse supervisor and director of First Connections at Family Service of Rhode Island.David L. Ryan/Globe Staff

During the pandemic, “there’s a health care crisis, housing crisis, and financial crisis going on all at once. And everyone is in need,” said Quinton, who said she works a second job as a counselor for the early intervention program Looking Upwards just to support her family. “It makes it much harder when everyone turns a blind eye to these systems until they’re broken. Then the people like me and my coworkers are blamed for the broken system.”

About a decade ago, Quinton said the program would receive about 10 referrals each week. Just between Monday and Tuesday of this week alone, she received nine COVID-19 positive referrals and 16 from the hospital. McDuff said they received 70 referrals in a week at the beginning of January. Each admission visit takes about an hour, not including the hour to hour-and-a-half it takes to do the paperwork for each family. And the week isn’t over yet.

When asked if she’s afraid of leaving children behind due to overwhelming demand, she said, “We are a critical program that has been pushed to the side.”

“We are the most underfunded, forgotten, invisible program that’s a catch-all for all the vulnerable kids in need in the state,” Quinton said. “It’s absolutely terrifying what is happening in front of my eyes.”