The Marathon County Start Right program, led by Children’s Service Society of Wisconsin, aimed to improve maternal and infant health outcomes by expanding culturally and linguistically responsive home visiting services for families of color in rural Marathon County. Recognizing the disproportionate impact of systemic racism on communities of color—including reduced access to care and increased risk for poor maternal and child health outcomes—this project sought to strengthen family support and reduce disparities through comprehensive, evidence-informed programming.
Over the course of the grant, 18 Spanish-speaking families received personalized home visits, developmental screenings and parenting education using the Parents as Teachers curriculum. Services were tailored to each family’s unique circumstances, covering topics such as postpartum care, child development, nutrition, mental health and parenting in a new cultural context.
The Challenge
Marathon County faces significant geographic and demographic challenges that limit access to early childhood and family support services, particularly for underserved Hmong and Hispanic families living in rural areas. Children’s Service Society of Wisconsin has provided home visiting services through the Start Right program since 1994 and is the only home visiting program available in the county, which spans over 1,500 square miles. As a result, many families in isolated areas are unaware of this resource to support maternal, child and family well-being.
The demand for culturally and linguistically appropriate services is growing rapidly. In western Marathon County, the Hispanic population has doubled over the past decade, and the region is home to more than 10,000 Southeast Asian residents. The city of Wausau has the second-largest per capita Hmong population in Wisconsin, with 12% of its residents identifying as Hmong. Despite these shifting demographics, the capacity to provide language-specific home visiting services remains limited.
Barriers related to language, legal status, and trust in institutions further complicate access to care. Many Spanish-speaking parents are hesitant to participate in programs that involve home visits due to fears around immigration enforcement. However, trust is greatly improved when services are provided by someone who speaks their language and understands their cultural context. Hiring bilingual, culturally responsive home visitors is therefore essential to overcoming these barriers and ensuring families receive the support they need during the critical early years of a child’s life.
Project Goals
The goal of this project was to expand and strengthen the Start Right home visiting program to reduce racial and ethnic disparities in maternal and child health in Marathon County. By hiring a 0.90 FTE bilingual Spanish-speaking home visitor, Children’s Service Society of Wisconsin aimed to reach more Hispanic families in rural areas and provide culturally responsive, trauma-informed support to those facing barriers such as poverty, trauma and limited access to care. Key goals for this project included:
Increase access to care by providing personalized home visits to families from pregnancy through age five, supporting maternal health, parenting skills and child development.
Improve outreach and engagement through partnerships with H2N and tailored recruitment strategies to enroll families most at risk.
Support whole-family well-being through education, postpartum care, referrals to medical and mental health services and connections to community resources addressing social determinants of health.
Enhance parenting capacity using the Parents as Teachers curriculum and evidence-based tools that build confidence and promote healthy parent-child interactions.
Identify and respond to needs through regular screening and goal setting to monitor child development, family stability and early intervention needs.
Results
Children’s Service Society of Wisconsin was able to continue offering high-quality, culturally responsive home visiting services to 18 Spanish-speaking families living in rural Marathon County. All participating families received education on parenting and early childhood development, as well as comprehensive case management support. Many of the mothers served were undocumented and navigating complex barriers to care, with seven being first-time parents and two beginning services during pregnancy. Eight fathers also participated in some home visits, helping to promote more holistic family engagement.
One of the project’s most impactful outcomes was the role of the bilingual home visitor as a trusted advocate. She provided critical assistance with navigating health systems, accessing WIC, scheduling medical appointments without insurance and connecting families to essential services like food, housing and postpartum mental health care. She also intervened in legal matters, helped families experiencing safety threats and provided emotional support in times of trauma. In addition to direct support, the home visitor empowered families to build their self-advocacy skills, engage in English classes and better understand parenting norms and laws in the U.S. She promoted healthy child development through the Parents as Teachers curriculum and addressed concerns such as developmental delays, nutrition and family safety.
Over the course of the year, all project activities met or exceeded their targets. Families received individualized education, regular developmental screenings (including ASQ-3 and ASQ-SE), postpartum assessments using the Edinburgh scale and referrals to services such as Health First, FoodShare, BadgerCare, Rebecca’s Closet and other local organizations.
Looking to the Future
Looking forward, Children’s Service Society of Wisconsin remains committed to advocating for continued investment in culturally grounded maternal and child health programs that meet families where they are and foster resilience, equity and early childhood success.
Lasting Impact
While the project achieved many successes, sustainability challenges placed the program at risk. Due to unexpected funding losses, the program was unable to hire an additional Spanish-speaking home visitor and instead used grant funds to maintain the position of the current home visitor. Unfortunately, the home visitor left her role in late 2024 after securing another position, leading to the early closure of all open cases and the suspension of the home visiting program for Spanish-speaking families.
Despite this setback, the program demonstrated the profound impact that culturally and linguistically appropriate home visiting can have on families navigating poverty, trauma, and immigration-related barriers. The relationships built, services delivered, and advocacy provided helped amplify the voices of families who are often overlooked by traditional systems of care.
