The Parent Trainers:

A Nationwide Study of Home Visitation Programs

 

National Physicians Center

May, 1999

 

 

The U.S. Department of Health and Human Services documented 3 million reports of child abuse or neglect made to authorities in 1997.  Of these, 963,870 were classified as either substantiated or indicated.  This represents the fourth straight decline in substantiated/indicated reports since these reports hit a record high of 1,018,692 in 1993.[1] While this reported decline in abuse is encouraging, the fact that nearly a million known cases of child abuse and neglect occur in the United States every year is a human tragedy that demands our attention.

 

The strong desire to “do something” has led many activists concerned about children’s issues to promote the implementation of universal home visitation programs that would teach parenting skills to new parents and monitor these families for potential abuse.

 

The leading advocate of home visitation as a means of preventing child abuse is an organization called Prevent Child Abuse America (PCAA).  The centerpiece of PCAA’s current efforts is a home visitation program known as Healthy Families America (HFA). The HFA model targets families determined to be “at risk” for committing child abuse.  However, the ultimate goal, according to Deborah Daro (former research director for PCAA) “is to bring home visitation services to all new parents.”[2]

 

The Healthy Families Model

 

Healthy Families identifies new mothers in the hospital by:

 

·        screening the medical records of new mothers for 15 risk factors said to be associated with abuse

 

·        interviewing new mothers in the hospital if two or more of the risk factors are present

 

·        administering a questionnaire during the interview called the Family Stress Checklist designed to explore the mother’s family history and her emotional and psychological state

 

·        classifying the family as either “high risk” or “low risk” for abuse based on the responses to the questionnaire

 

·        offering the services of a home visitor to families classified as “high risk”

 

PCAA emphasizes participation in the program is always voluntary.  However, a “high risk” mother who initially refuses the program can expect to be pursued for up to three months as HFA workers try to gain her confidence and enroll her in the program.  These “creative outreach” efforts may include numerous phone calls and visits, along with offers of free gifts, all for the purpose of gaining consent to regular home visits.  PCAA recommends a case be closed only if the mother “continues to refuse service for two to four months.”[3]

 

 

If the family agrees to participate in the Healthy Families program, they will be assigned a Family Support Worker (FSW) who will make regular visits to the home.  Ideally, visits will continue until the child reaches age five.  The purpose of these visits is to:

 

·    teach “positive” parenting skills

·    connect families with social services agencies

·    monitor the home for actual or potential abuse or neglect

 

PCAA is also developing a computer database to track all participating parents and children. 

 

Causes for Concern

 

In our fragmented society, there are likely many young mothers who would desire and could benefit from the assistance of a wise and helpful visiting mentor.  However, home visitation programs like Healthy Families present several areas of concern.

 

1.      Privacy issues.

It is unclear whether proper safeguards are in place to ensure the privacy of families and the confidentiality of medical records are properly protected in these programs.

 

2.      Voluntary and informed consent.

Mothers targeted by the program may not be given complete information concerning the program, or an appropriate opportunity to consider the offer of enrollment before accepting.

 

3.      The nature of the teaching. 

PCAA’s philosophy of parenting is not shared by all Americans.  There are legitimate concerns about the government officially endorsing PCAA’s philosophy of parenting (or any one philosophy of parenting) as one that should be taught to all new parents.

 

4.      The duplicitous role of the home visitor.

The home visitor is presented as a “helper” but is also responsible for “determining the safety of the home”[4] and making reports to authorities if “abuse or neglect or imminent harm are suspected.”[5]  Constitutional concerns arise when government-sponsored workers are, in effect, engaging in a “search” of a private home under false pretenses and without probable cause.

 

5.      Collection and use of client data.

Mothers targeted by the program may not be fully informed about how the personal data collected may be used by HFA programs.  Questions also arise about whether full consent is obtained before this data is transferred to other persons or entities.

 

Does it work?

 

Considering the serious problem of child abuse and neglect in America, some might be willing to overlook these concerns, arguing that “minor” violations of privacy and legal rights are acceptable if the program truly prevents child abuse. However, HFA programs have been studied extensively and have not shown any clear success in preventing child abuse.

 

·        In 1997 $90 million was spent on over 320 HFA programs in 42 states and the District of Columbia.  Seventy-two percent of these funds came from taxpayers.[6]  In spite of PCAA’s claims that research consistently confirms the effectiveness of these programs, no comprehensive, national evaluation of its programs has ever been conducted.

 

·    Six control-group studies have been conducted on individual HFA programs currently in operation.  Five of the six studies failed to show conclusively that the program had a significant impact on child abuse rates or measures of child abuse potential among first-time mothers enrolled in the program.  The sixth study used a method of calculating child abuse rates that makes its findings ultimately inconclusive. 

 

·    No well-constructed control-group study of an HFA program has shown clear success in reducing child abuse rates or measures of child abuse potential in a given target population.

 

Conclusion

 

Child abuse is a serious issue that should receive ongoing attention and our best efforts at finding solutions.  However, using a one-size-fits-all formula, such as home visitation, to address the complex problem of child abuse is neither cost effective nor logical.  The enormous cost of universal home visitation programs may actually put more children  “at risk” as funds are diverted from already overburdened Child Protective Services agencies. 

 

Effective strategies to deal with the problem of child abuse and neglect must begin by reforming the current child protection system to insure that child safety is the top priority. Limiting time in  foster care and providing permanency through adoption and private group homes / “orphanages” are viable alternatives to the present system.  Prevention efforts such as voluntary family education classes and community-based respite care centers should be promoted in order to intervene before abuse occurs.

 

These are promising alternatives to the intrusive and costly home visitation programs that have been shown to be failures in scientific studies.