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By Stan Watson, Ph.D.
Director of Research, Alabama Family Alliance

It is estimated that substantiated reports of child abuse and neglect only involve approximately 1.5 percent of all children. Actual child deaths as a result of abuse are a small fraction of even these cases. According to the U.S. Department of Health and Human Services, substantiated cases of child abuse and neglect have been declining for four straight years. This hasn't stopped policy makers from coming up with "big government" solutions to this rare and declining problem.

In 1991, the U.S. Advisory Board on Child Abuse and Neglect recommended that "the federal government should begin planning for the sequential implementation of a universal, voluntary neonatal home visitation system" The homes of new parents would be subject to visitors who would teach parenting skills and monitor these homes for possible abuse.

In 1992, Prevent Child Abuse America, an advocacy group, launched a nationwide initiative called "Healthy Families America" (HFA) designed to institutionalize "home visitation" child abuse prevention programs in states and communities around the country. As Deborah Daro, former PCAA research director, told Congress, the ultimate goal of this initiative "is to bring home visitation services to all new parents." This would lead America toward the day when every new parent will be assigned a government-sponsored home visitor to make weekly visits, teach government approved "positive" parenting skills, and monitor the home for possible abuse.

Such a program would be enormously costly and the necessary government funds are not yet available. Due to these "fiscal constraints" the program currently focuses its efforts on first-time parents who have been determined to be "at risk" for committing child abuse.

In spite of the "fiscal constraints," however, the program is popping up all over. According to PCAA, there are now over 300 HFA sites in operation in 42 states and the District of Columbia. They screened more than 28,000 new parents for child abuse potential in 1997 and provided "home visitation services" to nearly 18,000 families. HFA programs are now costing taxpayers more than $65 million per year. Other organizations and government agencies are involved in the home visitation concept, as well. A recent PCAA survey found that one in five families with children under age one have already received some type of home visitation services from HFA or a similar program.

How Does the HFA Program Operate?

In order to target its services to "at risk" families, the HFA program has developed a screening process to determine whether the parents of a newborn are potential abusers. This involves employing "Family Assessment Workers" (FAWs) who gain access by various means to the medical records of women who are pregnant or have just given birth. According to PCAA materials, "the assessment worker begins each day by checking with hospital admissions to find out who has delivered [a baby] over the past 24 hours." Then, the assessment worker will, "review the medical record for information on 15 demographic and socio-economic factors" such as marital status, family income, history of emotional or psychological problems, etc.

HFA programs seek the cooperation of hospitals, clinics and physicians to provide this information. In some cases the FAW is allowed direct access to patient records. In other cases, hospital staff do the initial screen of patient records and then notify the FAW of those mothers who meet the criteria.

If the mother meets the "at risk" criteria, the FAW will visit her in the hospital or shortly after she returns home in order to administer the Kempe Family Stress Checklist. This is a questionnaire that asks deep, probing, open-ended questions in order to measure 10 risk factors said to be associated with a propensity toward child abuse. On each issue the respondent is scored from 0 (no risk) to 10 (the highest risk). The father is also questioned, if he is available.

A mother determined to be "high risk" is offered the services of a home visitor. The FAW discusses the family's needs as these have been revealed through the assessment process. The FAW offers home visitation services as the solution to these needs.

As the process was described in the Orlando Sentinel, the FAW is "part salesperson, part recruiter." Her job is to sell Healthy Families. "Although preventing child abuse is the program's mission," said the Orlando Sentinel article, "the word 'abuse' never crosses [the FAW's] lips." Rather, "she extends an olive branch: Need bottles, breast pumps, things like that when you get home? Such helpfulness is a door-opener." By offering free items to the needy family, HFA programs achieve a high acceptance rate; as high as 90 percent in some places.

Generally, parents will be contacted at home several times, by phone or in person if they initially refuse the program in the hospital. According to PCAA materials, a case is only to be closed "if parent(s) continue to refuse services for two to four months." Clearly, it takes several refusals before a targeted mother can expect contacts from HFA staff to end.

Once in the program, participants are assigned a "Family Support Worker" (FSW). This person is often a "paraprofessional" or trained volunteer who may have a few weeks or only a few days of training. One PCAA document acknowledged that more than one in four FSWs have no college training.

According to PCAA materials, the home visitor's job is to "work with families to identify strengths and specific needs, link them to health and social services, and provide family support and parenting education." The three basic functions of the home visitor are, first, to teach parenting skills; second, to enroll the family in any social services for which they may be eligible; and finally, we are told in PCAA materials, "the home visitor is a monitor."

What do HFA Home Visitors Teach?

HFA programs do not use a nationally mandated curriculum for their parenting education. Rather, each HFA program selects its own curriculum materials, often drawing from two or three sources or even developing their own. However, PCAA publishes extensive materials on parenting. These materials give a clear indication of the parenting philosophy of the organization.

The PCAA philosophy is based on the premise that "a major problem all parents face is their limited knowledge of parenting. Few adults have an opportunity to learn any principles of child rearing beyond those they have personally experienced." This is a problem because, in PCAA's view, what most parents learned about child rearing from their parents is wrong.

For example, most people learned from their parents the habit of "thinking and saying that your child misbehaves." According to a PCAA booklet on parenting, "children don't misbehave." Parents do need to learn "some effective methods for modifying behavior", but "labeling the child as misbehaving is not one of them. Nor is punishment, of any kind."

According to PCAA, parents should have "only a few rules" because "the more rules you have, the harder it will be for our children to remember them." Furthermore, parents should "give kids a voice" in making these rules because "even a child of five or six can talk with you and help you set fair limits." If a child disobeys one of these rules, "sometimes" the parent should look to the child for advice. "Your child can help you decide what is fair to do when a rule is broken.".

PCAA publications are emphatic about spanking. It is "harmful to children." It teaches children to "solve problems by hitting others." It is "worse than useless" and it sets "a truly terrible example." It is "difficult to say", according to PCAA, "where the line between corporal punishment and abuse lies." It should not be surprising, then, that in PCAA is dedicated to "the elimination of physical punishment of children" and to encouraging "the education of parents, teachers, and other child caregivers on alternative forms of discipline."

Do HFA Programs Actually Work?

You would think that having a monitor in the home of potentially abusive families would almost certainly lead to a reduction in the rate of abuse, but in spite of PCAA claims that their program is backed by years of research, evaluators have had great difficulty showing the program to be a success in the most rigorous control-group evaluations. Even if the concept did show some limited success, there are at least five reasons why government funding for these programs should be discontinued. These can be summarized as follows:

1. Privacy issues. The modus operandi of HFA programs necessarily involves an invasion of privacy, a violation of medical record confidentiality and an intrusion into the sanctity of the family.

2. Voluntary and informed consent. PCAA claims that participation in the program is entirely voluntary. However, it seems clear that mothers targeted by the program are not given complete information as to the nature of the program, nor are they given an reasonable opportunity to consider the offer of services before it is accepted. A recovering, postpartum mother is hardly in a condition to thoughtfully consider the implications of allowing an HFA visitor into the home. A mother in financial distress may feel compelled to join the program in order to obtain the many free items that are offered.

3. The nature of the teaching. PCAA's philosophy of parenting is not shared by all Americans. The government should not be in the position of officially endorsing PCAA's philosophy of parenting as the one taught to all new parents.

4. The duplicitous role of the home visitor. The home visitor who presents herself as a "helper" is also working in "collaboration" with child welfare authorities to "determine the safety of the home" and make reports to authorities if "abuse or neglect or imminent harm are suspected." When government sponsored agents are effectively engaging in a "search" of a private home under false pretenses and without probable cause, it is a violation of the Fourth Amendment.

5. Collection and use of client data. There are legitimate concerns whether mothers targeted by the program are fully informed as to how personal data collected on them may be used by HFA programs. It is doubtful that full and informed consent is obtained before this data is transferred to other persons or entities.

Some in government have begun to see the dangers of this type of program. Congressman Henry Hyde recently issued a letter to his Congressional colleagues alerting them to the fact that millions of dollars of federal money are going into these programs. Rep. Hyde described the home visitation concept as "big brother' intervention as we have never seen it before. It is a case of the 'village' mentality run wild. Americans have never experienced such intrusion in their family lives.

To contact Dr.Stan Watson, PhD directly, call 800-642-6797 or alabamaprc@wwisp.com.

This text was adapted from an article which appears in the July 1999 edition of The DeWeese Report, a newsletter published by the American Policy Center, 13873 Park Center Road, Herndon, VA 20171.