Family Matters

Home Visits: A Powerful Weapon Against Child Abuse

Trained home visitors can improve infant mortality rates, help kids do better in school and decrease child abuse. Why U.S. moms should follow Europe's lead and invite them into their living rooms.

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Patricia Doyle / Photographer's Choice / Getty Images

Every new mother has so many questions: Is my baby growing well? Is she reaching her developmental milestones? Why does she cry so much and what can I do about it?

To get answers, moms can turn to one other for advice or save up their questions for the next pediatrician visit, which could be months away.

But some moms, like April Magnuson, can just open their front door. Once a week, home visitor LeAnn Roe arrives at Magnuson’s doorstep with the latest information on the stage of development that her 13-month-old daughter, Emily, should have reached. Roe is a family support worker who builds relationships with low-income pregnant or new mothers in rural Carter County, Kentucky, supporting them, dispensing advice, answering questions. Magnuson is one of 22 moms with whom Roe interacts; she’s been visiting Magnuson, 25, since the nursing student learned she was pregnant.

(MORE: Child Abuse Pediatricians Recommend Basic Parenting Classes to Reduce Maltreatment and Neglect)

The home visitation model, popular in Europe, is hardly a staple of new motherhood in the U.S. But research has found that home visits not only help moms feel more confident and better supported, but they also reduce the incidence of preterm birth, infant mortality and child abuse and help children do better in school. “We think of it as a way to reach families,” says Libby Doggett, director of the Pew Home Visiting Campaign at the Pew Center on the States. “The best home visiting programs can return nearly $6 for every $1 spent on home visitation through better birth outcomes, fewer children dying and kids who are less likely to get into trouble with the law.”

The U.S. Centers for Disease Control and Prevention estimates that the total lifetime cost of maltreatment for children abused in 2008 was $124 billion, but home visits can slash maltreatment by up to half, according to research in the Journal of the American Medical Association. It’s an outcome that Pew is promoting heavily in April, which is Child Abuse Prevention Month. Pew is such a strong believer in the home-visitation model that it helps states set up their own programs, a task that has been eased along by a $1.5 billion pot of federal money that’s part of the Affordable Care Act. Forty-nine states — not North Dakota — have submitted applications for funding; Kentucky has one of the most extensive programs, with trained visitors such as Roe in each county who reach nearly every eligible at-risk family.

Roe is a master at gaining women’s trust, a must if they’re going to allow her into their living rooms. She helps them make homemade toys to interact with their babies (picture books to promote early literacy and shape sorters out of empty coffee cans) and refers infants who are lagging behind developmental milestones to early intervention services. “I’m somebody they can talk to and count on for support,” says Roe, whose services are paid for by the government. “I provide the information but whether they do what we talk about is up to them.”

(MOREHow Child Abuse Primes the Brain for Future Mental Illness)

Although states determine eligibility for home visitation in various ways, the target population is generally the same — poor moms, single moms, homeless moms and those with a history of domestic violence. Teen moms are particularly at risk, so Roe does her part to prevent child abuse by educating parents about typical infant behavior — sometimes they cry and cry and there’s nothing much you can do about it — and showing them videos about shaken baby syndrome. She talks to moms and dads about the difference between discipline, which involves consequences, and punishment, which is physical. “Spanking is a whole lot quicker than giving an explanation to a child, and distraction requires more effort than just swatting a hand,” says Roe. “Every parent has that potential to lose it because babies are overwhelming, but for teenage parents, it’s particularly overwhelming.”

In actuality, every mother — and father — could stand to benefit from the kind of information that Roe communicates. But wealthier parents can afford to take parenting classes or buy books on whatever childhood challenge is frustrating them at the moment. For Magnuson, who lives in Olive Hill, Kentucky, Roe’s home visits are what helped prepare her to become a mother. Roe taught Magnuson what Emily should be eating and how to put her in a safe place and take a five-minute breather when things get too stressful. She taught her about the importance of playing Pat-a-Cake with Emily, how the rhythmic clapping and rhyming verse are like brain candy for a baby.

Kentucky will stop paying for Roe’s visits once Emily turns 2, making her second birthday a bittersweet occasion for her mother. “[LeAnn]’s been like a mentor,” says Magnuson. “If this program didn’t exist, I would not have known what to do. I would not have been as good a parent.”

MORENurturing Moms May Boost Children’s Brain Growth

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