Prevention of Child Neglect, Part 2

by Child Welfare Information Gateway

(Page 12 of 15)

Home Health Visitation

Early intervention with parents identified as high risk for neglect, using lay or professional home health visitation, has proven to be an effective prevention strategy. High-risk parents may be identified by reason of their poverty, mental retardation, drug abuse, or lack of social support; by their own history of being maltreated; by observing parent-infant interactions for indicators of poor bonding; or by use of standard risk assessment instruments. Identifying high-risk factors that reliably predict neglect is still an elementary inexact science requiring further research, but clearly the parental groups listed above are at higher risk than the general population.

Provision of prenatal and postnatal inhome visitation by nurses, other professional helpers, or paraprofessional parent aides to young, first-time parents at high risk for neglect is one form of early intervention. Home visitors initiate contact with the mothers during their pregnancy or at the time of their delivery in the hospital, and provide followup inhome visits for up to 2 years.

In one successful program, home health nurses instructed high-risk parents in normal child development and child care practices, mobilized informal support and involvement in parenting tasks, and linked families with community health and social services. Subsequent reports of abuse and neglect were significantly lower for the young, single, and low SES parents, who received the home visitation prenatally and for the next 2 years (4 percent), than for those who received only developmental screening and free transportation for medical appointments (19 percent).

Hawaii's Healthy Start program utilizes trained paraprofessionals to deliver followup, inhome visitation to high-risk mothers. Based on the success of the program in Hawaii, the program is being adopted as a child abuse prevention model in many States. The program has been successful in preventing neglect in 99 percent of the high-risk families served over a 4-year period.

In other programs, lay home visitors are used to make contact with the new mother in the hospital at the time of delivery and visit in the home twice during the first month and at least monthly thereafter for up to 1 year. Lay home visitors are trained to teach parent-infant interaction, home management, specific child care, and problem-solving skills. The goal is to reduce family stress by assisting in problem solving and connecting families with medical and social services to meet needs identified by the family. Lay home visitors also provide emotional support, encouragement, and guidance to young parents during the stressful adjustment to the demands of parenting.

Parents at high risk of neglecting or abusing their children, by reason of their own history of abuse or neglect, are the focus of the STEEP program (Steps Toward Effective, Enjoyable Parenting). Mothers are recruited through obstetric clinics during their pregnancy. The program begins with home visits during the second trimester of pregnancy to help mothers deal with feelings about pregnancy and impending parenting responsibilities. Home visits by a "family life facilitator" continue every other week until the baby is 1 year old. From the time the babies are about 4 weeks old, the facilitator conducts biweekly group sessions with groups of eight mothers and their infants. The facilitators provide basic child development information, coach mothers to respond appropriately to their infant's cues and signals, and help mothers recognize their infants' special characteristics and needs. The teaching method is demonstration, with active involvement of mother and baby, not didactic teaching.

A major goal of the STEEP program is to help mothers to modify negative, dysfunctional "representational images" of themselves that flow from their own history of being abused or neglected. Mothers who are products of child maltreatment often view themselves as incapable of being good parents to their children. The facilitator encourages active parent discussion and reassessment of early life experiences and their influence on current parenting. A strong theme of the program is empowerment of the parent.

Family Planning

Chronically neglectful families tend to be large families with more than the average number of children. Caring for three or more children with insufficient resources creates unusual stress, setting the stage for neglect. Growing families need help choosing family planning methods suited to their moral and cultural values and to their abilities to successfully use various birth control methods.

Parent Skills Training

Parent education programs that are structured and designed to focus on specific parenting skills have been successful in improving the adequacy of child care provided by high-risk parents. In selecting a parent education program, the professional must always consider the program's cultural/ethnic appropriateness for the target family or group. Parent education programs and materials must be developed and written in language that is understandable by parents with limited education and literacy levels. Parent education programs offered through neighborhood schools, public health agencies, mental health centers, churches, and other organizations may be especially attuned to cultural factors affecting parents in the immediate community. The WINNING program developed by Dangel and Polster uses a series of eight instructional video tapes that introduce the parent to basic child management skills. Bavolek and Comstock's Nurturing Program includes audiovisual aids and a structured format that can be used with groups or individually in the parent's home.

The MELD (Minnesota Early Learning Demonstration) is an intensive 2-year center-based parent education and support program for young mothers. It offers special programs for Hispanic families, hearing impaired parents, and parents of children with special needs. Groups of 10-20 mothers meet for 2 to 3 hours weekly over 2 years, in four 6-month phases. They learn about health care, child development, home and child management, and personal growth. Immediate outcomes demonstrated by the program are encouraging.

About the Author

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Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.