Infant Home Visiting

Families Under Surveillance

Twila Brase, R.N., P.H.N.

Undoubtably every mother would like help with her newborn infant, but how many mothers would be willing to submit her child and family to a comprehensive parenting, child health, and home environment evaluation by a government employee?

Home visiting, the rapidly advancing child abuse prevention strategy, is actually a family surveillance mechanism. Under the guise of child health and development, state employees observe family relationships and physical surroundings within the home to determine the quality of parenting, the use of health care services, compliance with immunization schedules, and the safety of the home. This information is then entered into a central database.
Cradle-to-Grave Tracking
One Congressman has come out visibly against the home visiting program. Representative Henry Hyde in a October 1998 letter to Colleagues called home visiting "cradle-to-grave tracking of newborns" and "big brother intervention as we have never seen before."
At this time, parent acceptance of a home visitor is strictly voluntary, but there may be increased pressure to either mandate the program or institute it in such a way as to coerce parent participation through fear: those not volunteering are naturally suspect of abuse or so the theory goes. Gay Bakken, a county planner quoted in the September 15, 1998 St. Paul Pioneer Press, admits, "[O]ftentimes, the families who need our help the most are the ones who say no thanks." How this need has been determined without a visit is unclear. Therefore, if a family simply refuses on the basis of opposition to government surveillance, they may automatically be under suspicion.
Who Defines Abuse?
Abuse is not a clearly defined term which is cause for concern when government officials or employees enter the homes of unsuspecting parents. Some of the home visitors may be public health nurses with a better grasp of child abuse indicators, but some may be trained home visitors with no medical training. All may have biases which influence their reports on child abuse potential. Some may believe that refusing to immunize children or sending them to bed without supper for disobedience is physical abuse. Others may say that mothers who leave their children at day care are depriving them of family bonding and increasing their risk of illness andinjury.
One Family's Story
Unfortunately, some families have experienced these biases first hand. Although the Frankford family was not involved in home visiting, Frankford v. Missouri Division of Family Services (MDFS) is one example of external bias. According to a March 1997 Rutherford Institute Litigation Report, Phil and Crystal Frankford were "investigated after their child fell and sustained minor injuries. Even though a doctor ruled out child abuse, MDFS placed the Frankfords on the state registry of abusers after finding that a piece of broken furniture in their home created a danger to the child."
Universal Parent Education
Home visiting is the thrust of Healthy Families America(HFA), a federally funded national initiative developed by the National Committee to Prevent Child Abuse (NCPCA). Initially targeted at at-risk" children and families through the "Family Preservation and Support" program, it is now expanding to include all families. In fact, Healthy Families America has a vision "that one day, all new parents will receive the education and support they need at the time their baby is born and in the months and years thereafter."
While no one can argue the merits of protecting children, one can surely protest the deceptive and intrusive nature of home visiting programs. New moms, pleased with any opportunity to receive free advice, are rarely informed that the home visitor is not there primarily to help the mother or answer her questions. The visitor is there to observe the family, educate them according to state-defined goals, and report on their progress or resistance. As an example, a 1997 Minnesota law rates the effectiveness of universal home visiting on the following criteria:
"1) appropriate child growth, development, and access to health care;
2) appropriate utilization of preventive healthcare and medical care for acute illnesses;
3) lower rates of substantiated child abuse and neglect;
4) up-to-date immunizations;
5) a reduction in unintended pregnancies;
6) increasing families' understanding of lead poisoning prevention;
7) lower rates of unintentional injuries; and
8) fewer hospitalizations and emergency room visits."
"Chilling Effect"
Although several amendments requiring informed consent were offered by concerned Minnesota legislators, proponents of home visiting defeated them by claiming that giving the information to mothers would have a "chilling effect" on their ability to assess families for child abuse.Therefore, the 1997 state legislature deniedfamilies the right to know upfront the true intent of government visitors. As a result, few families know that they are under the judgmental gaze of an abuse-evaluating, data-collecting government employee.
Database Tracks Families
And where will all this data be stored? According to documents gathered by the Alabama Physician's Resource Council, which is nearing completion of a comprehensive report on home visiting, the NCPCA suggests a uniform system for "describing the number and characteristics of families receiving services." Called the HFA Program Information Management System (PIMS), it will "track information on assessments of families," including "household characteristics, participant characteristics, risk factors for abusing or maltreating children, home visits/services...outcomes...and termination information."
Next Step: Managed Care
The ultimate goal for Healthy Families America is integration of home visiting into managed care organizations with mandatory state reporting. In the meantime, infant home visiting programs carry several names including: Healthy Families; Better Beginnings, Better Futures; Starting Points; Universal Contact, and Healthy Start.
Before a home visitor comes knocking, mothers concerned about the preservation, privacy, and integrity of their families may want to think twice before throwing out the welcome mat.

Twila Brase is President of Citizens' Council on Health Care. This article was printed in the March/April Intellectual Ammunition, a publication of the Heartland Institute.