Maternal Home Visiting FAQ
By Melanie Blow
Maternal Home Visiting programs are the single best tool we have for ACE prevention. Unfortunately, most people don’t know what they are. So here’s a quick introduction into what they are and what they do.
Q-What are maternal home visiting programs?
A- For our purposes, they are programs that teach new mothers life skills, parenting skills and help them bond with their new baby, and that the mother engages in before she has started abusive patterns with her baby. They prevent abuse, neglect and maltreatment of children and have a host of other benefits for both the child and the parent(s) who participate.
Q- How can someone know who’s going to abuse a child before they abuse one?
A- It’s not as hard as it sounds. Scientists have studied what causes parents to abuse children for the last 40 years. The two things that are most responsible for a mother abusing, neglecting or mistreating her child are her failure to bond with the child, and external stressors. Stressors make bonding harder, and abuse more likely.
Q- Being a new mother is the most stressful thing there is. How does someone distinguish between the stressed-out mothers who will abuse their kids and the stressed-out mothers who won’t?
A- Yes, almost everyone considers starting motherhood to be very stressful. But certain things like surviving abuse, social isolation, being in an abusive relationship, poverty, being a minor, and having a very difficult pregnancy all make bonding harder and postnatal stress higher.
Q- Why can’t you just send them to parenting classes?
A- Training only fixes a lack of knowledge. Some parents make very bad choices because they don’t know better, and for them, classes can help. But if a parent doesn’t find spending time with their child gratifying, it doesn’t matter how much they know about parenting- the right choices won’t feel good to them, and the wrong choice may, and the wrong choices are at least easier. For example, you can tell someone that they need to hold their baby, talk to their baby and play with their baby, but if they don’t enjoy it, the baby is likely to spend most of the day in a crib or car seat.
Q- How do you teach someone to bond with a baby?
A- A woman’s brain chemistry and electrical activity actually change when she has a baby. Similar changes happen in men’s brains if they’re living with a baby, and in the brains of adoptive parents of either sex. Those changes provide the nuts-and-bolts of bonding, but stressors work against it. Much of what a home-visitor will do, at first, is encourage the mother to hold the baby, play with the baby, feed the baby, etc,. to facilitate bonding. And being around a supportive, kind, non-judgemental person who is respectful to both mother and baby makes a huge impact, as well.
Q- How long does it take for the visiting to work?
A- The leading modalities of the program, Nurse Family Partnership and Healthy Families America, stay with the woman from the time she enrolls until her baby starts Head Start, Kindergarten, or some other program where the child is leaving the house regularly and surrounded by mandated reporters. Parents don’t necessarily stay in it that long, and since the programs are completely voluntary, they can leave whenever they want.
Q- Why can’t you just send really good home visitors in to these kids’ homes after they’ve been reported to CPS?
A- The first incident of child abuse that gets reported to the authorities is probably not the first incident of abuse the child suffers. Once a child is abused, even if it is only one instance, their ACE score grows, and ACE scores aren’t undone after abuse stops. It’s also much easier to nurture, teach and coax struggling parents into being good ones before they become abusive rather than after. There are also a lot of other benefits from these programs that don’t involve child abuse. Children involved in these programs are healthier, they come to school developmentally on par and ready to learn. Parents involved in these programs are more likely to access mental health, educational and vocational services. They are less likely to use drugs, receive less public assistance and are less likely to be living below the poverty line.
Q- Why are there different programs?
A- Nurse Family Partners was the first program developed. They do a fantastic job, but they only serve the first child of a mother who enrolls prenatally. Healthy Families America does as well as Nurse Family Partners with that same population, but they will also work with mothers who don’t enroll until after the baby is born, and will even work with mothers who have abused an older child. And they achieve remarkable, statistically significant results with all these groups. There are lots of other, often local, programs that try to use the same basic ideas. There are also programs that focus very intensively on early literacy and school readiness. But by limiting themselves to toddlers, they can’t do as good of a job at preventing ACEs as programs that target infants.
Q- Don’t the mothers become abusive the day after the program ends?
A- No. These programs are about 40 years old, and there is a remarkable amount of research showing that parents who participate retain their parenting and life skills. One cohort of children have been followed through middle-school, and the data on them proves the benefits don’t “wear off”.
Q- Are these programs mandatory? Shouldn’t they be?
A- I’ve never heard of any maternal home visiting program, even a short-lived pilot, that was mandatory or court-ordered. It seems that coming up with a mandatory program is a poor way to use resources, when right now over 90% of the new parents who are willing to participate can’t be offered a slot.
Q- Can men enroll?
A- They can definitely enroll in Healthy Families America, if they are the primary caretaker of the baby by the time the baby is three months old (Nurse Family Partners only accepts women enrolling while pregnant). If a man is living with an enrolled mother, in either program, the home visitor will work with him on his bonding, life skills and parenting skills.
Q- Are there any people who can’t be helped by the program?
A- Mothers who are in abusive relationships are unlikely to respond well, and are probably unlikely to opt into the program. Mothers tend to drop out if their caseworker quits and is replaced by a new one. And nothing will work for everyone. In the unlikely case that the mother becomes abusive, the worker’s presence provides the baby with a level of safety, as they will spot abuse early, and they are mandated to report the abuse to CPS.
Q- Are there any types of abuse this doesn’t prevent?
A- The two main programs were designed before there were child sexual abuse prevention curricula, so neither program specifically aims to prevent that. However, home visitors are sometimes trained in recognizing sexual abuse, and they can pass this knowledge on to the families they serve. Helping mothers bond with their children makes them less likely to stay with a partner who abuses their child, sexually or otherwise. This is very significant, as no one is more likely to sexually abuse or kill a child than their step-father/step-father-figure. Keeping a child out of foster care goes a long way towards protecting them from sexual abuse, since a child living with neither biological parent is ten times more likely to be sexually abused. Research has found that Maternal Home Visiting programs provide some protection against sexual abuse, but since it takes sexual abuse victims so long to disclose, we simply don’t know yet how well they work at preventing this abuse.
COO, Stop Abuse Campaign
A survivor of incest, psychological abuse and a host of other childhood trauma, Melanie now uses her talents to prevent Adverse Childhood Experiences. Melanie has over a decade of legislative advocacy regarding children’s issues, and she has been published in newspapers, magazines and blogs all across the country.
Melanie has an ACE score of 6.
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