A psychiatrist-legislator's little-noticed provision in one of the
1,000-plus-page health care reform bills in Congress would create the first
federally funded program for home visits to expectant mothers and families
with children under age 6. However, the program has drawn criticism from some"
family rights" groups over concerns about its efficacy and
The legislation to establish a regular funding stream for such a voluntary
program was sponsored by Rep. Jim McDermott (D-Wash.), a child psychiatrist.
He and other supporters said that existing nonfederal home-visitation programs
have provided critical supports to families in need.
"Home-visitation programs have a proven track record of increasing
the chances that a child will have a safer, healthier, and more productive
life," said McDermott in a written statement in July. Home-visitation
programs generally entail various types of health care workers—including
nurses and mental health counselors—surveying the homes of families over
many months or years and offering parenting advice.
Home-visitation programs, which have existed in various forms for several
decades, have long received funding from state and local governments and
private entities. The programs have functioned with a variety of purposes, but
they are frequently touted as a way to prevent parental child abuse and
That laudable goal has led more than 40 state governments to fund various
types of voluntary home-visitation programs that serve up to 500,000 children
and their parents every year, according to research estimates. McDermott said,
however, that those served are only 15 percent of the population that needs
McDermott sponsored a bill (HR 2667) to fund home visitation earlier this
year, but it never advanced. Similar legislation sponsored by Sen. Robert
Menendez (D-N.J.) also stalled. However, much of the language from the
McDermott legislation was rolled into the massive health care reform bill (HR
3200) approved in July by three House of Representatives committees.
The push for the federal funding through the health reform bill—$750
million in the first five years—stems from the contention by visitation
advocates that a massive boost is needed to reach millions of children at risk
President Obama's proposed budget also requests $8.6 billion for such
programs, but congressional Democrats dropped the program from their budget
Critics of the home-visitation program said they support the goal of
reduced child abuse but worry that the "voluntary" provisions are
poorly defined and thus could easily morph into a mandatory program for many
parents, including those who home-school their children.
"Once the federal government gives the money to the states, there is
no oversight or even mandate that states make sure the programs are
voluntary," maintained Will Estrada, director of federal relations for
the Home School Legal Defense Association. He and other critics note that
although the current legislation describes the programs as voluntary, the
language does not specify whether they remain voluntary if a parent changes
his or her mind after agreeing to participate.
"If families want to choose these programs, that's great. But if you
have to let a government official in to teach you how to raise your children
and to monitor that your children are developing, then you could easily lose
control of your children and have them taken away," Estrada said.
The nonspecific language leaves ample room for "mission creep"
of home-visitation programs to require participation of large swaths of the
public eventually, said Stephen Krason, Ph.D., president of the Society of
Catholic Social Scientists.
"It's valid to be concerned that something that appears to be
voluntary can evolve to be mandatory," Krason said.
McDermott's office did not respond to requests for comment from
Psychiatric News about the potential for abuse in the program.
Supporters of home visitation maintain the programs effectively address a
"The increase of child abuse and neglect cases ... is a sobering sign
that our efforts to date are insufficient," said Joan Sharp, executive
director of the Council for Children and Families, at a congressional hearing
in June on federal support for home-visitation programs.
However, research on home-visitation programs generally has found that the
programs do not achieve the highly touted goal of preventing child abuse or
neglect, according to researchers who have reviewed the studies on home
"Of those programs that look at child abuse and neglect directly
(i.e., substantiated cases), only a few have reduced child abuse and
neglect," said Jeanne Brooks-Gunn, Ph.D., at the congressional hearing.
She is a professor of child development at the Teachers College and College of
Physicians and Surgeons at Columbia University who supports home
Others are supportive of the goals of the program, even as they question
the premise that efforts are needed to prevent a nationwide wave of parental
Richard Wexler, executive director of National Coalition for Child
Protection Reform, highlighted the findings of home-visitation researchers
that child maltreatment is relatively rare in the general population, which
runs counter to suggestions of an abuse epidemic.
"That's worth remembering amid the hype about an 'epidemic of child
abuse' and all the damage that hype can do to children, as well as helping to
explain why any reduction in maltreatment caused by home visiting will be hard
to detect," Wexler said.
Information on the visitation bills can be accessed at<http://Thomas.loc.gov>
by searching on the bill numbers, HR 2667 and S 1267>. ▪