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MEDICAL PRIVACY
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.
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Citizens' Council on Health Care
1954 University Avenue West, Suite 8, St. Paul, MN 55104
Phone: 651.646.8935 / Fax: 651.646.0100, e-mail
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