A POSITIVE RESPONSE TO CHILD ABUSE

It seems that society may have at last stumbled on a way to stop the horrendous problem of child abuse. At least, this appears to be the case based on a program developed in the U.S. state of Hawaii which has pioneered a program which has an almost unbelievable success rate -- 99% -- in preventing child abuse and neglect.

The program, called "Hawaii Healthy Start", consists of an intensive hospital screening of mothers when they arrive in labour at the hospital. The Healthy Start assessors are on staff at all of the state's hospitals and have access to the records filled out by these mothers on admission.

Through these records, as well as a bedside chat with the mother which is a "screening tool" to determine a list of risk factors, the assessor chooses those mothers who are likely to need home visiting and marks them for a follow-up interview. This assessment is merely a structured, non-threatening conversation with the mother, rather than a formal interview.

The risk factors include:

1. She is single, separated or divorced.
2. Her partner is unemployed.
3. Her income is inadequate, or she gives no information on source of income.
4. She has no permanent address.
5. She has no telephone.
6. She has fewer than 12 years of education.
7. The emergency contact name she gives is not an immediate family member or partner.
8. She has a history of substance abuse.
9. She had late or no prenatal care.
10. She has had an abortion in the past 12 months or has had two during her lifetime.
11. She has a history of psychiatric care, not including "life crisis" counselling.
12. She sought an abortion for this pregnancy.
13. She investigated giving up the baby for adoption.
14. She gives indications of serious marital or family conflict.
15. She is suffering from depression or has in the past.

If numbers 1, 9 or 12 apply, if two or more items apply or if seven of the factors are unknown, a more in-depth assessment will be done, usually before the mother leaves the hospital, or, failing that, in a telephone interview when she gets home.

No notes are taken during the conversation to increase the sense of relaxation and informality. Often, the mother feels nurtured by having the conversation -- it may be the first opportunity she's had to openly express feelings about her childhood and her present relationships and stresses.

After the conversation, the worker fills out a Family Stress Checklist based on the information she has acquired. If there is a potential child abuse danger, the mother is asked whether she would mind having a support worker visit her after the birth to see how she and the baby are doing. Fewer than 1% refuse.

The great advantage of this program is that it not only improves parent-child relationships, but it also identifies child development problems early. The recent explosion of research into how a child's brain develops indicates that what happens to a child in the first three years shapes not only his future emotional health, but also, how well he will be able to communicate and learn. The first three years after birth are crucial to a child's emotional, social and cognitive development.

The family support workers are usually ordinary women who are experienced mothers. They work closely with the family and the more frequent the visits, the greater the interaction and response.

The Hawaii Healthy Start Program costs the state government about $2,500 (US) a year for each family visited.

Researchers from the Centre on Child Abuse Prevention Research in Chicago have confirmed that the Hawaiian program has had great success in influencing positive child development, much stronger parent-child relationships, and less punitive discipline. For those in the program, very little abuse was detected, and imminent abuse was quickly spotted and referred to the child-protection system, so that intervention could happen before harm occurred.

At present, 300 local US jurisdictions have adopted the Hawaiian model to local needs. Some jurisdictions use nurses and others use lay visitors (who may be regarded as less threatening by the mother).

According to leading pediatricians and child-welfare workers in Canada, we need to replicate the Hawaiian program here, in order to attack the roots of delinquency, crime, domestic violence, welfare dependency and wasted human potential.

So far, only one province, New Brunswick, has attempted universal screening followed by visits for at-risk families. It is much easier, however, for a small province to make a decision to move in this direction: the whole of New Brunswick is smaller than Metro Toronto in population. However, Ontario and British Columbia have recently announced intentions to begin modest home visiting schemes, but nothing on the scale of the Hawaiian model.

For example, with only $10 million earmarked for the program in Ontario, it won't be comprehensive as this amount doesn't go very far to cover the recruitment of quality volunteers, to train them or to allow them frequent and lengthy home visits.

Ontario's plans are a start, however, and all provincial governments should be encouraged to initiate this program. The results are obviously well worth the cost.

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