When Stacy Hartzler visits a pregnant teenage girl to counsel her about her health and how to care for her child, she thinks of what she is doing as promoting healthy families, but she is also on the front line of the fight to end child abuse.
Hartzler left a position as the director of neurology and orthopedics at an Arizona hospital more than three years ago to join the Best Babies Initiative in Denver, one of a growing number of programs based on the Nurse-Family Partnership.
She visits young unwed women and teenagers in their homes and offers counseling on their own health, infant health, parenting skills and family planning as well as more general issues such as continuing education and job hunting.
The idea that training young women in healthy parenting skills could be the best way to prevent most cases of child abuse and neglect is not new, but at a time when far-too-frequent horror stories suggest a crisis in the child welfare system, there is growing acceptance that prevention is the key to solving the problem.
That acceptance has come not only from child welfare advocates, who point to the results of studies done over nearly three decades, but also from the federal government.
The Bush administration has recently asked Congress to double the funding provided to states for child abuse and neglect prevention programs, seeking to boost funding to $65 million.
Dr. Wade Horn, the assistant secretary for children and families in the U.S. Department of Health and Human Services, said part of what has helped convince him of the role that promoting a young mother's health, parenting, social and job skills can play in cutting down on child abuse is the result of the studies done of the Nurse Family Partnership.
"While it is true there are some parents who abuse kids because they are psychologically disturbed, in the majority of cases it's because of other factors," Horn said. "What the Nurse Family Partnership program does is take care of some of those other factors."
Those "other factors" include ignorance about proper child care and parenting, isolation from family members, health care professionals or counselors, and despair about the situation they are in, Horn said.
When a mother is an unwed teenager from a poor family, the risk that all the stresses could result in neglect or abuse of a child are increased, experts say.
A Preventable Problem
The vast majority of parents who abuse or neglect their children have no intention of hurting them; they just either do not know any better or react to their child's behavior without thinking, child welfare professionals say.
Those are the cases that can be prevented, and according to some studies they already are being reduced.
Horn said studies have found that the Nurse-Family Partnership program brought about a 70 percent reduction in the cases of abuse over the life of a child. The studies looked at populations of families considered to be at risk for child abuse, randomly assigned members to either receive or not receive counselling under the program, then followed the children until they were 16 years old.
That reduction in cases of abuse translates into substantial savings. Studies have found that for every dollar spent on a program like the Nurse-Family Partnership, as much as $5 is saved on the cost of dealing with the problems created by abuse.