And those problems strike society on many levels. Studies have shown that children who suffer abuse are more likely to have problems in school, more likely to exhibit antisocial behavior including violence and crime, more likely to wind up on social assistance and more likely to abuse their own children than those who are not abused.
What makes the results all the more impressive is that parents receive counseling for less than three years, ideally beginning at the time the woman is 16 weeks pregnant and continuing until the child is 2 years old.
"There are some clients you wish you could help longer, but that's mostly the younger ones, the 12- and 13-year-olds," Hartzler said.
With what studies have found about the Nurse-Family Partnership model, you might think that David Olds, the University of Colorado psychologist who developed the program, would have been trumpeting its success for years. Instead he has been cautious.
"We wanted to know that the evidence would be solid," he said. "This is complex, and we wanted to be sure we had our program model sufficiently developed and our method sufficiently articulated to be able to communicate it to others."
And he is realistic about the prospects for success.
"This program does not wipe out child abuse and neglect," he said. "There are cases that this program will not affect, but I am convinced partly because the nurses are able to get to young families early, before the baby's even been born. It won't eliminate child abuse and neglect, but it will have a significant effect."
Another effect could be that by reducing the number of cases of abuse or neglect that child welfare agencies have to deal with, the overworked agencies would be able to respond more effectively to cases when they arise, Olds said.
All too often, when horrible cases of abuse are discovered — such as the 15-year-old Tennessee boy whose father and stepmother were charged last week with chaining him to his bed and starving him until he weighed just 49 pounds — it turns out that child welfare services had been alerted to concerns about possible abuse but had failed to follow up thoroughly.
Focus on High-Risk Families
The Nurse-Family Partnership, the model for the programs Horn would like to see boosted around the country, is focused on high-risk families — unwed, low-income teenagers having their first child, Hartzler said. The average age of her clients is 15, she said.
Most are referred by agencies such as the county health system, school districts, Planned Parenthood or the state Department of Health Services, but some refer themselves, and she said a growing number are referred by former clients.
Beginning the counseling before the child is born — and as early as possible in the pregnancy — is important because of the impact that the mother's behavior can have on the baby's health and behavior, Olds said.
For example, he said, at least seven longitudinal studies have found that children whose mothers smoked during pregnancy are more likely to be inconsolable as infants, more likely to have worse "terrible twos" and more likely to exhibit antisocial behavior when they reach school age than youngsters of mothers who did not smoke.
"To the extent that women take better care of themselves during pregnancy, the child is going to be easier to care for, and it is going to be more enjoyable to care for the child," Olds said.
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