Home visits the key to preventing child abuse

By Adele Horin

The Sydney Morning Herald.

September 30, 2004

The country's soaring child abuse rates would fall dramatically if all vulnerable new mothers were visited by community nurses, research indicates.

A national home visiting scheme that targeted teen mothers, isolated single mothers and disadvantaged indigenous women would cut child death and injury rates, and reduce the number of children taken into state care, it shows.

"Australia needs a national co-ordinated program of nurse home visitors," said Julie Quinlivan, associate professor of obstetrics and gynaecology at the University of Melbourne.

Dr Quinlivan is a keynote speaker at the National Critical Early Childhood Years conference in Melbourne this week.

Her research showed dramatically better outcomes for children born to teen mothers who were part of a nurse home visiting program compared with a control group. In the non-visited group, 13 per cent of the children had adverse outcomes after six months, as against 3 per cent in the visited group.

Among the 89 babies whose mothers were not visited by nurses, three died, one had head injuries, and seven had been put into care. Of 89 babies whose mothers received weekly visits from a nurse, one had died, and one had been put into care.

The study, undertaken in Perth, confirmed findings from two large US studies which have followed children over 15 years.

Nurses gave practical help and parenting advice, such as pointing out cupboards need child locks.

"The research shows the very dramatic benefits of nurse home visitors," Dr Quinlivan said. "A two-year program of regular visits can break the cycle of adversity."

The US studies also showed the visited children later performed better at school and were less likely to be delinquent.

Dr Quinlivan said the results were so compelling the Bush Administration last year committed $US500 million a year to a nurse home visits program in disadvantaged areas.

Australia had a hodge-podge of services, most using volunteers or para-professionals - paid untrained workers; most of the services were stretched thinly, and some were poorly targeted.

Only South Australia had a nurse home visiting program of the kind worldwide research showed worked best.

All mothers were screened when they gave birth, and about 10 per cent were found to fit the criteria of women who would benefit from the nurse visits. These were new teen mothers, isolated sole mothers, and disadvantaged indigenous mothers.

Dr Quinlivan said research showed the visits needed to be carried on over two years, at first weekly, and then every fortnight and every month.

She said the much-lauded NSW Government program Families First worked well in some areas but not in others. It was not a co-ordinated statewide approach to home-visiting, did not assess all women who gave birth, and used volunteers and para-professional home visitors as well as nurses.

"It's hard to say whether the money is wasted," she said. "It's been established since 1998 but there has been no evaluation of outcomes."

Dr Quinlivan said research had shown para-professionals were ineffectual in achieving good outcomes because mothers did not seem to take them seriously. Only one proper evaluation of the use of volunteers had been undertaken in the world. It showed volunteer visitors did not improve issues such as child abuse and injury rates but did seem to help mothers read and play more with their children.

"Nurses are probably best at producing improvements in the hard-core areas of child abuse," Dr Quinlivan said.

With child abuse notifications increasing dramatically - from 97,000 in 1996 to 198,000 in 2003 - Dr Quinlivan said what "we are doing currently is not working to prevent abuse and neglect".