Mary Hernandez peers anxiously about as her car pulls up in front of Juanika Hickman's duplex in the crime-ridden east end of Davenport, Iowa.
The week before, Ms. Hernandez arrived to find the street clogged with police cars. Juanika's mom, a crack addict, had been stabbed during a fight on the sidewalk, trying to protect Juanika.
Throughout the ruckus, Juanika's six-month-old baby, Travon, was left alone inside the house. "What happens next time there's a confrontation?" Hernandez asks before stepping out of her car to greet Juanika. "I don't want the baby in danger."
Hernandez is now one of a handful of people working to keep Juanika's roly-poly baby, nicknamed "fat man," safe. As a home visitor, she is part of a pioneer program in Iowa that is gaining attention nationwide as an effective means of preventing child abuse.
In 1995 alone, more than 3.1 million children were reported abused and neglected, according to the Chicago-based National Committee to Prevent Child Abuse.
Many experts believe home visitation offers a common-sense and compelling solution: Send trained adults on regular visits to support at-risk mothers and fathers in coping with the difficulties of parenthood and a range of life crises, and thus help keep parents from mistreating their children. If the visitors see signs of abuse, they must notify child welfare officials.
One of the most effective and far-reaching home-visitation initiatives is the Healthy Families America program, started in 1992 by the NCPCA. The widespread anecdotal evidence of its success has led a growing number of US communities to experiment with the approach. In the past two years, the number of states participating in the program has grown from 19 to 30, while program sites across the country have mushroomed from 31 to 186.
Home visitation has been endorsed as the most critical element in a comprehensive approach to prevention by the US Advisory Board on Child Abuse and Neglect.
But experts caution that the quality of home-visitation programs is not uniform. "There is tremendous variation," says David Olds, a University of Colorado professor who has studied the programs.
The best results tend to be achieved by programs that use highly trained professionals such as nurses, provide frequent visits starting before birth to promote healthy pregnancies, and help parents not only with child-rearing but also schooling, housing, and economic self-sufficiency, says Prof. Olds.
Studies proving the effectiveness of home visitation are difficult to do, says Olds, partly because some high-risk families decline to join.
Still, there is much anecdotal evidence of the effectiveness of programs such as Davenport's four-year-old Healthy Families America program, run by Lutheran Social Services of Iowa. "We have not had any actual abuse," says LSSI's Lynne Meesky of the 185 families served so far. The majority are in school, working, or self sufficient. The families have stayed together, and 50 percent of the fathers are involved with their children.
Ms. Meesky makes rounds of Davenport maternity wards to offer the service to new parents judged to be at risk for child abuse. Risk factors include a lack of prenatal care, unemployment, single parenthood, and a history of drug use or criminal behavior. About 60 percent of the parents agree to an initial home visit, and of those roughly 85 percent sign up for the formal visitation program, Ms. Meesky says.
She says the high sign-up rate reflects the positive support offered by Ms. Hernandez and other professional home visitors.
"This is all about giving these young moms an opportunity to experience success in parenting," Meesky says. Visits are weekly at first and then shift to monthly or trimonthly if the parent is adjusting well. Visitors weigh and measure the babies, arrange immunizations, and teach the parents about the stages of child development. They might also drop off diapers.
When Hernandez began visiting 15-year-old Juanika and her newborn, Travon, six months ago, she was concerned because the high-school dropout spent little time holding her baby. Since then, Juanika has grown very attached.
Meanwhile, however, external dangers to the mother and child have grown from the father and his girlfriend. Despite a recent court order barring the father from seeing Travon, Juanika feels threatened.
"She's got to find another place," says Hernandez, who is trying to find low-cost housing outside the neighborhood for the two. One obstacle is Juanika's reluctance to leave her addict mother, who works as a hotel housekeeper. Juanika cares for her Mom, buys the groceries, and pays the bills.
Hernandez, herself once a single mother of five, is well positioned to help Juanika. The teenager clearly trusts the older woman.