06 July 2009

Prevention Programs Work

The Nurse-Family Partnership program . . . has been very successful both in preventing child abuse and neglect and serving the needs of parents and children. In this program, a public health nurse visits a low-income, first-time parent during pregnancy and for the first two years of a child’s life.43 The nurse works closely with the mother to improve prenatal health, help parents provide more competent care to the child, and address the family’s economic stability by helping parents develop and accomplish goals relating to staying in school and finding work, as well as helping parents plan subsequent pregnancies. The program specifically addresses poverty-related problems, such as substance abuse. The results of the program are striking. Families receiving this kind of support have a 79 percent lower incidence rate of child abuse and neglect than similarly situated families,46 as well as numerous other benefits.47 Moreover, it appears to be cost-effective.48 The program costs approximately $8,700 per family[.] . . .


46 See David L. Olds, Prenatal and Infancy Home Visiting by Nurses: From Randomized Trials to Community Replication, 3 PREVENTION SCI. 153, 161-63 (2002) (discussing this finding in greater detail, including evidence that reductions in child abuse and neglect persisted over a fifteen year period, despite an initial up-tick following the end of the program, but that the participating families who did not experience lower rates of child abuse or neglect were those where domestic violence was present); U.S. DEP’T JUSTICE, OJJDPMODEL PROGRAMS GUIDE, Nurse-Family Partnership, supra note 43, at 5.

47 Studies documenting the positive benefits of the program for both parents and children abound, but to give just one example, children in the visited homes had lower rates of involvement in the criminal justice system. See David Olds et al., Long-term Effects of Nurse Home Visitation on Children’s Criminal and Antisocial Behavior: 15-Year Follow-up of a Randomized Controlled Trial, 280 JAMA 1238, 1241 (1998).

48 I am not arguing definitively that a preventive approach will save the state money, although there are good reasons to think it will. See, e.g., Glazner et al., Final Report, supra note 44, at 11 (documenting that during the fifteen-year period following intervention, the average visited family used, in 2001 dollars, $56,600 less in government services and paid $8,300 more in taxes than a control group, resulting in a 393% recovery over the fifteen year period on the amount invested). My intention is to point out the economic and non-economic costs of the current system and suggest that it may save money, and certainly reduce human harm, to take a preventive approach to child welfare.

From here (some citations omitted; emphasis added).

Some other highly effective prevention programs noted in the same, University of Colorado professor written, source include:

(1) the Children's Sentinel Nutrition Assessment Program: "'food insecurity is associated with a greater likelihood of illnesses severe enough to warrant
hospitalization for infants and toddlers,' that infants and toddlers in food insecure households are 30 percent more likely to have a history of hospitalization, and that one pediatric hospitalization costs an average of $11,300, whereas that same amount of money would buy food stamps for a family for almost five years."

(2) Housing First programs: "in which the state provides housing to the chronically homeless—individuals who are often struggling with multiple problems, such as substance abuse and mental illness—without imposing any conditions on the recipient, cost far less than the 'system of shelters, hospitals, mental hospitals, and incarceration that marks the cycle of life on the streets' and . . . [produces] positive outcomes for clients in the areas of mental health and substance abuse[.]"

More generally, childhood experiences matter:

SARA MCLANAHAN & GARY SANDEFUR, GROWING UP WITH A SINGLE PARENT:WHAT HURTS,WHAT HELPS 1-2, 89-91 (1994) (“Compared with teenagers of similar background who grow up with both parents at home, adolescents who have lived apart from one of their parents during some period of childhood are twice as likely to drop out of high school, twice as likely to have a child before age twenty, and one and a half times as likely to be ‘idle’—out of school and out of work—in their late teens and early twenties”; further noting that only about half of this effect can be attributed to the effects of lower income);

THE NAT’L CTR. ON ADDICTION AND SUBSTANCE ABUSE AT COLUMBIA UNIV., FAMILY MATTERS: SUBSTANCE ABUSE AND THE AMERICAN FAMILY 27 (2005) . . . (. . . teens who have an “excellent relationship” with one or both parents are at a lower risk for substance use and that parental praise, affection, and family bonding are also associated with a lower risk of teen substance use);

KRISTIN ANDERSON MOORE & JONATHAN F. ZAFF, CHILD TRENDS, BUILDING A BETTER TEENAGER: A SUMMARY OF “WHAT WORKS” IN ADOLESCENT DEVELOPMENT 2 (2002) . . . (“Teens who have warm, involved and satisfying relationships with their parents are more likely to do well in school, be academically motivated and engaged, have better social skills, and have lower rates of risky behavior than their peers”; “Teens whose parents demonstrate positive behaviors on a number of fronts are more likely to engage in those behaviors themselves and teens whose parents take part in risky behaviors are more likely to do the same”; Parents who monitor their children “in age-appropriate ways have teens with lower rates of risky physical and sexual behaviors, as well as lower rates of drug, alcohol, and tobacco use”);

CATHY S.WIDOM & MICHAEL G.MAXFIELD, NAT’L INST. OF JUSTICE, RESEARCH IN BRIEF: AN UPDATE ON THE “CYCLE OF VIOLENCE” 1 (2001) . . . (“[B]eing abused or neglected as a child increases the likelihood of arrest as a juvenile by 59 percent, as an adult by 28 percent, and for a violent crime by 30 percent.”);

COUNCIL OF ECONOMIC ADVISORS, TEENS AND THEIR PARENTS IN THE 21ST CENTURY: AN EXAMINATION OF TRENDS IN TEEN BEHAVIOR AND THE ROLE OF PARENTAL INVOLVEMENT 2-3 (2000) . . . (. . . teens who spend more time with their parents—regularly eating dinner with the family, for example—do better in school and suffer less from various forms of risk-prone conduct, such as the use of drugs and alcohol, violence, and suicidal behavior, even holding constant poverty, family structure, race, and other such factors.)

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