Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
24822775
label
Home Visiting [1]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
24822775
sourceUrl
contentType
document
title
Home Visiting [1]
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Nicole Rabner's Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
24822775
levelOfDescription
fileUnit
otherTitles
42-t-7763278-20121035S-037-008-2015
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
5794f7a116fde67f
ocrText
Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. bio
Felicia Pearson (1 page)
nd
P6/b(6)
002. bios
Roundtable Discussion Participants (partial) (1 page)
nd
P6/b(6)
003a. memo
Nicole Rabner to Agency Liaison re Request for Assistance (partial)
02/12/1998
P6/b(6)
(1 page)
003b. memo
Nicole Rabner to FLOTUS re Home Visitation Event (1 page)
02/11/1998
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15416
FOLDER TITLE:
Home Visiting [1]
2012-1035-S
kc1055
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency |(b)(2) of the FOIA|
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information |(a)(4) of the PRAJ
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
The President and Mrs. Clinton
HONORARY CO-CHAIRS
Carol Berman Timothy Boggs Gahl Hodges Burt
Debbie Dingell Martha S. Naismith
CO-CHAIRS
THE BENEFIT COMMITTEE
Decker Anstrom and Sherry Hiemstra
Marilyn Harris
Robert Barnett and Rita Braver
Peter D. and Florence Hart
Grace Bender
Joe Hassett and Carol Melton
Jason and Rita Berman
Mary 1.. Howell
Michael S. Berman
Joel and Carol Jankowsky
Frank and Carol Biondi
Doug Johnson and Liz Robbins
T. Berry and Christina Brazelton
James A. Johnson and Maxine Isaacs
Daniel Bross and Robert Cundall
Vernon and Ann Jordan
Christopher and Lucy Buckley
Mickey Kantor and Heidi Schulman
Richard Burt
Peter and Judy Kovler
Michael and Harolyn Cardozo
Kenneth and Evelyn Lipper
Jan Turner Colburn
Edward and Robyn Mathias
Eliot and Melanie Cutler
Ulrich and Harriet Meyer
Honorable William Daley
Representative George Miller
Tucker and Hynda Dalton
Richard and Julia Moc
Rhett and Mimi Dawson
Bill and Alison Paley
Representative John Dingell
Stuart and Ginger Pape
Tom and Chris Downey
Howard and Gail Kern Paster
Ron and Beth Dozoretz
Scott and Courtney Pastrick
Kenneth M. and Sydney Duberstein
Honorable Federico and Ellen Pena
Steven 1.. Engelberg
Kyle and Marsha Pruett
David and Rae Forker Evans
Hilary B. Rosen
Senator Dianne Feinstein
David and Alice Rubenstein
Sydney McNiff Ferguson
James H. Schwartz
Martin Franks and Mari Schleuning
Honorable Donna E. Shalala
Matt Gerson and Susan Kaplan
Stuart and Ann Stock
Dan and Rhoda Glickman
Philip and Lynn Straus
Stanley and Nancy Greenspan
Peter and Eleanor Szanton
Patrick and Abbey Griffin
Togo and Gail West
Robert and Mary Haft
Elaine Wolfensohn
Bill and Robie Harris
Bud and Cynthia Sikes Yorkin
Irving Harris
Barry and Pamela Zuckerman
ZERO TO THREE
BOARD of DIRECTORS
Kvle Pruett. M.D.
President
Kathryn E. Barnard. R.N., Ph.D.
T. Berry Brazelton. M.D.
Maria D. Chavez. Ph.D.
Robert N. Emde. M.D.
Linda Gilkerson. Ph.D.
Stanley I. Greenspan. M.D.
Robert J. Harmon. M.D.
Irving B. Harris
Gloria Johnson-Powell. M.D.
Sheila B. Kamerman. D.S.W.
J. Ronald Lally. Ed.D.
Bernard Levy
Alicia E Lieberman. Ph.D.
Samuel J. Meisels. Ed.D.
Harriet Meyer
Dolores G. Norton. Ph.D.
Joy D. Osofsky, Ph.D.
Jeree H. Pawl, Ph.D.
Arnold J. Sameroff. Ph.D.
Marilyn M. Segal, Ph.D.
Rebecca Shahmoon Shanok, M.S.W.Ph.D.
Jack P. Shonkoff, M.D.
Lynn G. Straus, M.S.
Bernice Weissbourd. M.A.
Serena Wieder, Ph.D.
G. Gordon Williamson, Ph.D., OTR
Harry H. Wright, M.D., M.B.A.
Barry Zuckerman, M.D., F.A.A.P.
Matthew E. Melmed
CELEBRATING TWENTY YEARS
Executive Director
Celebrating
2
Years
Under the patronage of
President and Mrs. Clinton
During the miraculous first years. a child develops crucial intellectual.
emotional and social abilities to give and accept love. to be confident and
secure. to be curious and persistent abilities that will enable a child to learn.
Carol Berman Timothy Boggs Gahl Hodges Burt
relate well to others and lead a productive life.
Debbie Dingell Martha S. Naismith
ZERO TO THREE. the National Center for Infants, Toddlers and Families. was
Co-chairs
established in 1977 by internationally renowned leaders in the fields of
medicine. child development. mental health. and research science to advance
invite you to
the healthy development of America's babies and young children. We are the
nation's leading resource on the first years of life. We support parents.
celebrate the Twentieth Anniversary of
professionals and policymakers by:
Promoting the discovery of new knowledge
ZERO TO THREE
Translating cutting edge research into language and approaches parents and
caregivers can use and understand
with an evening of
Fostering professional excellence through training. and related activities
CONVERSATION, ENTERTAINMENT & INSPIRATION
Designing and demonstrating model approaches for working with babies
and families
followed by a buffet supper
We invite you to celebrate with us. SO that together. we can help give children
in honor of the cast
the best possible start in life!
Tuesday, February 10th, 1998
Terrace Theater
This evening is made possible through the generous
support of the following
The John F. Kennedy Center for the Performing Arts
Washington. D.C.
Underwriter
Johnson & Jobnson
Benefactor
R.s.v.p.
6:45 p.m. Reception
Time Warner
Card enclosed
7:30 p.m. Performance
8:45 p.m. Cast Party
Sponsor
General Motors
Invitation printing courtesy of Corporate Press. Inc.
Invitation design courtesy of Terry Isner & TMI Design
Melanne Verveer
Nicale tools
/
to me re;
Mis
-
6
Monday. October 5, 1998
THE CHRISTIAN SCIENCE MONITOR
Britain Plans to Rescue
SAMANTHA PEARCE/AP
NEW PRIORITY:
British Prime
Its Endangered Families
Minister Tony
Blair poses with
preschoolers
Prime Minister Tony Blair, seeing a threat
outside his
London residence
to social cohesion, outlines steps for his
May 6. His
government to improve family life.
government is
proposing a range
By Alexander MacLeod
of new programs
Special to The Chnstian Science Monitor
aimed at
LONDON
strengthening
in 4 British families is headed by a single parent. More
families and
One 1 in 3 births are outside of marriage. Britain leads low. Europe
improving child-
than in teenage pregnancies. The marriage rate is a record
rearing. Britain
Is British social cohesion fraying?
has the highest
Prime Minister Tony Blair thinks so, and
he set out a plan last week to return the
Borrowing from
teen pregnancy
rate in Europe.
family to the heart of British life.
the US, adult
The marriage rate
He wants his Labour-led government to
'mentors' will
is at a record low.
help rebuild faith in marriage and to teach
counsel
parenting skills across the nation.
Mr. Blair promises to put money into
teenage girls
courses on parenting. marriage counsel-
on the risks of
ing for couples who plan to wed, tracking
of children by family-support services. a
pregnancy.
one-stop service for families with children
under teens. and holding parents legally responsible for their children's
three years old. curfews for pre-
behavior. family is central to our vision of a modern Britain in built the
"The kinds of rights and responsibilities that we learn week.
on home." the Blair told a Labour Party's annual conference last
"Strong families mean a strong Britain."
His plan takes him into politically sensitive territory.
See FAMILIES Page 6
Guidance, Oversight for British Family
FAMILIES from Page
will continue to track their ious people, including politicians,
charges for several years.
have been practically banging on
Five years ago his Conservative
Borrowing from US experi-
my door pleading for the Hamil-
predecessor
John
Major
ence, a system of adult "mentors"
ton scheme to be launched in
promised to promote family val
to advise and counsel teenage
their own areas."
ues: But the back to basics" cam-
girls on the risks of pregnancy.
Blair is pledged to stick to the
paign backfired when several se:
Marriage registrars to offer
previous government's spending
nior supporters..were forced to guidance to young couples who
limits for two years, but it is a
admit to, marital infidelity and
are not connected with a particu-
measure of his determination to
other indiscretions:
lar church and might otherwise
boost the family that he has called
The Labour government how
wed without any marital advice at
on ministers to trim their budgets
ever is promising to beyond
all. At 279,000 a year, marriages
SO that the family initiative can be
rhetori with series of concrete
in Britain are at an all-time low,
adequately funded
measures designed to bring par
and 58 percent of all weddings
Commenting on the planned
ents and their children closer to
are civil ceremonies.
family institute, which promises
gether and reduce the incidence
Stringent new laws giving po-
to be a centerpiece of the govern-
of teenage pregnancies and sin
lice powers to pick up children
ment's program, Health Minister
gle parent families
Tessa Jowell says, "We're
Among key measures in a,
talking about the kind of
government action plan to
support men and women
be unveiled this week:
'We're talking about the kind of
would have got at times
Creation of a govern
support men and women would
when society was more sta-
ment-funded-national: family
blè and families lived closer
institute to promote family
have got at times when society
together.
life. The institute will offer
was more stable
The Sure Start program
parents courses in child
-
Health Minister Tessa Jowell
will include literacy classes.
rearing and in a country
It will seek to identify chil-
where 3 000 children every
dren who need help from an
week see their parents di-
early age. All parents will be
vorce, advise couples on how to
for truancy, and to subject 10-
visited by a Sure Start represen-
strengthen their marriages.
year-olds and under to a 9 p.m.
tative within three months of the
A $918 million dollar "Sure
street curfew. Parents will be
birth of their child.
Start" program in 250 areas of
made legally responsible for their
"We are aiming at a society
Britain. It will bring together ser-
children's behavior, and will be
where children's life chances are
vices for under-three-year-olds
fined if their offspring persis-
handed out on the day they are
and their parents, including
tently offend.
born," Ms Jowell says.
state-funded day care, play-
Police say pilot schemes in sev-
Britain's opposition Conserva-
groups, and post-natal advice.
eral British cities have cut youth
tives have been slow to criticize
Arrangements for health vis-
crime significantly. One such
Blair's family initiative, largely be-
itors, community nurses, and vol-
teenage-curfew plan has been
cause in office they themselves
unteers from family support or-
running for some months in
advocated a return to family val-
ganizations to monitor the
Hamilton, in the north of Eng-
ues
progress of children through
land. Chief Constable John Orr
It is thought likely, however,
school.
says, "The vast majority of par-
that opposition leader William
Instead of making contact with
ents and most of the children are
Hague will attack Blair's action
young mothers and babies only at
telling us that they agree with
plan once it is published and the
the time of birth, health visitors
what we are trying to achieve. Var-
full details are known.
02/04/99 11:49 FAX 202 334 3829
NRC CBASSE
I
002/010
home
NATIONAL RESEARCH COUNCIL
COMMISSION ON BEHAVIORAL AND SOCIAL SCIENCES AND EDUCATION
visiting
and the
INSTITUTE OF MEDICINE
BOARD ON CHILDREN, YOUTH, AND FAMILIES
2101 Constitution Avenue, Washington, DC 20418
COMMITTEE ON INTEGRATING THE SCIENCE OF
TELEPHONE: (202) 334-1396
EARLY CHILDHOOD DEVELOPMENT
FAX: (202) 334-3829
February 3, 1999
Nicole Rabner
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Nicole:
I am writing to invite you to attend a two-day workshop on Home Visiting Interventions, to be held on
Monday, March 8 and Tuesday, March 9, 1999, at the Georgetown University Conference Center. The
workshop, which is sponsored by the Board on Children, Youth, and Families of the National Research
Council and the Institute of Medicine, will bring together researchers, practitioners and policy makers to
address a set of core questions about home visitation interventions, using recent evaluations of this
intervention strategy as a departure point. The meeting is funded by the David and Lucile Packard
Foundation.
The workshop is timed to coincide with the release of the issue of the Packard Foundation's The Future of
Children on "Revisiting Home Visiting." In addition, results from a meta-analysis of home visiting
interventions commissioned by the Packard Foundation will be presented at the workshop. The goals of the
workshop are to portray the diversity of home visiting interventions; place the knowledge base about home
visiting in the context of other pertinent basic and intervention research literatures; consider where there is
agreement about the conditions under which, for whom, and for which outcomes a home visiting strategy is
and is not effective; and identify the most promising avenues for future research and policy.
The Georgetown University Conference Center is located at 3800 Reservoir Road, NW. The workshop will
be held on the Main Floor; when you arrive, please check the monitors located directly inside the entrances
for the exact room. Directions, a map, and information about parking and public transportation are
enclosed, along with an agenda and project summary.
We would be delighted if you could join us for this important workshop. Please let us know by returning
the enclosed reply form via fax to 202-334-3829 by Monday, February 15, 1999. If you have any questions,
please feel free to contact me at 202-334-1349.
Sincerely,
Deborah
Deborah A. Phillips, Ph.D.
Staff Officer
Board on Children, Youth, and Families
The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering
to serve government and other organizations
02/04/99 11:49 FAX 202 334 3829
NRC CBASSE
1
004/010
BOARD ON
Children, Youth,
and Families
National Research Council/Institute of Medicine
PROJECT SUMMARY
HOME VISITATION
Home visitation has emerged as one of the most popular strategies for promoting maternal and
child health, fostering beneficial home environments, and promoting young children's
development. Evaluations of home visiting interventions have also proliferated in recent years,
bringing a vast store of new information to policy debates at all levels of government. However,
this research base remains scattered, and policy makers have expressed uncertainty about the
strength and consistency of findings associated with different approaches to home visitation.
Ambiguity also exists as to whether home visitation interventions should be targeted to specific
at-risk populations or used as a universal health promotion strategy. Even the definition of home
visiting remains open, and questions remain as to whether it is the most effective means of
accomplishing the desired outcomes.
In this context, the Board on Children, Youth, and Families will hold a two-day workshop on
March 8-9, 1999, on home visiting programs. A new synthesis of home visitation evaluations
will be presented at the meeting. Authors of several of the major evaluations, as well as experts
involved in implementing home visitation programs, will comment on the synthesis. Invited
speakers will then address a set of core questions about this intervention strategy: For which
outcomes is home visiting most effective? For whom is home visiting most effective? What are
the critical staffing issues? What are the critical elements of effective home visiting strategies?
What are the biggest barriers to success? Where can we and can we not get a consensus on these
issues? What are the frontiers for new research and program development? What are the central
messages for public policy?
The workshop will also build on past studies of the National Research Council and the Institute
of Medicine that reviewed home visitation interventions in the areas of family violence, the
prevention of mental disorders, and maternal and child health. Workshop participants will
include experts in maternal and child health and mental health, psychology, sociology, statistics,
evaluation research, economics, anthropology, ethics, family law, family and community services,
and public policy. A workshop summary will be published.
The workshop is funded by the David and Lucile Packard Foundation.
For further information, please contact Deborah Phillips, Study Director, at 202-334-1396 or
<[email protected]>, or Nancy Geyelin Margie, Research Assistant, at 202-334-1349 or
<[email protected]>.
The Board on Children, Youth, and Families was established in 1993 under the joint aegis of the National
Research Council's Commission on Behavioral and Social Sciences and Education and the Institute of
Medicine. The Board provides a national focal point for authoritative, nonpartisan analysis of child and
family issues that center on policy decisions.
02/04/99 11:50 FAX 202 334 3829
NRC CBASSE
005/010
BOARD ON
Children, Youth,
and Families
National Research Council/Institute of Medicine
Workshop on Revisiting Home Visiting
Monday, March 8 & Tuesday, March 9, 1999
Georgetown University Conference Center
Washington, DC
DRAFT AGENDA
Monday, March 8, 1999
DAY ONE:
WHAT CAN WE NOW SAY ABOUT HOME VISITING STRATEGIES?
8:30 - 9:00
Welcome, Introductions, and Purpose of the Workshop
Ruth T. Gross, Professor of Pediatrics, Emerita, Stanford University
(a) To portray the diversity of home visiting interventions
(b) To consider where there is agreement about the conditions under which, for whom,
and for which outcomes a home visiting strategy is and is not effective -- where are
the opportunities for agreement and where not?
(c) To place the knowledge base about home visiting in the context of other pertinent
basic and intervention research literatures
(d) To identify the most promising avenues for future research and policy
9:00 - 10:00 Perspectives on the Standards of Evidence in Assessing Home Visiting
David Olds, Kempe Prevention Research Center for Family and Child Health,
University of Colorado at Denver
Robert Granger, Manpower Demonstration Research Corporation
Deborah Daro, National Center on Child Abuse and Prevention Research
Moderator:
Ann Segal, Office of the Assistant Secretary for Planning and Evaluation,
U.S. Department of Health and Human Services
02/04/99 11:50 FAX 202 334 3829
NRC CBASSE
5
006/010
10:00 - 11:00 Summaries of New Efforts to Synthesize Research on Home Visitation
Discussion of The Future of Children: Revisiting Home Visitation:
Deanna Gomby, The David and Lucile Packard Foundation
Discussion of Home Visiting Summit:
Matthew Melmed, Zero to Three: National Center for Infants, Toddlers and
Families
11:00 - 11:15 BREAK
11:15 - 12:30 Presentation of Meta-Analysis of Home Visiting Interventions
Mark Appelbaum, Department of Psychology, University of California at San
Diego
Monica Sweet, Department of Psychology, University of California at San Diego
12:30 - 1:15 LUNCH
1:15 - 1:45 Cost Analysis and Effectiveness of Home Visiting Interventions
Steven Barnett, Graduate School of Education, Rutgers University
or
Deborah Montgomery, American Institutes for Research
Commentary and Discussion-What Can We Say Today About Home Visiting?
1:45 - 2:30
Home visiting for which outcomes?
Researcher: Anne Duggan, School of Medicine, Johns Hopkins University
Practitioner: [To be determined]
2:30 - 3:15
For whom is home visiting most effective?
Researcher:
Mary Wagner, Center for Education and Human Services, SRI
International
Practitioner: Pilar Baca, Kempe Prevention Research Center for Family and Child
Health, University of Colorado at Denver
3:15 - 3:30
BREAK
3:30 - 4:15
What are the biggest barriers to success?
Researcher:
John Landsverk, Services Research Center, Children's Hospital - San Diego
Practitioner: Mildred Winter, Parents as Teachers National Center, Inc.
4:15 - 5:00
What are the critical elements of effective home visiting strategies?
Researcher:
Amy Baker, The Children's Village
Practitioner: Tammy Mann, Senior Program Associate, Zero to Three (invited)
02/04/99 11:50 FAX 202 334 3829
NRC CBASSE
007/010
Tuesday, March 9, 1999
DAY TWO:
What can we learn from other research and interventions to inform the future of home visiting?
Research on Family Circumstances: Implications for Home Visiting
9:00 - 9:45 Circumstances of Families in Poverty
Jeanne Brooks-Gunn, Teachers College, Columbia University
9:45 - 10:30 Maternal Depression/Mental Health
William Beardslee, Judge Baker Children's Center, Harvard University (invited)
10:30 - 10:45 BREAK
10:45 - 11:30 Child Abuse and Neglect
David Kolko, Department of Child Psychiatry and Psychology, University of
Pittsburgh Medical Center, and Child and Parent Behavior Clinic, Western
Psychiatric Institute and Clinic
11:30 - 12:15 Cultural and Linguistic Diversity
Delia Pompa, Office of Bilingual Education and Minority Languages Affairs,
U.S. Department of Education (invited)
12:15 - 1:00 LUNCH
1:00 - 3:00
What can we learn from other services and intervention strategies?
Center-based programs:
Donna Bryant, Frank Porter Graham Child Development Center, University of North
Carolina at Chapel Hill
Comprehensive Child Development Program:
Jean Layzer, Abt Associates, Inc.
Early Head Start:
JoAnn Robinson, Kempe Prevention Research Center for Family and Child
Health, University of Colorado at Denver
Family Preservation:
Ronna Cook, Westat (invited)
Elyse Kaye, James Bell Associates (invited)
Moving to Opportunity:
Jens Ludwig, Department of Public Policy, Georgetown University
Parent Education Programs:
Heather Weiss, Harvard Family Research Project, Harvard University (invited)
Teen Parent Programs:
Ellen Eliason Kisker, Mathematica Policy Research, Inc.
Moderator:
Jean Layzer, Abt Associates, Inc.
02/04/99 11:50 FAX 202 334 3829
NRC CBASSE
5
008/010
3:00 - 3:15 BREAK
3:15 5:00 Conclusions: Panel Discussion
Anne Cohn Donnelly, Kellogg School of Management, Northwestern University
Brenda Jones Harden, Department of Human Development, University of
Maryland
Lisbeth Schorr, Project on Effective Services, Harvard University
Discussion Points:
What do we know now that we did not know three years ago?
What have we learned about how to make sure that home visiting occupies the best
possible place on the landscape of service strategies?
Where can we and can we not get a consensus?
Where are the best opportunities for future research-program development?
What are the take home messages for public policy and how can we best
convey them?
02/04/99 11:51 FAX 202 334 3829
NRC CBASSE
009/010
Workshop on Home Visitation Interventions
sponsored by
Board on Children, Youth, and Families
National Research Council/Institute of Medicine
LOGISTICAL INFORMATION
DATES:
Monday, March 8, and Tuesday, March 9, 1999
LOCATION:
Georgetown University Conference Center
(a.k.a. The Thomas and Dorothy Leavey Center)
3800 Reservoir Road, NW
Washington, DC 20057
phone: 202-687-3200
BY PUBLIC TRANSPORATION:
The Conference Center is approximately 5 minutes by taxi from the Rosslyn and Dupont
Circle Metro stations. Alternatively, the University provides bus service to the Dupont
Circle and Rosslyn Metro stations during the week. The Georgetown University
Transportation Shuttle (GUTS) leaves from the Conference Center and runs every 20
minutes from 7:00 a.m. to 9:30 a.m. and from 3:30 p.m. to 7:00 p.m., and every 30
minutes from 9:30 a.m. to 3:30 p.m., Monday through Friday. The bus service does not
operate on weekends. For free admittance, Conference Center's guests must show their
room key or a conference brochure.
BY CAR:
Directions are attached. Covered parking is available on the premises at the rate of $12
per day or $2 per hour.
Campus Map
39TH ST.
ST. 387H
B7TH ST.
TST.
SSI.
N
RESEAVER ROAD
RST.
RESERVOIR RD,
ST. 357H
0 ST,
Mongral
St. Mary's
FOXHALL
GEORGETOWN
WORK
RD.
UNIVERSITY
34TH ST.
PST.
CONFERENCE
CENTER
OST.
67. a
28TH ST.
Blan
Demail
N ST.
PROSP DI ST.
Mober
PMO
Dogth
Hends
CANAL RD.
WHITEHURST
Lovey
BRIDGE
FREEWAY
Relax
BAREBALL
29
mm
ICO
anned
66
METRO
Directions from
You will want to be in the left lane as
From Reservoir Road:
you cross over Key Bridge. At the
the South:
Follow Reservoir Road until you get
end of Key Bridge take a left at the
to Entrance #1 of Georgetown
light. This is Canal Road. Follow the
From Richmond & South:
University Hospital, turn right. Note
road as it bears to the right. At this
Follow I-95 North, also known as I-395
that you will not see any Marriott
North. Take exit toward Memorial
point the road will change names and
signs, but it will say Georgetown
Bridge. The road will divide, follow
become Foxhall Rd. At the third light
University Medical Center and
signs for Key Bridge. You will want to
take a right onto Reservoir Rd.
Conference Center as you enter
be in the left lane as you cross over
(See from Reservoir Rd.)
Entrance #1. Follow the road straight
Key Bridge. At the end of Key Bridge
back, it will dead end into an under-
take a left at the light. This is Canal
Directions from
ground parking garage. This is the
11:51 02/04/99 FAX 334 202 3829
Road. Follow the road as it bears to
Leavey Center Building. Enter the
the North:
the right. At this point the road will
parking garage and turn right. In
change names and become Foxhall
front of you will be the door to the
From Route 270:
Conference Center Elevator. This is
Rd. At the third light take a right
Follow 270 South towards
onto Reservoir Rd.
the elevator that will bring you to the
Washington/Virginia. Take I-495
Conference Center Lobby. If you need
(See from Reservoir Rd.)
South to Virginia. Follow to Cabin
to drive directly to the Conference
From National Airport:
John Parkway Exit 40 (Glen Echo).
Center Entrance, you will need to
Continue on the Parkway past Chain
(20 Minutes)
turn right before you enter the parking
Bridge Rd. And take a left at the next
Take the George Washington Parkway
garage. The entrance is under the
NRC CBASSE
light. This Is Arizona Avenue. At the
North. Follow signs for Key
green awnings on your left.
top of the hill take a right onto
Bridge/Route 50. Follow until Key
MacArthur Blvd. When the road
Bridge Exit. You will want to be in
divides bear left onto Reservoir Road.
the left lane as you cross over Key
(See From Reservoir Rd.)
Bridge. At the end of Key Bridge take
a left at the light. This is Canal Road.
From BWI Airport,
Follow the road as it bears to the
Baltimore & North:
right. At this point the road will
Follow I-95 South to I-495. Take the
change names and become Foxhall
Rd. At the third light take a right
I-495 West Exit towards Silver Spring.
onto Reservoir Rd.
Continue towards Virginia on I-495
South. Follow to Cabin John Parkway
(See From Reservoir Rd.)
Exit 40 (Glen Echo). Continue on the
From Dulles Airport
Parkway past Chain Bridge Rd. and
take я left at the next light. This is
& West: (40 Minutes)
Arizona Avenue. At the top of the
Follow Dulles Airport Access road to
hill take a right onto MacArthor Blvd.
I-66. Follow I-66 East to the Key
When the road divides bear left onto
Bridge Exit. Exit and stay in left lane.
Reservolr Road.
010/010
At the third light take a left and stay
(See From Reservoir Rd.)
in one of the middle lanes.
lalking It Over
By Hillary Rodham Clinton
Home visitation helps
fledgling mothers cope
education, support and a patient
searcher on the Elmira study, Dr.
y daughter, Chelsea,
M
ear. Home visitors also help with
David Olds. We agreed that we
turns 18 this month.
critical issues such as ensuring
must invest more in research,
How vividly I remem-
that the child receives regular
replicate proven models and
ber the overwhelming
medical attention and nutrition
make existing programs better.
feelings of love and responsibility
as she lay in my arms 18 years
and that the parent is provided
Because children's experi-
ago. During the nine months of
with referrals to peer-group activ-
ences in the earliest years of life
pregnancy, I had studied and
ities, transportation, housing,
are central to their healthy devel-
read about parenting, but nothing
child care, employment and
opment, the president has pro-
prepared me for the sheer mir-
medical care.
posed increasing our investment
acle of having a child.
With the support of her home
in activities that promote early
Despite my efforts, I soon dis-
visitor, Felicia is now the proud
learning and improve the quality
covered that grasping child-
and confident mother of Domin-
of child care in our country: A
rearing concepts in the abstract
ico, a gurgling, smiling and
major element of the president's
and knowing what to do with the
healthy 3-month-old. On the day I
child care proposal is the Early
baby in your hands are two very
visited, Felicia's home visitor was
Learning Fund, which will pro-
different things. Babies don't
checking the baby's development,
vide challenge grants to commu-
come with instructions. Even the
offering some age-appropriate
nities that promote early learn-
most fortunate among us need
toys and answering Felicia's ques-
ing, including home-visiting
some calm reassurance and a lit-
tions and concerns. From her
programs.
tle guidance to get through those
vantage point in the home, the
I don't think I know a mother
scary firsts - breast feeding, dia-
visitor is able both to evaluate the
who hasn't sought help and sup-
per changing, bathing that slip-
child's growth and development,
port in those first months and
pery little creature. But what
and to assess whether the child's
years after having a child. Most
about parents who have known
surroundings are suitable and
of us have help available, but
only poverty or neglect? What
nurturing. When I asked Felicia if
sadly, too many don't. I met one
about parents without a support-
she thought home visits would
young woman who told me that,
ive community? And what about
help others, she said, "Oh, yes, I
without the advice of her home
those who have grown up trapped
feel so rich. Having Lynn really
visitor, she would never have
in cycles of abuse and low expec-
helps."
known that talking and reading
tations?
Equipping parents to be the
actually improve the development
When families lived closer to-
best they can be is critical to the
of her newborn daughter's brain.
gether, it was easier for relatives
Raising healthy children is the
to pitch in during the early
future of our country. Long-term
most important and the hardest
months of a newborn's life. When
studies tell us that home-
job any of us will ever have.
women worked primarily in the
visitation programs can help. Re-
Home-visitation programs can
home, they provided a neighbor-
searchers have just completed a
make that job easier. And that
hood support system to lend a
15-year study of 324 first-time
means healthier children,
hand to new mothers. But now,
mothers who participated in the
healthier families and healthier
relatives and neighbors aren't as
Prenatal and Infancy Nurse
communities.
readily available, and programs
Home Visitation Program in El-
to help fledgling parents are few
mira, N.Y. The results are dra-
and far between.
matic: significant reductions in
This week, I visited the home
government assistance, child
of a single mother in Alexandria.
abuse, unintended second preg-
Depressed and scared when she
nancies, substance abuse and
became pregnant, Felicia was re-
child hospitalizations. And now
ferred to a program called
that these children are teen-
Healthy Families Alexandria,
agers, there's evidence that this
which was launched in 1993 when
program can reduce incidence of
the area began to experience
juvenile crime. The costs of the
some disturbing trends, including
program were fully recovered by
increasingly high rates of child
the time the children were 4
poverty and abuse, teen preg-
years old, thanks to less use of
nancy, low birth-weight babies
government services and fewer
and vaccine-preventable diseases.
subsequent pregnancies.
At the heart of the program is
I believe that one of our great-
the family support worker, a
est challenges is to identify pro-
trained professional or para-
grams like this that work and
professional who visits the new
make them more widely available
mother on a regular basis, both
to families who would benefit
before and after birth, to offer
from them. This week, I spent
some time with the lead re-
The Washington Times
THURSDAY, FEBRUARY 12, 1998
February 9, 1998
HOME VISITATION EVENT AND ROUNDTABLE DISCUSSION
Date:
Tuesday, February 10, 1998
Location:
Alexandria, VA
Time:
2:00 - 2:30pm Home Visitation
3:00 - 3:45pm Roundtable Discussion
From:
Nicole Rabner
I.
PURPOSE
The purposes of this event are: (1) to spotlight the success of home visitation in strengthening
families and promoting healthy child development, and (2) highlight the importance of the
President's proposal -- as part of his child care initiative -- to create an Early Learning Fund to
support community-based home visitation efforts.
II.
BACKGROUND
There are two pieces to this event: you will first accompany a home visitor on a routine home
visitation and then participate in a roundtable discussion on the promise of home visitation. The
home visit will provide an opportunity for you to learn firsthand about the Healthy Families
Alexandria home visitation program: the roundtable will provide a forum to discuss the success
of home visiting generally in strengthening families and promoting healthy child development
and to highlight two approaches to home visitation (Healthy Families America and the Elmira,
New York program).
Home Visitation
As you know. while there are various different programmatic approaches to home visitation, all
share a common thread -- intensive. routine visits by a trained worker to pregnant mothers or
new parents who may be at risk of child maltreatment and who generally demonstrate need for
parenting support. Not surprisingly, there is considerable debate within the field about which
programs best improve child outcomes. There is also debate about the extent to which it is
possible to generalize the promising research findings from one program to the field of home
visitation generally. Dr. David Olds. the lead researcher of the Elmira study, for instance,
questions whether his findings can be used to support the Healthy Families America model. Dr.
Olds also questions whether Healthy Families America has been adequately evaluated. The
principal differences between the two programs are that the Elmira study employs nurses as
home visitors and serves only unmarried women, while Healthy Families America relies on
paraprofessionals. i.e. trained workers. and serves both married and unmarried mothers.
In order to avoid any discussion of the relative merits of existing programs, the roundtable
1
discussion should focus on home visitation generally, and on the promise of home visitation for
strengthening families and improving child outcomes.
Healthy Families Alexandria -- Healthy Families America
Healthy Families Alexandria is a local arm of the national Healthy Families America program,
which serves 320 communities around the country, and is promoted by the National Committee
to Prevent Child Abuse. Healthy Families America was modeled on Hawaii's "Healthy Start"
program of comprehensive, intensive home visiting services.
Healthy Families Alexandria serves about 100 first-time mothers in the City of Alexandria who
have risk factors that may predispose them to child maltreatment. Prenatal and first-time
mothers with a child less than 2 months are eligible for voluntary referral, assessment,
enrollment, and services until the child is 5 years old. The Healthy Families Alexandria model
provides (1) systematic, proactive early identification of at-risk families and (2) home
visiting/case management services delivered by trained. largely paraprofessional Family Support
Workers. Using "best practices" identified by over 20 years of research and referrals from
partners such as the local social services agencies and hospitals, Healthy Families Alexandria
helps parents enhance their parenting skills. use needed community resources, and better manage
their lives to reduce risks leading to child maltreatment.
The program began in Alexandria in 1993 in response to troubling statistics in the Alexandria
area: one in four children living in poverty; Virginia's highest rates of child maltreatment and
teen pregnancy; higher proportions of low birth weight babies born to non-white women; high
rates of vaccine-preventable disease: and alarming increases in proportions of preschool children
with developmental delays, handicapping conditions and other difficulties.
In July, 1997, Healthy Families Alexandria released a 42-month outcome evaluation report. This
independent evaluation showed promising results:
82% of women attended all recommended prenatal medical appointments
92% of infants were born at healthy birth weight
98% of infants had a primary health care provider within 2 months of birth
93% of infants received recommended immunizations and well-care
87% of mothers did not have another child within 24 months
98% of enrolled families had no founded reports of child maltreatment
96% of infants showed no developmental delays
The cost of the Healthy Families America program is approximately $2,700 annually per family.
The program has a range of funding sources: in Alexandria. the funding sources include the City
of Alexandria (via its Early Childhood Commission): United Way of Alexandria: the U.S.
Maternal and Child Health Bureau: the foundations of Freddie Mac, Phillip Graham, INOVA
Alexandria Hospital: and the March of Dimes. Meyer and Winkler.
2
Elmira, New York Pregnancy and Infancy Nurse Home Visitation Program
The Elmira study, called "Long Term Effects of Home Visitation on Maternal Life Course and
Child Abuse and Neglect." is a fifteen-year follow-up of a randomized trial of home visiting in
Elmira, New York. The results were published in the August 27, 1997, issue of The Journal of
the American Medical Association (attached).
The results show that this early intervention is beneficial both in the short- and long terms. In
this voluntary program, nurses begin to visit first-time mothers during pregnancy and continue
home visits for two years after the child is born. Nurse home visitors work intensively with
families to improve three areas: women's health behavior, including a reduction in substance use;
family caregiving for infants and toddlers, including preventive health care and early intervention
for emerging health problems: and maternal life-course development, including pregnancy
planning, education achievement. and finding work.
The 15 year follow-up study of the low-income, unmarried women in the Elmira program found
major program benefits. including:
79% fewer verified reports of child abuse or neglect
31% fewer subsequent live births
over 2 years' greater interval between the birth of their first and second child
30 fewer months receiving welfare
44% fewer behavioral problems due to alcohol and drug abuse
69% fewer arrests among mothers
54% fewer arrests among their children by the children's 15th birthday (this finding has
not yet been published it is the subject of a forthcoming paper)
Event Scenario
Home Visit:
You will participate in a routine home visitation of the Healthy Families Alexandria model by
accompanying Family Support Worker Lynn Kasonovich and Program Director Sally Campbell
on a visit to Felicia Pearson and her 3-month old son, Dominico (bios attached). The home
visitation will include exercises (using toys) designed to gauge the child's healthy development.
Roundtable Discussion:
After meeting with the program participants. you will proceed to the roundtable discussion. You
will make opening remarks. introduce the discussion participants. and introduce the first three
speakers: (1) Dr. Matthew Melmed. the Executive Director of the Zero to Three National Center
for Infants and Toddlers. who will discuss why the early years of a child's life are SO important
and describe home visitation generally: (2) Dr. David Olds. lead researcher of the Elmira study,
who will provide a brief overview of the Elmira program and its promising findings; and (3) Ms.
Betsy Dew. one of the founders of Hawaii's "Healthy Start" program and leading architect of the
3
Healthy Families America national program. who will talk about the program and its
demonstrated success. Ms. Dew will then moderate the discussion with three parents and a
Family Support Worker in the Healthy Families Alexandria program. Finally, you will turn to
Mr. Leland Bresland, CEO of the Freddie Mac Corporation, which has heavily invested in home
visitation programs and research. to make some remarks -- Mr. Bresland will emphasize that this
effort demands public-private partnership and business leadership. You will then conclude the
discussion.
III.
PARTICIPANTS
Home Visitation
The First Lady
Ms. Felicia Pearson, mother
Dominico Pearson. 3-month old son
Lynn Kasonovich. Family Support Worker
Sally Campbell. Healthy Families Alexandria program director
Roundtable Discussion
The First Lady
Dr. Matthew Melmed, Executive Director. Zero-to-Three National Center for Infants and
Toddlers
Dr. David Olds. Director. Prevention Research Center for Families and Child Health and Lead
Researcher of the Elmira Home Visitation program
Ms. Betsy Dew, Director and Senior Training Specialist, The Family Institute of Hawaii Family
Support Center and a Founder of the Hawaii Healthy Start Program
Mr. Leland Bresland, CEO. Freddie Mac Corporation
Brandi Church and Antoine Watson. Mother and Father served by Healthy Families America
Jane Rutherford. Single mother served by Healthy Families America
Valator Giliespie-Ballah. Family Support Worker for Healthy Families Alexandria
Roundtable Discussion Audience
Approximately 40 supporters of the Healthy Families Alexandria program. local officials and
community leaders (see attached list).
IV.
SEQUENCE OF EVENTS
YOU will proceed to home visit site -- the home of Felicia Pearson.
YOU will join the Family Support Worker, Lynn Kasonovich, and the Healthy Families
Alexandria program director in the home visitation.
YOU will depart the home and proceed via motorcade to the roundtable discussion site.
4
YOU will meet briefly with the roundtable discussion participants, and proceed to the
roundtable discussion.
YOU will make opening remarks and introduce the first three speakers: Dr. Matthew
Melmed, Dr. David Olds. and Ms. Betsey Dew.
Dr. Matthew Melmed. Dr. David Olds, and Ms. Betsey Dew will each make brief
remarks.
Ms. Betsy Dew will then moderate the discussion among the Healthy Families
Alexandria parents and Family Support Worker.
Ms. Betsey Dew will ask Mr. Leland Bresland, CEO of the Freddie Mac Corporation to
make remarks.
Mr. Leland Bresland will make brief remarks
YOU will make closing remarks and end the program.
YOU will depart.
V.
PRESS PLAN
Home Visit: One Print Reporter -- TBD
Roundtable Discussion: Open Press
5
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. bio
Felicia Pearson (1 page)
nd
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15416
FOLDER TITLE:
Home Visiting [1]
2012-1035-S
kc1055
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA|
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors |a)(5) of the PRA|
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA|
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
ROUNDTABLE DISSCUSSION ON HOME VISITATION
FEBRUARY 10, 1998
BIOS OF DISCUSSION PARTICIPANTS
Matthew E. Melmed. Executive Director, The Zero to Three National Center for Infants and
Toddlers.
Since his arrival in 1994, Mr. Melmed has focused Zero to Three's efforts on promoting
prevention and healthy development in early childhood. Under his leadership, Zero to Three
helped establish the Early Head Start National Resource Center for the U.S. Department of
Health and Human Services which provides training and technical assistance to the new Early
Head Start programs nationwide. Zero to Three has also initiated a national public awareness
campaign for parents and launched the Business Leaders for Babies Alliance -- a corporate effort
aimed at involving the business community in Zero to Three's issues. As you know, Zero to
Three was very involved in developing the White House Conference on Early Childhood
Development and Learning.
Before coming to Zero to Three. Mr. Melmed served for thirteen years as Executive Director of
the Connecticut Association for Human Services and Managing Attorney for Connecticut Legal
Services. Mr. Melmed is the recipient of a number of awards including the Child Advocacy
Award from the Collaboration for Connecticut's Children and the Lewis Hine Award for
Exceptional Service to Children and Youth from the National Child Labor Committee.
David Olds. Professor of Pediatric. Psychiatry and Preventive Medicine at the University of
Colorado Health Sciences Center.
Dr. Olds directs the Prevention Research Center for Family and Child Health at the University of
Colorado Health Sciences Center where he investigates methods of preventing health and
developmental problems in children and parents from low-income families. His original work,
carried out in Elmira, New York. examined the effects of prenatal and postpartum nurse home
visitation on the outcomes of pregnancy, infant caregiving, and maternal life-course
development. and determined the impact of those services on government spending. Dr. Olds had
received numerous awards for this research, including the Charles A. Dana Award for
Pioneering Achievements in Health, and the Lela Rowland Prevention Award from the National
Institute of Mental Health.
He is currently carrying out an urban replication of the Elmira study in Memphis. Tennessee and
another replication of the Elmira and Memphis studies in the Denver metropolitan area.
1
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
002. bios
Roundtable Discussion Participants (partial) (1 page)
nd
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15416
FOLDER TITLE:
Home Visiting [1]
2012-1035-S
kc1055
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information |(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRAJ
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions |(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
[002]
Betsy Dew. Director and Senior Training Specialist with the Family Institute of Hawaii Family
Support Center.
As one of the Founders of Hawaii Family Support Center in 1975, Ms. Dew designed and
implemented the Family Assessment/Early Identification program. With Dr. Calvin Sia and
colleague Gail Breakey, she pioneered the Healthy Start Program and advocated for state-wide
expansion, developing and implementing the state-wide training and technical assistance
program. She was involved in the design and development of the Healthy Families America
(HFA) initiative. She has conducted numerous conference presentations and seminars on
Healthy Start and HFA and has provided consultation in family support program planning,
design and implementation for many states as well as Australia, New Zealand, and the
Philippines. Ms. Dew is currently working as a consultant to communities developing family
support programs and as a trainer for basic and advanced training seminars throughout the U.S.
and abroad.
Jane Rutherford. Parent served by Healthy Families Alexandria.
P6/(b)(6)
Leland Brendsel. Chairman and CEO. Freddie Mac Corp.
Before he was elected chairman in 1989, Mr. Brendsel served as president and chief executive
officer of Freddie Mac for four years. Mr. Brendsel has played a key role in developing the
secondary mortgage market by championing innovative ways of improving lending practices and
expanding homeownership opportunities. In 1991 Mr. Brendsel created and is Chairmian of the
Board of Freddie Mac Foundation. which works to improve the lives of at-risk children and their
families. He runs several times each year in Freddie Mac's Reach Out to a Child 5K walk/runs,
which raise money for foster care and adoption programs.
Mr. Brendsel has been the recipient of numerous awards, including: Washingtonian of the Year
in 1991. the Washington UNICEF Council Children s Champion in 1992. and the Child Welfare
League of America's Corporate Advocate of the Year in 1995.
Brandi Church and Antoine Watson. Parents served by Healthy Families Alexandria.
P6/(b)(6)
2
Healthy Families for most of their support.
Velator Giliespie Ballah. Family Support Worker, Healthy Families America.
Ms. Ballah has been an HFA support worker for four years. and has done extensive community
service work. She is a mother and grandmother.
3
HEALTHY FAMILIES MEET AND GREET
FEBRUARY 10, 1998
1. Linda Dunphy, Director. Healthy Families.
2. Maxine Baker Stokes, Executive Director. Freddie Mac Foundation.
3. Tori Thomas, Chairman. The Winkler Corporation.
4. Catherine Hanley, Chairman. Fairfax County Board of Supervisors.
5. Chris Zimmerman, Chairman. Arlington County Board of Supervisors.
6. Patsy Tiser, Virginia State Senator.
7. Pat Graham, Chairperson. NUFS Board.
TOGETHER FOR CHILDREN
Preyent.Child Abuse, Virginia
Summer 1997
Spotlight on Healthy Families Virginia
infants showed no developmental delay;
92% of families experienced no repeat
pregnancy within one year after birth;
over 92% of families served indicated
Northern Virginia Family Service
they found the program helpful in raising
experience, it is expected that Healthy
Since 1991, Northern Virginia Family
their child and would recommend it to a
Families programs in Prince William Area
Service (NVFS) has been a leader in
friend; and 99% of families experienced
and Arlington will yield positive results.
northern Virginia in working with com-
no founded incidents of child abuse.
Though the service delivery models are
munities to establish Healthy Families
Healthy Families Prince William Area
slightly different in each jurisdiction due
America programs. NVFS has also been
began providing service in July 1996 in
to a variety of factors, the outcome will be
an active participant on the state level
collaboration with the Prince William
the same - healthier families.
with the Healthy Families Virginia Net-
Health District, Potomac Hospital, and
For more information on the Healthy
work. Through a partnership with the
Prince William Hospital. The program
Families programs supported by North-
Fairfax County Department of Human
has a strong and active Advisory Council
em Virginia Family Service, please call
Development in 1991, the organization
and has recently hired a Father Involve-
Healthy Families Alexandria, Sally
developed Healthy Families Fairfax,
ment Specialist to augment its team of
Campbell at 703-823-8153; Healthy
which is now operated by the county. In
experienced family support workers.
Families Arlington, Anne VorDer
1993, working with community leaders
NVFS has partnered with the Arling-
Bruegge at 703-533-2560; or Healthy
in Alexandria, the agency implemented
ton County Department of Human Ser-
Families Prince William Area, Sue
Healthy Families Alexandria. After a year-
vices to integrate and implement the
Hanye at 703-680-3607.
long planning process, NVFS was selected
Comprehensive Health Investment
by Healthy Families Prince William Area
Project of Virginia (CHIP) and Healthy
to help them implement their program in
Families America models. Healthy Fami-
1996. Most recently, a task force in Ar-
lies/CHIP Arlington will address the lim-
lington, which completed an extensive
ited access to consistent child health care,
community-needs assessment, concluded
the need for parenting support, and child
that a Healthy Families initiative was the
abuse prevention. This will be accom-
approach that would best meet the needs
plished by building a system of coordi-
identified. NVFS became the agency
nated health care for young children ages
partner to help plan for implementation.
0-6 and by providing a system of intensive
The agency was awarded a grant from
home-visiting support to improve family
the Freddie Mac Foundation to support
functioning and parenting skills, and to
the development of a regional infrastruc-
prevent child abuse and neglect among
ture for the geographic area, including
enrolled families. Families will be assigned
the four localities in northern Virginia,
to a Healthy Families or a CHIP track,
Washington, and several counties in
depending on the mix of services needed
Maryland served by the foundation. Last
to address specific family strengths and
year, NVFS convened the Healthy
needs. The Healthy Families component
Families America National Capital Area
will specifically target pregnant mothers
Consortium, bringing together public
who screen at-risk for child abuse and
and private agencies from the region.
neglect and who are first-time mothers-
Healthy Families Alexandria recently
the critical window of opportunity for
received high marks in a report by an
influencing long-term parental behavior.
independent evaluator. The report found
Based on the results of Healthy Fami-
that throughout the 30-month evalua-
lies Alexandrta, the support of key com-
tion period: 92% of infants were born at
munity leaders and residents, new and
normal to above birth weight; 86% of
exciting results from research on early
infants were immunized on time; 96% of
childhood brain development. and staff
10
Healthy Families Virginia
Supporting parents right from the start.
in Initiative Coordinated by Prevent Child Abuse. Virginia
The Problem
Serious social and health problems face families today. Economic stress. lack of affordable
housing and inadequate health and child care are challenging many parents. The absence of family and social
support systems often cause problems to become overwhelming. The consequences for children include poor
nutrition. low immunization rates. lack of school readiness and increasing rates of child abuse and
neglect.
In 1996. over 3 million children were reported as abused and neglected. The most recent statistics
indicate that one in five children live 111 poverty, one in ten
infants lack a routine source of health care and at least
100.000 go to sleep homeless every night.
11
The time of child-
The Solution -- Home Visitation Programs
birth presents a golden
In Creating Caring Communities. a blueprint for
opportunity for
Federal policy created by the U.S. Advisory Board on Child
prevention programs."
Abuse and Neglect. the following recommendation can be found:
"The Federal Government should begin planning for
Anne Cohn Donnelly
the
implementation of a universal. voluntary. neonatal home
visitation system."
Visitation programs allow localities to address a number of factors that can lead to abusive
behavior, therefore confronting the symptoms of child maltreatment before a crisis occurs. Visitors can
work with families to ensure that the children receive well-child care and immunizations and that the
mothers receive prenatal care and respite care. if necessary. The visitor can teach parents to develop
realistic expectations regarding child development and can model positive discipline techniques. The home
visits provide an early warning Sy stem for families in need of additional assistance. The parents become
good consumers of available resources. such as housing assistance. job training programs. substance abuse
treatment programs and day care. If visitor services continue for several years. great strides can be made
in reducing problems such as dev elopmental. learning and emotional disabilities, runaways, juvenile
delinquency. truancy. teen pregnancy. substance abuse and criminal behavior.
Home Visitor Programs Target New. First-Time Parents
In an article entitled "Why Focus on New Parents to Prevent Child Abuse," Anne Cohn Donnelly,
National Committee to Prevent Child Abuse Executive Director. states. "The time of childbirth presents
a golden opportunity for prevention programs. New parents are typically seeking assistance at this time
and are. therefore. more likely to voluntarily engage in services designed to help them care for their
children." She cites a study completed by Dr. David Olds which reports that regular pre- and post-natal
home visits by nurse practitioners contribute to a significant reduction in reports of child abuse -- 4%
in the treatment group compared to 199 in the control group. A nationwide study. by the National Committee
to Prevent Child Abuse. on the existence of statewide parent education and support programs found that most
states do have several community based programs. However, few of those programs are statewide, intensive.
comprehensive and well coordinated with other federal. state and local programs.
Healthy Families America -- Creating a Nationwide Initiative
Healthy Families America (HFA) was established in 1992 by
Characteristics of High Risk
the National Committee to Prevent Child Abuse in partnership with
Families
Ronald Donald Children's Charities. The goal of Healthy Families
America is to lay the foundation for nationwide. voluntary home
History of childhood abuse
isitor services for all new parents who need them. through a network
Emotional deprivation in
of statewide systems. HFA is based on two decades of research and on
childhood
Substance abuse
the experiences of the Healthy Start program in Hawaii. a model that
Emotional. mental illness
has been called "the most comprehensive statewide effort in the
Post-partum depression
nation" by the U.S. Advisory Board on Child Abuse and Neglect.
Teenage parents
National partners in HFA include groups as diverse as the American
Single or isolated parents
Nurses Association. the American Hospital Association. the National
Unrealistic expectations of infants
and children
Association for Consumer Credit and the U.S. Bureau on Maternal and
Violence or criminal history
Child Health. In the 1993 Annual Report of the NCPCA. it states that
Continuous and heavy child care
virtually every state had an HF.' task force at work. By Fall of 1997.
Marital or financial
thirty-seven states had operational HFA sites.
problems
Social isolation
The Hawaiian Model
"Healthy Start" the much-acclaimed "Hawaii Program" began as a demonstration model of the Hawaii
Family Stress Center in 1985. Three years later. an evaluation of the program revealed that not a single
case of child abuse had been reported among the project's 214 targeted high-risk families since the
demonstration began. By July 1990. Healthy Start services had been expanded to 11 sites throughout the
state with a rate of abuse and neglect of less than 1% (vs. the 20% abuse rate found in Dr. Olds's study).
Healthy Start begins services in the hospital with sy stematic screening of all new. first-time
parents to identify those most in need of at-home support and education. Most parents accept the
oluntary services offered and receive home visits from trained paraprofessionals. Once the family is
in the program. the first step IS to meet a family's immediate needs. Home visitors may help families to
secure emergency food and housing assistance or 10 complete application forms for health or social service
programs. As the visitors get to know the families better they offer emotional support and promote
attachment between parents and their child. The visits taper off in frequency as the family's stability
improves. Involvement continues until the child reaches age five and enters school. All families are
linked to a health care provider to ensure that their children receive ongoing well-child care. are
screened for developmental delays and are immunized on schedule.
Healthy Families Virginia -- Coordinating Efforts Across the Commonwealth
In Virginia. as in most states. the groundwork for home visitation programs is already in place.
Prevent Child Abuse. Virginia has been the catalyst and coordinator for the initiative since its formative
stages and will continue in that role.
The Virginia initiative will include assessing needs and coordinating existing efforts.
Recognizing that no single prevention or intervention program can address the entire range of families'
needs. Healthy Families Virginia sites will link families with various local programs and services.
building onto existing resources whenever possible.
As coordinator of the Healthy Families Virginia (HFV) initiative. it is the responsibility of
Prevent Child Abuse. Virginia in provide training and technical assistance for communities as they
organize. The HFV Director will also identify and share information about potential funding sources with
communities. as well as coordinating public awareness activities for the advancement of the Healthy
Families Virginia initiative. In this way. it is hoped that a single focus will be created in support of
families. Prevent Child Abuse. Virginia hosts regular meetings SO that HFV sites. other communities and
advocates can share information about this prevention approach and plan further advocacy strategies.
Joining the National Initiative
Communities may qualify for recognition as a Healthy Families America site by meeting certain
criteria. First, a task force with representation from a variety of key community stakeholders must be
convened. These stakeholders must engage in a
comprehensive planning process which includes a commu-
nity needs assessment. service identification and
The Healthy Families Virginia
coordination. implementation planning, and resource
Goal
development. They will formally organize themselves to
continue administering the initiativ conce implementation
has begun and agree to adhere to the HFA Critical Elements
All parents have available
or best practice standards which include the following
support so that they can
points. Family assessment serv rees must begin prenatally
successfully raise children
or at birth. Home visiting services must be intensive (at
and create healthy
least weekly) and caseloads limited to 15-25 per home
communities.
visitor. Attention must be given 10 child health and
school-readiness. The staff and program materials must
All children should be born
reflect the cultural. linguistic. racial and ethnic
healthy. enter school ready
diversity of the population served. The staff must also
to learn. and become
have intensive, standardized initial training and regular
productive. well-adjusted
inservice training and all activities must be evaluated.
adults.
The Washington Post
A model program-which has been copied in more than 20 states-is helping families at risk
to raise happier and healthier children.
'We're Breaking The Cycle Of Abuse
23. SUE LYNN AH YUEN
Sue Lynn
At the center of Healthy Start's
fit the profile of a moth-
Ah Yuen and
cess is the home visitor, who functi
her 3-year-
A
or who might have prob-
old son,
as an advocate, confidant
lems raising her child:
Kainana. in
without becoming a crutch. To k
She was single. home-
Honolulu.
more, I accompanied Cammie H
less and an unemployed
For parents
like Sue
monds. a home visitor at Fan
college dropout when
Lynn,
Support Services of West Ha
her son. Kainana. was
Healthy
she went to see Sherri Cox. 21. Co
born. But Ah Yuen. a
Start offers
support
who lives with her parents
das
Hawaii resident, got help
without
ter. Christa, 2-was referred to H:
long before a crisis OC-
becoming a
monds by a clinic when she
curred, thanks to an early
crutch.
months pregnant, shortly after she
Below:
intervention program called Healthy Start
Healthy
left a troubled marriage.
On the day Ah Yuen left the hospital.
Start staff
"Cammie got me a lawyer
-
Healthy Start paired her with a home
members
with me to court to start fighting for
isitor named Mealii, who found her an
(I-p) Vicki
divorce." Cox told me. The divorce
Wallach,
artment and visited every week for
Gail Breakey,
granted. And. since Christa's bi:
seven months. "With Mealis's support,
Ha'sheo
Hammonds has been teaching the I.
I began to motivate myself." Ah Yuen re-
Mansfield
mother how to care for her baby. us
called. "So far. I've finished a clerical
and Betsy
Pratt.
a combination of books, role-modeli
program. and my next goal is to get my
direct supervision and visits to clin
bachelor's degree in social work." After
Healthy Start now operates with
nearly four years with the program. Ah
annual budget of $8 million. It is m
Yuen is raising a well-adjusted son and
ey well spent. "At minimal cost to
has had a second child
state-about $2500 for each 1
Healthy Start's goal is to help new
parents raise healthy and happy chil-
dren. Its approach-intervening early
with personal support for families at
risk-has been remarkably effective at
reducing child abuse in Hawaii and at
helping families who may be dealing
with poverty, homelessness. drug or al-
cohol abuse and chronic unemployment.
"This is a family-empowerment pro-
gram" said Gail Breakey. one of Healthy
Donnelly. executive di-
Start's founders and the director of the
herri Cox
rector of the National
Hawaii Family Stress Center. "All par-
S
Committee To Prevent
ents want to provide nurturing for their
needed help.
Child Abuse.
children. but many don't have their lives
New parents usually
together. so they aren't able to." And that
At age 19,
learn about Healthy Start at the hospi-
we are breaking the cycle of abus
is where Healthy Stan steps in.
tal. where they are visited by one of the
noted Dr. Jack Lewin, the former
The program's workers screen more
the Hawaii
program's employees shortly after their
rector of Hawaii's health departme
than half of the 20,000 babies bom in
resident
child is bom. These chats are not in-
which administers Healthy Start.
Hawaii each year and provide services
unrusive or judgmental. explained Gail
The programs based on Healthy St
to more than 3000 families. Almost all
Breakey, and they are conducted sole-
also are showing positive results. "C
accept Healthy Start's aid. and there IS
had just left
ly with the individuals' consent. During
families feel like they re a cut abc
less than a I percent incidence of child
a troubled marriage,
the conversation. the worker talks to
their peers." observed Carolyn Wi:
abuse among this group-far lower than
the parents about their current situation
heart of Healthy Families in San Ange
national average of 4.7 percent.
and she was six
and their past history, all the while lis-
Tex. "And the real payoff will con
Healthy Start was founded in 1985
tening for warning signs that might in-
when these babies have children."
and has been copied extensively na-
months pregnant.
dicate potential problems. "We look for
tionwide. Today. projects based bn ILS
Then Healthy Start
parents who were abused or neglected
For more information. write: H-
approach operate in more than 20 states.
as children." said Breakey. "We know
Families America. National
and almost every other state has a pro-
stepped in.
from research that there is an intergen-
To Prevent Child Abuse. f.
gram in development. said Anne Cohn
erational pattern.
Dept. P. Chicago. III. 606s
B
MARGERY
STEIN
Original Contributions
Long-term Effects of Home Visitation
on Maternal Life Course
and Child Abuse and Neglect
Fifteen-Year Follow-up of a Randomized Trial
David L. Olds, PhD; John Eckenrode. PhD: Charles R. Henderson, Jr; Harriet Kitzman, RN, PhD: Jane Powers, PhD:
Robert Cole, PhD; Kimberly Sidora, MPH; Pamela Morris; Lisa M. Pettitt: Dennis Luckey, PhD
Context.-Home-visitation services have been promoted as a means of
IN RECENT YEARS, home-visitation
improving maternal and child health and functioning. However, long-term effects
services have been promoted widely as a
have not been examined.
means of preventing a range of health
Objective.-To examine the long-term effects of a program of prenatal and early
and developmental problems in children
childhood home visitation by nurses on women's life course and child abuse and
from vulnerable families. The US Advi-
sory Board on Child Abuse and Neglect,
neglect.
for example, has recommended t
Design.-Randomized trial.
home-visitation services be made avail-
Setting.-Semirural community in New York.
able to all parents of newborns as a
Participants.-Of 400 consecutive pregnant women with no previous live births
means of preventing child abuse and ne-
enrolled, 324 participated in a follow-up study when their children were 15 years old.
glect.¹
Intervention.-Families received a mean of 9 home visits during pregnancy and
23 home visits from the child's birth through the second birthday.
See also PP 644 and 680.
Data Sources and Measures.-Women's use of welfare and number of sub-
sequent children were based on self-report; their arrests and convictions were
based on self-report and archived data from New York State. Verified reports of child
Many of these recommendations have
been based on the results of a random-
abuse and neglect were abstracted from state records.
ized trial of a comprehensive program of
Main Results.-During the 15-year period after the birth of their first child, in
prenatal and early childhood home visi-
contrast to women in the comparison group, women who were visited by nurses
tation by nurses that was conducted in
during pregnancy and infancy were identified as perpetrators of child abuse and
Elmira, NY.2." Findings from this trial
neglect in 0.29 vs 0.54 verified reports (P<.001). Among women who were unmar-
indicated that the program reduced the
ried and from households of low socioeconomic status at initial enrollment. in con-
rates of subsequent pregnancy, in-
trast to those in the companson group, nurse-visited women had 1.3 vs 1.6 sub-
creased labor force participation, and re-
sequent births (P=.02), 65 vs 37 months between the birth of the first and a second
duced government spending for low-in-
come unmarried women from the birth
child (P=.001), 60 vs 90 months' receiving Aid to Families With Dependent Chil-
dren (P=.005), 0.41 vs 0.73 behavioral impairments due to use of alcohol and other
drugs (P=.03), 0.18 vs 0.58 arrests by self-report (P<.001), and 0.16 vs 0.90 ar-
From the University of Colorado Health Sciences
Center Denver (Drs Olds and Luckey): Cornell Univer-
rests disclosed by New York State records (P<.001).
sity, New York, NY (Drs Eckenrode and Powers. Mr
Conclusions.-This program of prenatal and early childhood home visitation by
Henderson, and Ms Morris): the University of Roches-
ter. Rochester, NY (Drs Kitzman and Cole and Ms
nurses can reduce the number of subsequent pregnancies. the use of welfare, child
Sidora): and the Department of Psychology. University
abuse and neglect. and criminal behavior on the part of low-income. unmarried
of Denver (Ms Pettitt).
Reprints: David L Olds. PhD. University of Colorado
mothers for up to 15 years after the birth of the first child.
Health Sciences Center. 303 E 17th Ave. Suite 200.
JAMA 1997:278:637-643
Denver. CO 80203 (e-mail: David.Olds@uchsc edu).
JAMA. August 27. 1997-Vol 278. No 8
Home Visitation and Maternal Life Course-Olds et al 637
1997
of the first child through the child's
the poor. any woman who asked to partici-
sociate who managed the randomization.
be:
h birthday, ie, through 2 years after
pate and had no previous live birth was
The stratification was executed by using
of
the program ended.89 Although the rates
accepted into the study. Approximately
separate decks of cards for the groups
W(
of state-verified cases of child maltreat-
10% of the target population (low income,
defined by the women's race, marital sta-
pr
ment among high-risk families were re-
unmarried. or teenaged) was not recruited
tus at intake, and, for white women, the
co}
duced while the program was in opera-
because of late registration for prenatal
geographidregion in which they resided.
the
tion (through age 2 years),⁵ the effects
care, and another 10% was not recruited
To ensure reasonably balanced sub-
nit
were attenuated during a 2-year period
because they were not referred from the
classes, the decks were reconstituted pe-
clc
after the program ended,6 most likely be-
offices of private obstetricians.
riodically to overrepresent those treat-
mc
cause of increased surveillance for child
Four hundred of the 500 women en-
ment groups with smaller numbers of
me
abuse and neglect set in motion among
rolled in the study. All enrollees completed
subjects, a procedure similar to the
tiv
the nurse-visited families.⁷ Children's
approved informed consent procedures.
Efron biased coin designs.¹³ Women in
vis
health care encounters in which injuries
There were no differences in the age, edu-
treatments 3 and 4 subsequently were
CO!
were detected also were reduced from
cation, or marital status of women who
assigned on a rotating basis, within their
de:
ages 1 through 4 years.⁵²
chose to enroll and those who declined;
stratification blocks, to 1 of 5 nurse home
no:
Although this program produced posi-
there was a difference by race, with 80% of
visitors.
plt
tive effects on maternal and child health
white women VS 96% of the African-
There were 2 deviations from this ran-
du
from pregnancy through the child's
American women agreeing to participate.
domization procedure. First, 6 women
vis
fourth year of life,⁴¹¹ its long-term ef-
Eighty-five percent of the sample origi-
who were enrolled were living in the same
bii
fects remain unexamined. The present
nally recruited had at least 1 of the 3 risk
household as were other women who
for
study was conducted to determine the
characteristics used for recruitment. Forty-
were already participating in the study.
extent to which the beneficial effects of
eight percent were younger than 19 years,
To avoid potential horizontal diffusion of
Or
the program instituted early in the life
62% were unmarried, and 59% were from
the treatment in case of different assign-
cycle altered the life-course trajectories
households classified as low SES" at reg-
ments within households, the 6 new en-
of
of the mothers through the child's 15th
istration during pregnancy. Eleven per-
rollees were assigned to the same treat-
far
birthday. We examined the long-term ef-
cent of the sample was African American.
ment as their housemates. Second, during
me
fects of the program on 2 domains of ma-
the last 6 months of the 30-month enroll-
wi
ternal functioning: (1) maternal life
Treatment Conditions
ment period, the number of cards repre-
an
course (subsequent number of children,
The research design included 4 treat-
senting treatment 4 was increased in each
tio
use of Aid to Families With Dependent
ment conditions. Families randomized to
of the decks to enlarge the size of that
frc
Children [AFDC], employment, sub-
treatment 1 (n=94) were provided sen-
group and to enhance the statistical
lov
s' e abuse, and encounters with the
sory and developmental screening for the
power of the design to compare the in-
tal
C
nal justice system) and (2) perpe-
children at 12 and 24 months of age. Based
fancy home-visitation program with
me
tration of child abuse and neglect. We
on these screenings, the children were re-
treatments 1 and 2 on infant health and
on
hypothesized that the program effects,
ferred for further clinical evaluation and
developmental outcomes. A thorough
en
as in earlier phases of the study, would
treatment when needed. Families ran-
analysis conducted at earlier phases of the
sti
be greater for families in which the moth-
domized to treatment 2 (n=90) were pro-
trial indicated that this slight confound-
na:
ers experienced a larger number of
vided the screening services offered those
ing of treatments with time did not affect
tre
chronic stressors and had fewer re-
in treatment 1, plus free transportation
the treatment effects.
ple
sources to manage the challenges of liv-
(using a taxicab voucher system) for pre-
up
ing in poverty and being a parent.
natal and well-child care through the
Program Plan and Implementation
dr
child's second birthday. There were no dif-
The experimental home-visitation pro-
or
DESIGN AND METHODS
ferences between participants in treat-
gram was administered by Comprehen-
13.
ments 1 and 2 in their use of prenatal and
sive Interdisciplinary Developmental
ye.
Setting
well-child care (both groups had high
Services, Inc, of Elmira. In the home vis-
mc
The study was originally conducted in
rates of completed appointments). There-
its, the nurses promoted 3 aspects of ma-
en
and around Elmira, NY, a small city with
fore, these 2 groups were combined to
ternal functioning: (1) health-related be-
ha.
a population of 40 000 in a semirural area
form a single comparison group as in ear-
haviors during pregnancy and the early
of central New York State (NYS). Pa-
lier reports. Families randomized to
years of the child's life; (2) the care par-
Sti
tients were recruited from a clinic offer-
treatment 3 100) were provided the
ents provided to their children; and (3) ma-
ing free antepartum services sponsored
screening and transportation services of-
ternal personal life-course development
mi
by the county health department and the
fered those in treatment 2 in addition to
(family planning, educational achieve-
qu
offices of private obstetricians.
being provided a nurse who visited them
ment, and participation in the workforce).
lat
at home during pregnancy. Families ran-
In the service of these 3 goals, the nurses
(n:
Participants
domized to treatment = 116) were pro-
linked families with needed health and
su:
From April 1978 through September
vided the same services as those in treat-
human services and attempted to involve
of
1980, 500 consecutive eligible women were
ment 3, except that the nurse continued to
other family members and friends in
su
invited to participate. Pregnant women
visit through the child's second birthday.
the pregnancy, birth, and early care of
te:
were actively recruited for the study if
the child. The program was based on theo-
en
they had no previous live births, could reg-
Randomization
ries of self-efficacy, human ecology, and
fn
ister in the study prior to the 25th week of
Women were stratified by marital sta-
human attachment.¹⁴ The nurses used
en
gestation. and had at least one of the
tus, race, and 7 geographic regions
detailed assessments, record-keeping
for
f
ing sociodemographic risk charac-
within the county (based on census tract
forms, and protocols to guide their work
COI
it. LICS: young age (<19 years at regis-
boundaries). At the end of the intake in-
with families, but adapted the content of
the
tration), unmarried, or low socioeconomic
terview, women drew their treatment
their home visits to the individual needs
ite
status (SES) (Medicaid status or no pri-
assignments from a deck of cards and
of each family. They provided a compre-
dit
vate insurance). To avoid creating a pro-
placed them in a sealed envelope. The
hensive educational program designed to
sai
gram stigmatized as being exclusively for
cards were transferred to a research as-
promote parents' and other family mem-
sui
638 JAMA. August 27, 1997-Vol 278, No. 8
Home Visitation and Maternal Life Course-Olds et al
JAN
bers' effective physical and emotional care
Table -Profile of the Trial: Flow of Patients From Recruitment During Pregnancy Until 15 Years After Birth
of their children. The nurses also helped
of First Child*
women clarify their goals and develop
Treatments 1 and 2
Treatment 3
Treatment 4
problem-solving skills to enable them to
(n=184)
(n=100)
(n=116)
cope with the challenges of completing
Program implementation
their education, finding work, and plan-
Completed prenatal home visits.
8.6 (0-16)
8.6 (0-16)
ning future pregnancies. Developing a
mean (range)
close working relationship with the
Completed postnatal home visits.
22.8 (0-59)
mean (range)
mother and her family, the nurses helped
Intervening years
mothers identify small achievable objec-
Fetal. infant. or child death
10
7
9
tives that could be accomplished between
Child adoptedt
7
6
2
visits that, if met, would build mothers'
Maternal death
1
1
0
confidence and motivation to manage the
15-y follow-up study
demands of caregiving and become eco-
Missing (mothers)
12
1
4
nomically self-sufficient. The nurses com-
Refused to participates
pleted an average of 9 (range, 0-16) visits
Mothers
6
5
4
during the pregnancy and 23 (range, 0-59)
Adolescents
10
8
7
visits from the child's birth to second
Completed assessments
birthday. Details of the program can be
Mothers
148
79
97
found elsewhere.¹
Adolescents
144
77
94
Cases with CPS datal
142
77
95
Overview of Follow-up Study
Years of complete CPS data.
13.4 (3.2) [2.6-15.0]
13.3 (3.1) (2.9-15.0]
13.4 (3.1) (0.7-15.0)
The present phase of the study consists
mean (SD) (range)
of a longitudinal follow-up of those 400
"Of 500 eligible patients. 100 refused participation. The 400 participants were randomized to treatment conditions:
families who were randomized to treat-
treatments 1 and 2 were combined to form a companson group; treatment 3. nurse visitation during pregnancy: and
treatment 4. nurse visitation dunng pregnancy and infancy. Data are given as number, unless otherwise indicated.
ment and comparison conditions and in
There were 2 adoptions in which interviews were conducted with the child but not the mother. They are not shown
which the mother and child were still alive
in this table.
#For both cases in which the mother died. the adolescents were interviewed.
and the family had not refused participa-
Refusals include 8 mothers who refused to participate during eartier phases and were not approached for the
tion in earlier phases. The flow of patients
15-year follow-up.
from recruitment through the 15-year fol-
IChild Protective Service (CPS) data were used to determine the number of state-venfied reports of child abuse
and neglect.
low-up is presented in Table 1. As this
table indicates, we completed assess-
For the number of months receiving
ables was made explicitly without refer-
ments at 15 years on 81% of participants
AFDC, a normal variable, we can detect
ence to this information.
originally randomized and on 90% of wom-
a mean difference of 19 months in the
en for whom there was no miscarriage,
total sample and 30 months in the higher-
Assessments and Definitions
stillbirth, death (infant, child, or mater-
risk sample. For the number of subse-
of Variables
nal), or child adoption. There were no
quent births, also a normal variable, we
Assessments conducted at earlier
treatment differences in the rates of com-
can detect differences of 0.36 and 0.57 in
phases are specified in previous publica-
pleted assessments at the 15-year follow-
the total and high-risk samples, respec-
tions.⁵ᵃ⁸ Intake interviews, which were
up. Table 1 also shows that reviews of chil-
tively.
conducted with women before randomiza-
dren's Child Protective Service (CPS) rec-
For the count of number of verified
tion, included assessments of women's so-
ords were completed for an average of
reports of abuse and neglect, the small-
ciodemographic and personality charac-
13.4 years for those cases on which 15-
est detectable differences are 0.21 and
teristics (including a short-form measure
year interviews were conducted with the
0.33, respectively. The actual analyses in
of the locus of control scale of Rotter
mother. There were no treatment differ-
this report use more fully specified mod-
health-related behaviors, and health con-
ences in the number of years for which we
els than those used for the power calcu-
ditions. Women's household SES was es-
had CPS data.
lations, and thus have greater power.
timated by using the Hollingshead 4-fac-
tor method12, families were classified into
Statistical Power
Masking
low SES (III and IV) and higher SES (I
Sample size and power were deter-
The mothers were informed that they
and II) levels.
mined by the original design and subse-
were being interviewed as part of a
At the 15th-year interview, mothers
quent attrition of subjects. Power calcu-
follow-up to their participation in a
completed a life-history calendar that was
lations are given here for 3 key outcomes
study in which they originally enrolled
designed to help them recall major life
(number of months receiving AFDC,
when they were pregnant with their
events (such as births of additional chil-
subsequent births, and verified reports
first child. All data were gathered by
dren, marriages, employment, household
of child abuse or neglect) with the as-
staff members who had no access to the
moves, and housing arrangements). Wom-
sumption of a=.05 and = .20 (2-tailed
families' treatment assignments, except
en were asked to estimate the number of
tests); sample sizes as realized in the pres-
in a few cases in which the mothers in-
months that they used AFDC, Medicaid,
ent study; and means and SDs obtained
advertently revealed that they were
and food stamps, as well as the number of
from the comparison subjects in the pres-
visited by a nurse. Staff members who
times that they were arrested or convicted
ent study. The calculations were per-
gathered data were told that the 15-year
from the time of the birth of their first child
formed for the contrast of women in the
follow-up study was designed to assess
to the child's 15th birthday.
comparison condition (treatment 1 +
the long-range effects of prenatal and
Women also were asked a series of
treatment 2) VS those in the nurse-vis-
early childhood services, including home
questions adapted from the National Co-
ited-during-pregnancy-and-infancy con-
visitation by nurses. The principal in-
morbidity Survey" regarding the impact
dition (treatment 4)-for both the total
vestigators and statisticians had access
of alcohol and other drug use on major
sample and for the unmarried, low-SES
to the families' treatment assignments,
aspects of their lives since the birth of
subsample.
although the operationalization of vari-
their child. A variable was constructed
JAMA, August 27. 1997-Vol 278. No. 8
Home Visitation and Maternal Life Course-Olds et at 639
that summarized a count of 6 domains of
with the one used in the earlier phases of
groups were equivalent for families on
T:
men's lives that were affected by their
this research. It consisted of a 3x2x2 fac-
which 15-year assessments were com-
use of alcohol (missing work, experienc-
torial structure and 6 covariates. The
pleted. As indicated in Table 2, the treat-
ing trouble at work, having a motor ve-
classification factors were treatments (1
ment groups were equivalent both for
hicle crash or traffic violation, having com-
and 2 VS 3 vs 4), maternal marital status
the sample as a whole and for women
promised care of their children, having
(married vs unmarried, at registration),
who were|unmarried and from low-SES
received treatment). The same set of ques-
and social class Hollingshead I and II vs
households at registration.
tions was repeated for their use of illegal
III and IV, at registration). All interac-
and prescription drugs. The counts of do-
tions among these factors were included.
Rates of Subsequent Births
mains affected by their use of alcohol and
The basic conclusions reported herein
and Use of Welfare
other drugs were summarized to create a
were not modified by or limited to one
As indicated in Table 3, in contrast to
"substance use behavioral impairment"
race, and race was not included in final
their counterparts in the comparison
scale with values ranging from 0 to 12.
models.
group, nurse-visited unmarried women
Mothers provided consent for the re-
The 6 covariates included in the final
from low-SES households had fewer sub-
rch staff to review CPS records from
model were maternal age, education, lo-
sequent pregnancies (P=.03) and live
H
states in which they resided during the
cus of control, husband or boy friend sup-
births (P=.02) and greater spacing be-
interval from the birth of their first child
port, mother's employment status, and
tween first and second births (P=.001). In
(focal child) to that child's 15th birthday.
father's public-assistance status, all
addition, they reported using AFDC and
All reports involving either the mother
measured at registration. These covar-
food stamps fewer months than did un-
or the focal child were recorded.
iates had consistently significant rela-
married, low-SES women in the compari-
Substantiated reports were ab-
tionships with many of the outcomes
son group (P=.005 and P=.001, respec-
stracted to ascertain key features of the
amined in this report. All covariates
tively).
maltreatment incident. All NYS records
were tested for homogeneity of regres-
were searched, as well as those of most
sions for the hypothesized contrasts.¹⁸
Substance Abuse, Criminal Justice
other states in which families resided
Dependent variables for which a nor-
Encounters, and Child Abuse
during the 15-year period. In some
mal distribution was assumed were ana-
and Neglect
states, data were not available for the
lyzed in the general linear mc 'el and low-
Table 4 shows that nurse-visited, low-
entire 15-year period because these
frequency count data (eg, r. iber of sub-
SES, unmarried women reported being
states expunge their records on a peri-
stantiated reports of child ] altreatment)
impaired in fewer domains by alcohol or
T:
odic basis. A few other states prohibit
in the log-linear model (assuming a Pois-
other drug use, having been arrested
the release of case-level information. Six
son distribution). In the log-linear model,
fewer times, having been convicted
es had fewer than 4 years of CPS data.
the analysis was performed and estimates
fewer times, and having spent fewer
1 although none was indicated for
obtained in terms of the logs of the inci-
days jail (P=.005, P<.001, =.008, and
abuse or neglect, they are retained as
dence. We use the term incidence in re-
P<.001, respectively) since the birth of
valid cases for this analysis. As shown in
ferring to the actual count or mean of
their first child than did low-SES unmar-
s
Table 1, our search covered an average
counts over specific periods of measure-
ried women in the comparison group.
of more than 13 years of the 15-year pe-
ment.
Data from NYS showed that nurse-vis-
riod in each treatment group, and there
The distributions of each of the depen-
ited, low-SES, unmarried women had
were no treatment differences in the
dent variables were carefully examined,
fewer actual arrests (P<.001) and fewer
amount of time searched, either for the
and cases with outlying values (above
convictions (P<.001).
sample as a whole or for the low-SES,
20) were truncated to 20 to reduce the
New York State arrests were classi-
unmarried subgroups. The primary out-
likelihood that the differences observed
fied into 3 categories: property crimes
come variable reported herein is the to-
were the result of a few extreme values.
(eg, theft), person crimes (assault, rob-
tal number of substantiated reports dur-
This was done for 1 outcome variable,
bery), and other (eg, vice, major traffic
ing the entire 15-year period involving
number of days jailed.
offenses). Overall, 67% of the crimes
the mother as perpetrator.
All treatment contrasts focused on the
were for property offenses, 14% were
Mothers' records of arrests and crimi-
comparison of the combination of treat-
for person crimes, and 19% were for
1 convictions were abstracted from the
ments 1 and 2 (the comparison group) with
other offenses. The treatment differ-
NYS Division of Criminal Justice Ser-
treatment 4 (the pregnancy and infancy
ences for low-SES, unmarried women
C.
vices, after the principal investigator
nurse-visited group), because we hypoth-
were present for arrests for property of-
(D.O.) signed a nondisclosure agreement.
esized that the greatest treatment effect
fenses (0.12 vs 0.60; P<.001), but not at
C
were matched based on the wom-
would be exerted by the combination of
conventional levels of statistical signifi-
en's names, birth dates, ethnicity, and So-
prenatal and postnatal home visitation, as
cance for person offenses (0.02 vs 0.13;
cial Security numbers. Data on the num-
found in earlier evaluations.⁸⁵ We also
P=.10), and other offenses (0.02 vs 0.17;
p
ber of arrests and convictions and types of
show treatment effects for the group de-
P=.12) (data not shown).
offenses were abstracted from this data-
fined by women's being unmarried and
Table 4 also shows that in contrast to
C
base. Arrests were separated by whether
from low-SES households at registration
women in the comparison group, those
they occurred before randomization or be-
during pregnancy; this constitutes our op-
visited during pregnancy and the first 2
tween the child's birth and 15th birthday.
erationalization of women's experiencing
years of the child's life were identified as
p
(No arrests occurred between randomiza-
higher levels of chronic stress (being from
perpetrators of child abuse and neglect
b.
tion and the child's birth.)
a low-SES household) and having few per-
in fewer verified reports during the 15-
p
sonal resources to manage stress (being
year interval (P<.001). This effect was
fe
tistical Models and Methods
unmarried).
greater for women who were unmarried
И
The study was conducted with an in-
and from low-SES households at regis-
h
tent-to-treat approach. After examina-
RESULTS
tration (P<.001). The effect of the pro-
W
tion of a large number of classification
We conducted detailed examinations
gram on number of verified reports was
a:
factors and covariates, a core statistical
of 17 background variables to determine
especially strong for the 4- to 15-year
d
model was derived that was consistent
the extent to which the treatment
period after the birth of the child-ie,
S:
640 JAMA, August 27. 1997-Vol 278. No. 8
Home Visitation and Maternal Life Course-Olds et al
J.
Table 2.-Equivalence of Treatment Conditions on Background Characteristics Measured at Registration for Women Assessed at 15-Year Follow-up*
Whole Sample
Low-SES Unmarried Sample
Treatments
Treatments
1 and 2
Treatment 3
Treatment 4
1 and 2
Treatment 3
Treatment 4
Dependent Variables
(n=148)
(n=79)
(n=97)
(n=62)
(n=30)
(n=38)
Unmarned. %
62
59
64
Low-SES household. %
64
70
61
White, %
90
91
86
87
87
77
Smoker (>4 cigarettes/d). %
47
46
58
51
60
59
Male child. %
55
44
55
44
53
49
Mother working. %
39
36
31
24
20
20
Mother receiving public assistance. %
9
10
13
23
29
20
Father working, %
70
70
87
42
50
52
Father receiving public assistance. %
4
3
3
10
6
2
Husband or boyfriend in house. %
58
76
60
21
47
22
Maternal age, mean (SD). y
19.3 (2.9)
19.5 (3.1)
19.4 (3.7)
18.6 (2.5)
19.0 (2.8)
18.2 (3.3)
Maternal education, mean (SD). y
11.2(1.5)
11.6 (1.5)
11.1 (1.6)
10.7 (1.4)
10.9 (1.4)
10.3 (1.5)
Husband or boytriend education, mean (SD). y
11.4 (1.4)
11.7 (1.7)
11.5 (1.6)
11.1 (1.4)
11.0 (1.8)
10.8 (1.5)
Grandmother supportt*
100.4 (10.1)
97.7 (9.2)
101.3 (10.3)
101.6 (10.9)
98.1 (10.3)
104.1 (11.2)
Husband or boyfriend supportt
99 6 (10 5)
102.0 (9.0)
99.0 (9.9)
94.2 (10.6)
98.6 (9.4)
96.8 (9.3)
Locus of controlt
99.3 (10
100.6 (9.5)
100.6 (10.2)
97.5 (10.2)
99.2 (10.3)
99.1 (9.9)
Incidence of maternal arrests in New York State
0.09 (-2.50)
0.13 (-5.41)
0.06 (-8.98)
0.13 (-2.03)
0.13 (-2.02)
0.18 (-1.71)
prior to randomizations
*See first footnote to Table 1 for explanation of treatment groups. SES indicates socioeconomic status.
Standardized to mean- 100 and (SD)-10.
$Locally developed scale that assesses degree to which individual provides emotional and material support to mother.
$Incidence (log incidence) represents the mean number of infrequently occurring events within stated period. Individual cases may have values greater than 1. although the
range is small.
Table 3.-Adjusted Maternal Life-Course Outcomes From Birth of First Child to 15 Years*
Whole Sample
Low-SES Unmarried Sample
Mean No.
Mean No.
Estimate (95% CI),
Estimatet (95% Cf),
Dependent
Treatments
Treatments 1 and 2
Treatments
Treatments 1 and 2
Variables
1 and 2
Treatment 3
Treatment 4
vs Treatment 4
1 and 2
Treatment 3
Treatment 4
vs Treatment 4
Subsequent
2.1
19
1.7
0.4 (-0.1 to 0.8)
2.2
2.0
1.5
0.7# (0.1 to 1.3)
pregnancies
Subsequent births
1.6
1.4
1.3
0.3 (-0.0 to 0.6)
1.6
1.4
1.1
0.5% (0.1 to 1.0)
Months between
37.3
39.8
41.7
-4.4 (-14.9 to 6.1)
37.3
46.6
64.8
-27.55 (-44.1 to -10.9)
birth of first and
second child
Months receiving
65.9
70.2
52.8
13.1 (-0.9 to 27.0)
90.3
81.8
60.4
29.96 (9.0 to 50.7)
AFDC
Months employed
89.7
87.5
96 4
-6.7 (-20.4 to 7.0)
80.0
74.9
95.9
-15.9 (-36.6 to 4.6)
Months receiving
56.4
62.0
47
8.5 (-6.3 to 23.3)
83.5
84.0
46.7
36.86 (14.6 to 59.0)
lood stamps
Months receiving
70.0
71.1
61.8
8.2 (-7.6 to 24.0)
95.4
92.4
72.3
23.1 (-0.6 to 46.8)
Medicaid
*Adjusted for socioeconomic status (SES), mantal status. maternal age, education. locus of control, support from husband or boyfriend, working status, and husband or
boytriend use of public assistance at registration. See first footnote to Table 1 for explanation of treatment groups. AFDC indicates Aid to Families With Dependent Children:
CI, confidence interval.
tEstimate . (treatments t and 2 mean) (treatment 4 mean).
tP<.05.
§P<.01.
the period not assessed in previous re-
of alcohol and other drugs, arrests, con-
would be greater for women who experi-
ports (data not shown).
victions, and number of days jailed during
enced higher levels of stress and who had
the 15-year period after birth of their first
fewer personal resources, we did not fully
COMMENT
child. For most outcomes, the group that
operationalize the stress and resource
In contrast to women in the comparison
was visited only during pregnancy exhib-
variables prior to the beginning of the trial.
group, those visited by nurses during
ited levels of functioning that fell in be-
We chose to employ characteristics used
pregnancy and the first 2 years after the
tween the comparison group and the
for sample recruitment as indicators of
birth of their first child were identified as
group that was visited during pregnancy
chronic stress (coming from a low-SES
perpetrators of child abuse and negiect in
and infancy, indicating a dose-response
household) and having few personal re-
fewer verified reports. Among women
relationship for level of home visitation.
sources (being unmarried). The marital
who were unmarried and from low-SES
These findings have some limitations.
status and poverty variables chosen to re-
households at registration, those who
First, most of the positive results were
flect the personal resource and stress con-
were visited by nurses during pregnancy
concentrated among mothers who were
structs, however, are both well-estab-
and infancy had fewer subsequent chil-
unmarried and from low-SES households
lished risk factors for several adverse
dren, months receiving AFDC and food
at registration during pregnancy. While
outcomes. The concentration of program
stamps, behavioral impairments from use
we hypothesized originally that the effects
effects in women who are unmarried and
JAMA. August 27. 1997-Vol 278. No 8
Home Visitation and Maternal Life Course-Olds et al 641
e 4.-Adjusted Rates of Maternal Substance Abuse. Arrests. Convictions. and Child Abuse and Neglect Reports From Birth of First Child to 15 Years*
tabl
John
Whole Sample
Low-SES Unmarried Sample
Will
y
Incidence (Log Incidence)t
Incidence (Log Incidence)t
the
Estimate (95% CI),
Estimate (95% CI),
lene
Dependent
Treatments
Treatments 1 and 2
Treatments
Treatments 1 and 2
She
Variables
1 and 2
Treatment 3
Treatment 4
vs Treatment 4
1 and 2
Treatment 3
Treatment 4
vs Treatment 4
inte
Substance use
0.43 (-1.09)
0.45 (-0.82)
0.34 (-1 33)
24 (-0.39 to 0.87)
0.73 (-0.31)
0.61 (-0.49)
0.41 (-0.89)
0.58 (0.04 to 1.11)
impairments
Ref
A
0.22 (-2.02)
0.16 (-2.17)
0.09 (-5.21)
3.19 (-99.66 to 106.04)
0.58 (-0.55)
0.36 (-1.01)
0.18 (-1.74)
1.19 (0.49 to 1.89)
11
Convictions
0.13 (-2.29)
0.05 (-9.48)
0.03 (-9.62)
33 (-408.24 to 422.91)
0.28 (-1.28)
0.11 (-2.22)
0.06 (-2.74)
1.46 (0.38 to 2.54)
Cre
Days in jail
0.65 (-4.36)
0.13 (-9.20)
0.01 (-13.36)
9.00 (-481.52 to 499.53)
1.11 (0.10)
0.47 (-0.76)
0.04 (-3.22)
3.32 (2.16 to 4.48)
fact
NYS arrests
0.38 (-1.57)
0.34 (-1.12)
0.12 (-5.03)
3.46 (-105.59 to 112.50)
0.90 (-0.11)
0.39 (-0.95)
0.16 (-1.85)
1.74 (0.94 to 2.54)
Wa
NYS convictions
0.27 (-4.92)
0.28 (-1.32)
0.12 (-5.30)
0 38 (-226.81 to 227.57)
0.69 (-0 37)
0.29 (-1.25)
0.13 (-2.02)
1.65# (0.79 to 2.52)
vice
21
Substantiated reports
0.54 (-0.63)
0.35 (-1.26)
0.29 (-1.40)
0.77] (0.34 to 1.19)
0.53 (-0.64)
0.63 (-0.47)
0.11 (-2.25)
1.61M (0.87 to 2.35)
the
of child abuse and
rist
neglect
3.
"Adjusted for socioeconomic status (SES), marital status, maternal age. education. locus of control, support from husband or boyfriend. working status. and husband or
visi
boytriend use of public assistance at registration. See first footnote to Table 1 for explanation of treatment groups. NYS indicates New York State: CI, confidence interval.
chi.
tincidence represents the mean number of infrequently occurring events within stated penod. Individual cases may have values greater than 1. although the range is small.
4.
Estimate - (treatments 1 and 2 log incidence) - (treatment 4 log incidence).
R.
Scale summanzes the counts of behavioral impairments (eg. missing work. motor vehicle crash) reported by women resulting from their use of alcohol and illegal drugs.
cor
IP<.01.
hor
5.
of lower SES suggests that they need
this study, they were at least as accurate
in the context of a controlled experiment,
ver
these services and benefit from them to a
in reporting this undesirable behavior as
in which the program was conducted
of
greater extent than do those who are mar-
with high levels of fidelity to the under-
6.
were women in the comparison group.
an
ried and of higher SES. Consequently,
Finally, one may reasonably question
lying theoretical and clinical model.¹
eff
such services should be made available to
the extent to which the findings of this
The next challenge is to determine the
he
communities with high concentrations of
study may be generalized to a wider
extent to which this program can be rep-
93
low-income, unmarried women.
range of low-SES, unmarried women
licated.21 A modest dissemination effort
7.
pr
The second limitation is that several of
today. This question led to a recently
is currently being conducted under the
ve
the outcomes were based on self-report,
completed replication of this trial in
auspices of the US Departments of Jus-
36
hich may be subject to treatment-re-
Memphis, Tenn. with a sample of pre-
tice and Health and Human Services
8.
ed reporting bias. The data on mater-
dominantly low-income, unmarried Af-
that will shed light on community and
in+
j
nal use of AFDC and food stamps, for ex-
rican-American mothers and their fami-
organizational factors that contribute to
i
ample, were based on self-reports and
lies.19 The findings of the replication are
or undermine fidelity of program imple-
covered up to 15-year time periods. We
congruent with the Elmira trial for the
mentation in new program sites.
attempted to validate maternal report of
2-year period after birth of the first child
Finally, it should be emphasized that
welfare use by reviewing state and county
and indicate that the benefits of the pro-
although many different kinds of home-
records but found that they often were
gram, at least through the first child's
visitation programs have been promoted,
incomplete. Fortunately, we were able to
second birthday, are not limited by time,
it is incorrect to assume that our results
obtain archived data from independent
geography, or the sociodemographic
can be applied to home-visitation pro-
sources on other critical outcomes.
characteristics of the families served.
grams that are not based on this model.
The child abuse and neglect findings,
We believe that the results of these 2
While some other types of home-visita-
for example, were based on state archived
trials now provide sufficient evidence to
tion programs have shown some prom-
data, which makes them less susceptible
form a rationale for preliminary stages
most have failed.³ At least 2 well-
to reporting bias. Although we were un-
of program dissemination.
designed trials of other home-visitation
able to achieve complete reviews of these
One of the most fundamental consider-
programs are under way that should give
archived records for all families, they are
ations in planning program dissemination
us a better understanding of the range of
substantially complete, and there is no in-
is cost. As indicated in a forthcoming re-
program characteristics that can affect
dication that missing data resulted in any
port, the reduction in family size, use of
important aspects of maternal, child, and
b
in favor of the nurse-visited groups.
welfare, incidence of child abuse and ne-
family functioning.2 In the meantime,
It should be noted, moreover, that the ef-
glect, and maternal criminality 15 years
as health and social welfare policy. is re-
fects of the program overrode a tendency
after the birth of the first child found for
designed in the near future, we believe
for nurse-visited families to be identified
this program will lead to substantial sav-
that it makes sense to begin with pro-
for maltreatment at lower thresholds of
ings to government in several domains of
grams that have been tested, replicated,
caregiving dysfunction than were fami-
spending.20 In considering the cost of the
and found to work.
lies in the comparison group during the
program (estimated to be $3300 in 1980
first 4 years of the child's life-a form of
dollars and $6700 in 1997 dollars for 2½
This research was supported by a Senior Research
detection bias that worked against the hy-
years of service), it is important to note
Scientist Award (1-K06-MH01382-01) (Dr Okls) and
grants from the Prevention Research and Behavioral
pothesis of program efficacy.¹
that the investment in the service, from
Medicine Branch of the National Institute of Mental
Although it would have been prefer-
the standpoint of government spending,
Health, Rockville, Md (R01-MH49381). and the Assis-
able to have criminal records to corrobo-
was recovered for low-SES families be-
tant Secretary for Planning and Evaluation. US De-
te the mothers' reports of all arrests and
fore the child reached 4 years of age.' It
partment of Health and Human Services. Washing-
ton. DC (grant 96ASPE278A).
Invictions, the analysis of their arrests
would take longer for the investment to
The following federal agencies and private foun-
and convictions archived in YS produced
be recovered today because costs for such
dations contributed to earlier phases of this re-
a pattern of treatment effects that was
a program have increased more rapidly
search: the Bureau of Community Health Services,
even stronger than was found with mater-
than costs of welfare benefits.
Maternal and Child Health Research Division,
Rockville, Md: the Carnegie Corporation, New
nal report. Thus, in spite of the knowledge
It is also important to note that the
York. NY: The Commonwealth Fund. New York:
nurse-visited women had of the purpose of
effects reported herein were produced
the Ford Foundation, New York: The Pew Chari-
642
JAMA, August 27, 1997-Vol 278. No. 8
Home Visitation and Maternal Life Course-Olds et al
table Trusts, Philadelphia, Pa; The Robert Wood
dra Thomas, and Sharon Holmberg, RN. PhD. for
Services for their assistance with extraction and
Johnson Foundation, Princeton, NJ; and the
coding the data: Robert Chamberlin, MD. and Rob-
coding of the criminal justice data: Del Elliott, PhD,
William T. Grant Foundation, New York.
ert Tatelbaum, MD. for their contributions to the
Zorika Henderson, Dave Huizinga, PhD, and Richard
We thank John Shannon, PhD, for his support of
earlier phases of this research; the New York De-
Jessor. PhD, for their comments on the manuscript;
the program and data gathering; Alise Mahr. Dar-
partment of Social Services, in particular Renee
Jackie Roberts, RN, Liz Chilson, RN, Lyn Scazafabo,
lene Batroney, RN, Karen Hughes, Barbara Lee,
Hallock for assistance with the coding of CPS re-
RN, Georgie McGrady, RN. and Diane Farr, RN, for
Sherry Mandel, and Barbara Ganzel for tracing and
cords; Anthony Stack, Jim Blake, David J. van Al-
their home-visitation work with the families; and the
interviewing the families; Kathleen Buckwell, Son-
styne, and the NYS Division of Criminal Justice
families who participated in the research.
References
1. US Advisory Board on Child Abuse and Neglect.
9. Olds D. Henderson C, Phelps C, et ai. Effects of
mixed model: higher level, nonhomogeneous, and
Creating Caring Communities: Blueprint for an Ef-
prenatal and infancy nurse home visitation on gov-
random regressions. Biometrics. 1982;38:623-640.
fective Federal Policy on Child Abuse and Neglect
ernment spending. Med Care. 1993;31:155-174.
19. Kitzman H. Olds DL, Henderson CR Jr, et al.
Washington, DC: US Dept of Health and Human Ser-
10. Olds D, Henderson C. Tatelbaum R. Intellectual
Effect of prenatal and infancy home visitation by
vices, Administration for Children and Families; 1991.
impairment in children of women who smoke ciga-
nurses on pregnancy outcomes, childhood injuries,
2. Olds D, Kitzman H. Can home-visitation improve
rettes during pregnancy. Pediatrics. 1994;93:221-227.
and repeated childbearing: a randomized controlled
the health of women and children at environmental
11. Olds D, Henderson C, Tatelbaum R. Prevention
trial. JAMA 1997;278:644-652.
risk? Pediatrics. 1990;86:108-116.
of intellectual impairment in children of women who
20. Karoly LA, Everingham SS, Hoube J, et al.
3. Olds D, Kitzman H. Review of research on home
smoke cigarettes during pregnancy. Pediatrics.
Benefits and Costs of Early-Childhood Interven-
visiting for pregnant women and parents of young
1994;93:228-233.
tions: A Documented Briefing. Santa Monica, Calif:
children. Future Child. 1993;3:53-92.
12. Hollingshead A. Four Factor Index of Social
RAND; 1997.
4. Olds D. Henderson C, Tatelbaum R. Chamberlin
Status. New Haven, Conn: Yale University Social
21. Olds D, O'Brien R. Racine D, et al. Increasing
R. Improving the delivery of prenatal care and out-
Sciences Library; 1976. Manuscript.
the policy and program relevance of results from
comes of pregnancy: a randomized trial of nurse
13. Efron B. Foreing a sequential experiment to be
randomized trials of home visitation. J Community
home visitation. Pediatrics. 1986;77:16-28.
balanced. Biometrika. 1971;58:403-417.
Psychol. In press.
5. Olds D. Henderson C, Chamberlin R, et al. Pre-
14. Olds D. Kitzman H, Cole R. et al. Theoretical
22. Gutelius MF, Kirsch AD, MacDonald S. et al.
venting child abuse and neglect: a randomized trial
and empirical foundations of a program of home visi-
Controlled study of child health supervision: behav-
of nurse home visitation. Pediatrics. 1986;78:65-78.
tation for pregnant women and parents of young
ioral results. Pediatrics. 1977;60:294-304.
6. Olds D, Henderson C, Kitzman H. Does prenatal
children. J Community Psychol. 1997;25:9-25.
23. Black MM, Nair P, Kight C, Wachtel R.
and infancy nurse home visitation have enduring
15. Olds D. The Prenatal/Early Infancy Project. In:
Roby P, Schuler M. Parenting and early develop-
effects on qualities of parental caregiving and child
Price R. Cowen E, Lorion R. Ramos-McKay J, eds.
ment among children of drug-abusing women: effects
health at 25 to 50 months of life? Pediatrics. 1994;
Fourteen Ounces of Prevention: A Case Book of
of home intervention. Pediatrics. 1994;94(4, pt 1):440-
93:89-98.
Practitioners. Washington, DC: American Psycho-
448.
7. Olds D, Henderson C, Kitzman H, et al. Effects of
logical Association; 1988.
24. Landsverk J, Carrilio T. San Diego Healthy
prenatal and infancy nurse home visitation on sur-
16. Rotter JB. Generalized expectancies for inter-
Families America Clinical Trial San Diego, Calif
veillance of child maitreatment. Pediatrics. 1996;95:
nal versus external control of reinforcement. Psy-
Children's Hospital and Health Center; 1995.
365-372.
chol Monogr Gen Appl. 1966;80:1.
25. Duggan AK, Buchbinder SB. Fuddy L, Young E,
8. Olds D, Henderson C, Tatelbaum R, et al. Improv-
17. Kessler R. The National Comorbidity Survey:
SiaC. Hawaii's Healthy Start Home Visiting Program:
ing the life-course development of socially disadvan-
preliminary results and future directions. Int Rev
engagement of at-risk families. Presented at the an-
taged mothers: a randomized trial of nurse home VISI-
Psychiatry. 1994;6:365-376.
nual meetings of the Ambulatory Pediatric Associa-
tation. Am J Public Health 1988;78:1436-1446.
18. Henderson C. Analysis of covariance in the
tion; May 7, 1996; Washington, DC.
Home Visitation and Maternal Life Course-Olds et al
643
JAMA, August 27. 1997-Vol 278, No. 8
A companion study of black wom-
Nurses' Visits
en in Memphis indicated similar re-
sults in preliminary findings. That
study, to be published on Wednesday
Held Benefits
in The Journal of the American Med-
ical Association, was led by David
Olds, a pediatrics professor at the
For Children
University of Colorado Health Sci-
ences Center who worked on the orig-
inal Elmira project.
Ofthe Poor
In 1990, the program began re-
cruiting young, poor, unmarried
pregnant women in Memphis.
WASHINGTON, Aug. 26 (AP) -
Nurses visiting the women focused
After 15 years, a group of low-income
on prenatal health, parenting skills,
single mothers who had received
birth control, education and job
home visits from nurses during preg-
skills.
nancy and while their children were
By the time the children were 2
young was found to have had fewer
years old, the study found similar
arrests, less child abuse and less
effects: children were less likely to
reliance on welfare, two new studies
be injured or hospitalized and moth-
show.
ers were less likely to have pregnan-
The report gives new hope to those
cy-induced high blood pressure.
who work with teen-age mothers.
"It's among the most encouraging
Compared with poor unmarried
evidence we have," said Rebecca
mothers over all, the women in the
Maynard of the University of Penn-
study had 69 percent fewer arrests,
sylvania, who studies programs for
46 percent fewer reports of child
teen-age mothers.
abuse or neglect, 44 percent fewer
Other home-visit programs have
behavioral problems linked to drug
not produced such positive results,
or alcohol abuse and used 30 months
and researchers are unsure what
less of Aid to Families With Depend-
makes these programs different.
ent Children.
One factor may be the use of the
The follow-up study looked at 324
nurses to offer medical, child-rear-
women and their firstborn children
ing and other skills and advice to
in predominantly white Elmira, N.Y.,
poor young women who are pregnant
who had participated in the Prena-
for the first time.
tal/Early Infancy Project begun
But a companion editorial to Mr.
there by two researchers in 1977. The
Olds's research questions whether
new study showed "that the nurse
the program's results could be dupli-
home-visit program has enduring
cated on a broad scale.
and positive effects," said John Eck-
"Will the program still work if it is
enrode. a professor of human devel-
a large-scale social program run by
opment at Cornell University and a
public agencies, rather than a locally
co-author of the study.
controlled experiment run by scien-
The Elmira home-visit program
tists who were heavily invested in
spent about $7,000 over two and a
their theoretical model?" wrote Ter-
half years for each mother. The visit-
rie E. Moffitt of the Institute of Psy-
ing nurses discussed nutrition, pre-
chiatry in London. Still, Mr. Moffitt
natal care and child development,
called the results "impressive."
among other issues, with the moth-
The Federal Government is study-
ing the effectiveness of a visiting
ers.
"We knew from earlier studies of
program that did not use nurses in
the project that the home visits re-
Chicago, Portland, Ore., and Dayton,
sulted in fewer and less closely
Ohio.
spaced pregnancies, fewer cases of
To make a real dent in the lives of
child abuse and neglect and fewer
poor Americans, Ms. Maynard said,
emergency room visits," Mr. Ecken-
the program would have to be dis-
rode said.
seminated widely. About 400,000
teen-agers give birth for the first
time each year.
"All of those teens basically are at
very high risk." she said.
February 9, 1998
Zero to Three 20th Anniversary Gala
DATE:
Feb 10, 1998
TIME:
7:45 pm
LOCATION:
Terrace Theater
Kennedy Center
FROM:
Michael O'Mary
I.
PURPOSE
To attend Zero to Three's 20th Anniversary Gala and to read "Goodnight Moon."
II.
BACKGROUND
Zero to Three is one of the premier resources on development in the first three years of
human life. Established by leaders in a variety of disciplines, this not-for-profit
organization is committed to study, understand, and promote the importance of the
crucial early years of human life.
Tuesday's Gala celebrates 20 vears of Zero to Three's work to improve the lives of
America's babies, toddlers, their families and those who serve them. As you may recall,
one of the founders of this organization was Dr. Sally Provence, whom you studied
under at Yale.
Your role at the Gala will be to read "Goodnight, Moon" and to offer brief remarks
about the administration's commitment to early childhood development. Following the
performance, you will attend a meet and greet backstage at which you will have your
picture taken with the co-chairs, the sponsors, the Board of Directors, and members of
the Zero to Three organization. A list of participants is attached.
At last year's brain conference, you launched the Zero to Three national poll. The
results of this poll are attached.
Senators Kennedy, Kerry, Dodd, and Jeffords will be present to receive an award in
"recognition of enduring commitment and outstanding legislative achievements on
behalf of infants, toddlers and their families." Senator Hatch will also be honored, but
will not be attending.
Other celebrities and VIPs will have various roles throughout the evening. A list of
performances and performers is attached. Secretary Shalala is the only Cabinet Member
attending.
You will be seated next to Michael and Carol Berman in theater style seating.
The Executive Director of Zero to Three, Matthew Melmed is scheduled to be a
participant in the roundtable discussion you will attend during the afternoon of 2/10.
III.
PARTICIPANTS
-The First Lady
-Approx. 400 invited guests.
IV.
SEQUENCE OF EVENTS
The First Lady arrives Kennedy Center and is seated.
Kenny Loggins performs TBD.
Ron Silver introduces Jacques d'Amboise.
Jacques d' Amboise performs a children's workshop segment.
Ron Silver introduces the First Lady.
The First Lady reads "Goodnight Moon".
Ron Silver introduces "The Princess and them Pea-ano" and Award Recipients.
Upon conclusion of the "The Princess and the Pea-ano", Ron Silver introduces Ann
Reinking.
Ann Reinking performs "Me and My Baby".
Kenny Loggins sings "Return to Pooh Corner".
Upon conclusion of the song, the First Lady
proceeds to Room TBD for Meet and Greet
The First Lady departs
V.
PRESS
Open press.
VI.
REMARKS
Talking Points provided by Christy Macy.
FIRST LADY HILLARY RODHAM CLINTON
REMARKS AT CHILD VISITATION ROUNDTABLE
ALEXANDRIA, VIRGINIA
TUESDAY, FEBRUARY 10, 1998
Acknowledgments and welcome. I've just visited Felicia Pearson and her 3-month old
son Dominico, and took part in the home visit with her Family Support Worker, Lynn
Kasonovich, and Sally Campbell, the program director. Appreciation to all who helped
arrange this special day, including the Northern Virginia Family Services and those
involved in the Healthy Families effort.
We are all here today because we know our most important responsibility -- as
individuals, as communities, and as a nation -- is the care and nurturing of our children.
Today, we are putting the spotlight on the critical role that home visiting programs play
in carrying out that mission.
I'd like to begin by introducing today's panelists -- all of whom have been vital voices in
promoting the importance of home visits and their benefits for families and children.
Dr. Matthew Melmed, Executive Director, the Zero-to-Three National Center for
Infants and Toddlers;
Dr. David Olds, Director, the Prevention Research Center for Families and Child Health
and Lead Researcher for the Elmira Home Visitation Study;
Ms. Betsy Dew, Director and Senior Training Specialist, the Family Institute of Hawaii
Family Support Center and a Founder of the Hawaii Healthy Start Program;
Mr. Leland Bresland, CEO, Freddie Mac Corporation;
Ms. Valator Gilliespie-Ballah, Family Support Worker for Healthy Families
Alexandria;
Brandi Church, Antoine Watson, Jane Rutherford, parents served by the Healthy
Families program.
Community-based home visitation programs like the one I saw today not only help
strengthen families but also help promote children's ability to grow and learn during
their earliest and most vulnerable years. These programs help give parents the tools they
need to succeed in the most important job they have: raising their children.
I'm delighted that Dr. Olds is here to share with us the exciting results of an Elmira, New
York study of low income, single women who participated in a home visitation
program. Among its findings: dramatic reductions in reports of child abuse and neglect;
fewer subsequent live births; fewer mothers on welfare; and fewer child behavioral
problems.
I first saw the benefits of home visits first hand when I visited Hawaii in 1993, and
learned about Hawaii's Healthy Start program of intensive home visiting services. And
I've been watching with great interest as Healthy Families America has taken that model
and promoted similar programs -- like this one in Alexandria -- in hundreds of
communities across America.
Here in Alexandria, a July 1997 independent evaluation of the Healthy Families program
showed similarly promising results over the past 3 years: Among them: 92% of infants
born at healthy birth weight; 98% of infants had a primary health care provider within 2
months of birth; 93% of infants received immunizations; 96% of infants showed no
developmental delays.
The President is committed to helping families get the support they need, so that every
child's earliest experiences and interactions are positive ones -- ones that will help them
to learn and grow and connect with others over an entire lifetime. That's why he has
proposed a dramatic increase in our investment in activities that promote early learning
and improve the quality of child care in America.
Central to the President's child care initiative (the largest investment in child care in our
nation's history) is the establishment of an Early Learning Fund to provide challenge
grants to communities for programs that promote early learning -- as well as improve the
quality and safety of child care for children aged five or under. The President has
proposed an investment of $3 billion over the next five years for this new effort -- which
will support home visiting as well as other activities such as parent education and efforts
to improve child care safety and quality, including basic training for child care providers.
New scientific research now proves what we've known instinctively all along -- that
those first interactions with a child particularly in the first three years of life -- have a
dramatic impact on brain development and learning. To highlight these findings, the
President and 1 hosted the White House Conference on Early Children Development and
Learning in April 1997. Later that year, we held a White House Conference on Child
Care, to examine the implications of this new research for child care. I believe that home
visitation programs can enhance these efforts to ensure children get the care and attention
they need to succeed.
Before I introduce our first panelist, I want to underscore how important it is that all of us
in the public and private and non profit sectors work together as partners to promote and
expand home visitation and early learning programs. There's no mystery here. We
know what works. We know what children need to thrive and grow and learn. We know
what parents need to succeed. And we know the terrible consequences when we fail to
meet those needs. Let's continue to learn from the effective programs that already exist.
But more important, let's work together to replicate these efforts in every community in
America.
And now, I'd like to begin our discussion by turning to our first three speakers. Dr.
Matthew Melmed, Executive Director of the Zero-to-Three National Center for Infants
and Toddlers, will talk to us about why the early years of life are so important, and
describe home visitation visits generally. Then we'll hear from Dr. David Olds, who will
tell us about the exciting findings of the Elmira study on the benefits of home visits for
parents and children. We will then hear from Betsy Dew, who helped found Hawaii's
Healthy Start Program, and has worked with Healthy Families America to spread these
model efforts to over three hundred communities across the nation.
NVFS-FALLS CHURCH
TEL 703-241-1310
Feb 09,98
22:26 No. 057 P.02
Kathy Kell
Debbie Brown Anderson
Lynne Ball
Time Life
Northern Virginia Urban League
Executive Director
Winkler Foundation
Ron Carlee
Betty Connal
Dona Dei
Director
Perinatal Outreach Services
Director, Program Services
Department of Human Services
Inova Fairfax Hospital System
March of Dimes
Arlington County
The Honorable Kerry Donley
Dr. Susan Allen
Bill Euile
Mayor of Alexandria
Director of Public Health
Council Member
Arlington County
Alexandria City Council
Carol Farrell
Jared Florance, MD
Rosalyn Foroobar
Director, Office of
Director
Assistant Director of Nursing
Early Childhood Development
Prince William Health District
Alexandria DHS
Marilyn Gould
Pat Graham
Ellen Grunewald
Mobil Oil
Board President
Assistant Director of Social Services
Northern Virginia Family Service
Loudoun
Katherine Hanley
Verdia Haywood
Catherine Winkler Herman
Chairman
Deputy County Executive for Human
The Mark Winkler Corporation
Fairfax City Board of Supervisors
Services
Fairfax County
Joshua Lipsman, MD
Larry Mcandrews
Steve Meyerson
Director
President & Ceo
Vice-president
Alexandria Health Department
National Association of Children's
Community Affairs and Government
Hospitals
Relations
Inova Alexandria Hospital
Lynda Eubank
Meg O'Regan
Renette Oklewicz
Director of Social Services
Director
Manager, Community Relations
Arlington County
Department of Human Services
Freddie Mac Foundation
Alexandria
Del Pepper
Mary Phelps
Johanna Schuchert
Council Member
Program Manager, Prevention Services
Director
Alexandria City Council
Department of Family Services
Healthy Families Virginia
Fairfax County
Joanna Siegel
David Smith
Judith Southard
Program Officer and Director of
National Field Director
Director of Public Health Nursing
Evaluation
I Am Your Child Campaign
Alexandria Health Department
Arlington Health Foundation
NVFS-FALLS CHURCH
TEL : 703-241-1310
Feb 09,98
22:26 No 057 P.03
Maxine Baker Stokes
Cindy Suarez
Executive Director
Tori Thomas
Child Protective Services
Freddie Mac Foundation
Chairman
Prince William County
The Mark Winkler Co.
Lynn Vlad
Lois Walker
Program Director
Chris Zimmerman
Council Member
MotherNet America
Chair, Arlington County Board
Alexandria City Council
Arlington County
FIRST LADY HILLARY RODHAM CLINTON SPOTLIGHTS HOME VISITATION
February 10, 1998
I believe the President's [child care] proposal will help us all move together in fulfilling our most
important responsibility as individuals or as a nation -- the care and nurturing of our children.
First Lady Hillary Rodham Clinton
Announcement of Child Care Initiative, 1/7/98
Today, the First Lady visits Alexandria, Virginia to spotlight the importance of home visiting
programs to strengthening families and promoting healthy development in children's earliest years
of life. As a part of his ambitious child care initiative, President Clinton has proposed the creation
of an Early Learning Fund to foster early childhood development through a variety of family
support services, including home visiting. Through a discussion with parents, home visitors, and
experts, the First Lady will highlight the importance of investing in community-based early learning
efforts to promote healthy child development.
EARLY LEARNING IS CENTRAL TO THE PRESIDENT'S CHILD CARE INITIATIVE. Because
children's experiences in the earliest years of life are central to their healthy development, the
President has proposed that we dramatically increase our investment in activities that promote early
learning and improve the quality of child care in our country. A major element of the President's
child care proposal is the Early Learning Fund, which will provide challenge grants to communities
for programs that promote early learning and improve the quality and safety of child care for
children aged five or under. The President has proposed an investment of $3 billion over five years
for this new effort. The Early Learning Fund will improve the quality and safety of child care and
ensure that children reach school ready to learn, by supporting a range of activities, including home
visiting programs.
CHILDREN'S EARLIEST YEARS OF LIFE ARE CENTRAL TO THEIR DEVELOPMENT. New scientific
research shows that experiences after birth -- particularly in the first three years of life -- have a
dramatic impact on brain development and learning. To highlight these findings, the President and
Mrs. Clinton held The White House Conference on Early Childhood Development and Learning in
April, 1997. The conference pointed to the importance of children's earliest experiences in helping
them get off to a strong and healthy start. In October, 1997, the President and Mrs. Clinton hosted
The White House Conference on Child Care to examine the implications of the new research for
child care. This conference underscored the need to invest in improving child care quality and
supporting parents -- the very goals of the President's proposed Early Learning Fund.
LEARNING FROM EFFORTS IN VIRGINIA. Mrs. Clinton visits Alexandria, Virginia to spotlight the
home visiting program, Healthy Families Alexandria, which is a part of the national home visitation
effort, Healthy Families America. This program today serves 320 communities around the country
and providing intensive home visits to at-risk families during pregnancy and for the first few years
of a child's life. Mrs. Clinton will take part in a routine Healthy Families Alexandria home visit
and then participate in a roundtable discussion with experts and parents. The discussion will also
spotlight another home visitation effort that has been proven successful through a 15-year follow-up
study-- the Pregnancy and Infancy Nurse Home Visitation Program in Elmira, New York.
OF BETTER
UNITED STATES OF AMERICA
NEW PARENT SUPPORT
DeputyAssistant Secretary of Defense
Personnel Support, Families & Education
Office of Family Policy
4015 Wilson Blvd, Suite 917
Arlington, VA 22203-5190
703-696-5733
OF DEFERE
DRAINO
STATES
to
AMERICA
NEW PARENT SUPPORT
Programs to support new parents contribute to mission readiness, support family adaptation to military
life and are designed to enhance the knowledge and skills families need to form healthy relationships and
provide safe, nurturing environments for children. The military force is a young force; the Defense
Manpower Data Center (DMDC) reports that 42 per cent of active duty personnel are age 25 or younger
Like many civilian couples in American society many DoD personnel have children before they may
have completed their maturation into adulthood.
Of 1.4 million active duty military personnel:
More than 3,500 (3,577) military personnel have had their first child at the age of 19 or younger.
Twenty-five percent of the first births were to military personnel age 21 or younger.
The( most frequent) age for military personnel to have their first child was 21.
The mean and median age of military personnel having their first child was 24.
Since military families are usually separated geographically from thei r families of origin and civilian
peers who are now parents, they lack frequent physical access to the hometown social supports and parental
models. To address this the four Military Services have developed programs to support new parents during this
critical period.
The support provided by the Services for new parents provides improved quality of life for
service members and their families. It helps to reduce the potential for both child and spouse abuse during a
period of increased strain on relationships. The Services' programs to support new parents are based on
research, help new parents adjust to life in the military, offer a full range of comprehensive services, and
include appropriate documentation and program evaluation. The Services promote universal availability to
increase participation and reduce stigma. Within each Service the level of support is triaged so that more
intensive services with highly trained staff are offered to higher risk families.
Within this range of programs, the Services have developed special programs that use trained personnel
to visit new parents' homes. Such programs engage new parents in the various activities that support them,
and have shown particular promise in reducing the risk for child abuse in new parents deemed at higher risk
for child abuse. Such "home visitation" or "home visitor" or "home-visiting based" programs have been
studied in the civilian community and havebeen recommended by:
The General Accounting Office (1990)
The U.S. Advisory Board on Child Abuse and Neglect (1991)
The National Committee to Prevent Child Abuse (Daro, 1988) and
The Defense Science Board Task Force on Quality of Life (1995)
among others as an effective method to create a healthy start for new parents.
History of DoD New Parent Support Programs
Collectively, DoD home visiting programs for new parents are known as New Parent
Support programs. The Services began developing home-visiting based-programs through a
joint-Service program at Tripler Army Medical Center in Hawaii in 1984, a program now known
as "A Solid Parenting Experience Through Community Teaching and Support (ASPECTS)."
The ASPECTS program has used community health nurses as home visitors and parent
educators.
By the late 1980's the Army, Navy, Air Force, and Marine Corps were interested in
replicating civilian home visiting-based programs, based on the positive results of ASPECTS and
comparable civilian programs. The Air Force began the "First Time Parents" program, using
Family Advocacy Nurse Specialists, at several sites in 1988. In 1989 the Marine Corps began a
pilot demonstration program at Camp Pendleton, California, in partnership with Children's Hospital,
San Diego, using paraprofessionals. The same year the Air Force expanded the "First Time
Parents" demonstration program to 8 air bases. In 1990 the Navy implemented a home visiting-
based program at 10 major naval installations that had large numbers of young families. The
Army began its "First Steps" program in the early 1990's.
Initially these programs were authorized through the prevention component of the Family
Advocacy Program, and were supported with Family Advocacy Program funds from the Office
of the Secretary of Defense and with the respective Service's Operations and Maintenance
funds. In FY 1995 the Congress appropriated $20 million for DoD New Parent Support
Programs in addition to the amount for the Family Advocacy Program. This additional
appropriation spurred the expansion of these programs throughout the Services, and allowed
them to develop more comprehensive evaluation strategies. The Congress appropriated $25.6M
in FY 1996 and $20M in FY 1997 for these programs, and in FY 1998 the New Parent Support
programs became a line item in the DoD budget.
Ingredients of a Successful Home Visiting Program
There has been growing consensus that home visitation services to new families are an effective
way to reduce the potential for child and spouse abuse. Home visitation is thought to be a
promising strategy but, as David Olds cautioned in 1990, not all home visiting programs are the
same and not all programs achieve the same effect. However there are some generally accepted
guidelines for the most effective programs. Before reporting on what services were in fact
provided by each military Service, it seems reasonable to briefly review these guidelines
(Leventhal 1996) since they are the result of some consensus in the field and the DoD model
incorporates many of them.
Services should begin early, during the prenatal period or shortly after birth and should extend
through the first few years of a child's life. There is no consensus in the literature on the optimal
duration or intensity of services. However, current research supports the idea that services should
not be a one-shot contact accomplished early in the child's life, but need to be instituted at birth
or in the prenatal period, and continue through the first eighteen months to two years for
maximum effectiveness.
Current Status of DoD New Parent Support Programs
While each Service has developed unique New Parent Support Programs to meet the needs of its
personnel, there are similarities.
DoD New Parent Support Programs are available worldwide.
In 1996, there were New Parent Support programs at 204 installations, more than 2/3 of the
total DoD military installations. These programs served more than 54,000 military families,
which is more than 80% of eligible families.
In FY 1996 the Army had programs at 73 installations in Alabama, Alaska, California,
Colorado, Georgia, Kansas, Kentucky, Louisiana, Maryland, Missouri, New York, North
Carolina, Virginia, Washington, Germany, and Japan. These represent about 2/3 of Army
installations. The Army's program served approximately 7,500 families, including those in
its First Steps program
The Navy has 40 programs at fleet intensive sites in California, Connecticut, Florida,
Georgia, Illinois, Maine, Maryland, South Carolina, Tennessee, Texas, Virginia, Washington,
the District of Columbia, Guam, Puerto Rico, Iceland, Italy, Japan, and Spain. These
represent about 80% of all Navy installations. Of these, 23 use civilian employees, and the
remaining 17 are under a contract. The Navy follows the Healthy Families America model, a
national initiative sponsored by the National Committee to Prevent Child Abuse. In FY 1996
the Navy's program served approximately 38,600 families.
The Air Force has programs at 76 (90%) of Air Force installations, but due to staffing
constraints it only serves those families expecting their first child. Installations are located in
Alabama, Alaska, Arizona, California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho,
Illinois, Kansas; Louisiana, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New
Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South
Dakota, Texas, Virginia, Washington, Wyoming, Germany, Japan, Korea, and the U.K. In
FY 1996 the Air Force's program served approximately 8,000 families.
The Marine Corps has programs at all 18 installations under a contract with Children's
Hospital, San Diego. Installations are located in Arizona, California, Georgia, Hawaii, North
Carolina, South Carolina, Virginia, and Japan. In FY 1996 the Marine Corps' program served
approximately 3,000 families
The ASPECTS joint service program in Hawaii served appropriately 1,300 families.
The programs emphasize outreach to junior enlisted personnel
In Army and Navy families participating in New Parent support programs in FY 1996, 60% of
the sponsors were E-1 to E-4. In the Air Force, 75% were E-1 to E-5. In the Marine Corps, 56%
of the fathers and 78% of the mothers were E - 1 to E-4. In the ASPECTS joint-service program,
Hawaii, more than 80% of the spouses were E-1 to E-6.
Participation in the programs is voluntary
Each program offers basic support services to all parents with a child under the age of 6 who
request services, although emphasis is placed primarily on families experiencing their first birth
and secondarily on families with any newborn child. Parents choose which services they would
like to receive. Parents also participate in program evaluation on a voluntary basis.
Families are assessed for child abuse. More intensive services are offered to
those at higher risk levels.
Each Service uses its own method to assess new parents, based on research findings from civilian
studies, and assigns parents to one of several risk levels. Intensity of services offered is matched
to risk levels. In general, Level I families are deemed to be at low risk for child abuse. Level 2
families are those assessed as being at risk for child abuse. In general, very young parents, single
parents, parents with disabled or premature infants, and Bi-cultural or socially isolated families
are more likely to have been assessed as at higher risk for child abuse. Families with an open
case of child abuse may or may not be eligible for the New Parent Support program, depending
on the Service. The ASPECTS Joint-Serve program program screens families and emphasizes
more intensive services to high-risk families.
A full range of programs and activities are offered.
Prenatal activities include prenatal visitation at the medical treatment facility or home, parenting
education classes, referrals to other services and resources, telephone and office contacts. At the
time of the child's birth, activities include visitation at the hospital, referrals to other services and
resources, and telephone and office contacts. After the child is discharged from the hospital,
activities include visitation at the home, parenting education classes, parenting support groups
for mothers, parenting classes and support groups for fathers, "play mornings" as a respite for the
parent, referrals to other services and resources, and telephone and office contacts.
Short-term and long-term visitation is provided.
While parents can choose the number and frequency of visits, the programs emphasize
more frequent visits over a longer period for those assessed at risk of child abuse.
Command also supports the programs. Lt. Gen. George R. Christmas, USMC (ret.), former
Deputy Chief of Staff for Personnel, U.S. Marine Corps, has stated that the New Parent Support
program is one of the best quality of life programs available for Marines. Rear Admiral Richard
Buchanan, USN, stated:
The Navy family is important to us. What could better show how important than by helping to
educate our Navy parents about their most important role in life -- raising their children. The
Navy's New Parent Support Program is a significant part of that effort.
"The New Parent Support Program is a great idea for new parents who
are living far away from their families and close friends. It's very
reassuring to see a visiting nurse between visits to the doctor."
"I think this is a great program and it should be a program that all
Marine Corps families should participate in."
"I give two thumbs up for the program."
Program Evaluations
Each of the Services conducts ongoing evaluations of its New Parent Support Programs.
These rely on the use of standardized instruments administered to parents willing to be evaluated
at the beginning and end of their participation in the program. All four Services administer the
Child Abuse Potential Inventory (CAP), a measure for risk of child abuse widely used in the
field. The Army and Marine Corps also administer the Center for Epidemiological Studies
Depression Scale (CESD), the Index of Marital Satisfaction (IMS), the Maternal Social Support
Index (MSS) and the Family Environment Scale (FES). The Navy uses several other measures to
assess maternal support, maternal bonding, and family environment. The Air Force also uses the
clinical nursing assessment protocol.
The programs consistently show reductions in the Child Abuse Potential Inventory by the
participants, especially in parents assessed as moderate to high risk. A sample of 357 Air Force
parents showed a reduction in the mean abuse potential scores of 13 points for moderate risk
parents and 101 points for high-risk parents, with statistically high confidence levels. The Marine
Corps data is similar. Of the at-risk families with no known prior histories of abuse, 58% of the
participants scores declined in 6 months, and 30% declined below the clinically at-risk level. Of
the at-risk families with known prior histories of abuse, 66% of the participants scores declined
in 6 months, and 32% declined below the clinical at-risk significant level. After the parents had
participated for six months, the Marine Corps' home visitors found decreased percentages of
children at risk for excessive corporal punishment, inadequate supervision, inadequate emotional
support, inadequate attention to medical needs, protection from others' abuse, and emotional
maltreatment.
In addition, other measures show improvement. The Air Force families at moderate and
high risk in the sample showed improvement in ego strength, handling distress, flexibility, and
happiness. Of the Marine Corps at-risk families with no known prior histories of abuse, 68%
showed improvements in depression, marital satisfaction, and social support, and at least 38%
declined below the clinically at-risk level. Of the Marine Corps at-risk families with known prior
histories of abuse, more than 60% showed improvements in depression, marital satisfaction, and
social support, and at least 24% declined below the clinically at-risk level.
Most importantly, the programs find reduced numbers of child abuse reports from at-risk
families. Overall, only 4 percent of the at-risk families in the Marine Corps program had reports
of family violence (child abuse or spouse abuse). Only 15 per cent of the Marine Corps families
with prior histories of abuse who were in the program for more than a year had new child abuse
incidents. The ASPECTS program had only a 0.4% rate of substantiated abuse from its high
risk families, who had been served an average of 13 months by the program.
DoD Model for New Parent Support
In 1996 the DoD Community and Family Policy Coordinating Committee authorized a
joint Service working group to review the Services' implementation of programs to support new
parents, develop a DoD model for the New Parent Support program, and recommend a future
course of action for funding.
The working group believed that programs to support new parents are needed because a
two recent surveys found that a significant number of new recruits have experienced physical
abuse or sexual abuse as children. Since research has shown that people tend to parent the way
they were parented, such recruits are at high risk to maltreat their children when they become
parents. While support is provided with concern for the welfare of the children and parents as the
guiding factor, such programs are also cost effective. The average case of child abuse in DoD
costs at least $2,000, and the costs can range up to $7,200 for the initial intervention and legal
proceedings. Long-term treatment costs would cost significantly more, and costs for discharging
the service member and recruiting and training a replacement are even higher. In contrast, New
Parent Support cases cost an average of $251 per birth. In short, doing the right thing to support
new parents is not only morally rewarding, but makes best use of resources as well.
While the working group recognized the need for variety and flexibility in programs to
accommodate the unique requirements of each Service and local needs, it believed that a DoD
framework was needed to facilitate fiscal planning, evaluation, training, and equity. In particular,
the working group viewed a comprehensive DoD framework of services for new parents as a
useful step in ensuring optimum use of resources, promote consistency in concept and range of
services offered, and promote efficiency in service delivery.
The working group identified the range of services offered new parents and developed a
standardized New Parent Support program model for DoD with three proposed stages: "New
Parent Support - Standard," screening for at-risk parents and assessment of their needs, and
"New Parent Support - Plus."
New Parent Support - Standard
This program coordinates existing parenting programs available on military installations
and from nearby civilian a2encies. These programs include parenting classes sponsored by
military medical treatment facilities, family centers, child development centers, Family
Advocacy Programs, and chaplains, and by such civilian programs as the Red Cross, YMCA,
and public social services agencies. The programs also include crisis counseling and respite
programs available from family centers, Family Advocacy Programs, and civilian social service
agencies. This program should be available to all parents--to-be and to parents with children age
0-3, whether they live on or off the installation. The primary services are educational, with
information and referral to military civilian programs that can support parents.
Screening and Assessment to Identify At-risk Parents and
Their Needs
Health care providers routinely assess families during prenatal care, during the birth
process, and during well-baby checkups to identify areas where additional health and social
support is needed. In addition, staff of programs that assist parents, such as those in the proposed
"New parent Support - Standard" level, frequently identify families who can use additional social
services. Frequently one or both parents in such families are young, at great geographical
distance from families and friends who would otherwise provide face to face emotional support,
or experienced abuse and neglect as a child. Other families who can benefit from additional
support include those with a child with disabilities, those with bi -cultural marriages, and those
with lower incomes. Based on the experience of civilian home visiting -based programs, the
working group estimated that 18% of the babies born annually to active duty personnel would be
identified as at -risk.
As a result of the screening process, at-risk families will be referred for addi tional
services to the proposed "New Parent Support - Plus" program. The referrals will be voluntary,
and will emphasize the availability of additional resources that will build upon the parents'
strengths. During the referral process, staff will identify the parents' particular needs and seek to
address them through referrals for relevant support. For example, parents with high stress levels
will be encouraged to enroll their children in respite play programs in addition to having a home
visitor. Similarly, extremely young parents who may have experienced abuse during childhood
will be offered extra mentoring and modeling of appropriate parenting.
DoD New Parent Support
(New Parent Support - Plus)
This level denotes the additional services that should be provided to at-risk parents who
have children age 0-3. The program should accept self-referrals in addition to those who were
referred as a result of screening. The emphasis should be on voluntary participation in a
non-stigmatizing atmosphere that builds upon the parents' strengths. The services offered will be
based on intensive home visiting services provided by nurses and/or social workers and
paraprofessionals. The services will include role modeling/mentoring, respite care, health care
support, parent support self-help groups, individual and group counseling, and tutoring on child
development. The services will be offered for up to three years, but the working group estimated
that the average at-risk family would participate for six months.
The Family Advocacy Program should be the sponsor of this level, in coordination with
other social services and parent support provided on the installation or by local civilian agencies.
Based on the experience of civilian home visiting-based programs and the Services' experience,
the working group estimated that 90% of the high-risk families would enroll for services, and
that the annual caseload of each home visitor should be 50 families.
The working group estimated that existing resources meet the costs of the "New Parent
Support - Standard" component and of the screening of parents. The working group estimated
resource requirements for the "New Parent Support Plus" component. Based on the experience of
Hawaii Healthy Start and the Healthy Families America, which are civilian home visiting-based
programs, the working group then estimated that 90% of those families assessed as high risk at
the time of the child's birth would enroll during the child's first year of birth. The group
estimated that 5% of the families with children age 1-2 who had originally been screened as low
risk would be reassessed as high risk and would enroll in the "New Parent Support - Plus"
component during the child's second year of life. Similarly, the group estimated that 3% of the
families with children age 2-3 who had originally been screened as low risk would be reassessed
as high risk and would enroll in the "New Parent Support - Plus" component during the child's
third year of life.
Thus, the group estimated that of 1,000 births, 162 high-risk families would enroll in the
"New Parent Support - Plus" component during the child's first year of life, 36 would enroll
during the child's second year, and, 22 during the child's third year. This totals to an annual
caseload of 220 and requires about 4.5 full-time equivalent positions per year for this population.
The working group believed that the Services' experience and the civilian groups' experience
with high risk groups requires that two-thirds of these positions be filled with people with
master's degree level experience, and one third could be filled with people with lower levels of
education and experience.
Accordingly, the model for the "New Parent Support - Plus" component requires about
$251,000 per 1,000 births annually. The group consulted Defense Manpower Data Center birth
data and estimated that $27M in additional resources are required for a DoD population of
approximately 109,000 live births annually.
Funding for the OSD New Parent Support Program
As mentioned earlier, Congress appropriated $20M for the New Parent Support program
in FY 1995. At that time, an attempt was made to include this program in the FY 1997 and future
years DoD budget at the level of $20M, but the effort was unsuccessful. The Congress provided
appropriations for the program in FY 1996 and FY 1997. The Defense Budget for FY 1998
included $4M for this program. As a result, the program has had an 80% reduction of funds for
FY 1998. The Services have had to cut back the program even though they had wished to begin
implementation of the DoD model.
The Presidents budget request for FY 1999 includes $10M for New Parent Support,
which will support up to one year of services to approximately 10,000 high risk parents.
OSD New Parent Support Funds to Services
25
20
20
20
20
15
10
10
5
4
0
0
1990-1994
1995
1996
1997
1998
1999
2000
Conclusion
The widespread availability of DoD New Parent Support Programs, their outreach to
fathers, and the range of services to young parents explain their popularity with young military
families.
The programs reduce the risk of child abuse and neglect by enhancing the knowledge and
skills families need to form healthy relationships. Evaluation data from the Services have
demonstrated the effectiveness of home visiting-based prevention, especially for high-risk
families who receive more intensive services. Reducing child abuse and neglect in military
families reduces the need for expensive treatment and rehabilitation programs. By eliminating
the need for administrative and legal proceedings, these programs can provide cost savings to
DoD. In addition, since children in military families become a significant source of recruits for
the Services, raising them in healthy, safe, and nurturing enviroment has an additional benefit to
DoD.
The DoD New Parent Support Programs are a wise investment in quality of life for
military families. These programs contribute to mission readiness by supporting the adaptation
to military life, marriage, and parenthood of young families separated from their extended
families and friends by vast geographical distances. The information and emotional support they
provide reduce parental anxiety and thus enhance service members' ability to perform the
military mission effectively.
REFERENCES
Daro, Deborah. Intervening with New Parents: An Effective Way to Prevent Child
Abuse. National Committee to Prevent Child Abuse (formerly National
Committee for Prevention of Child Abuse). February, 1988.
General Accounting Office. Home Visiting: A Promising Early Intervention
Strategy for At-Risk Families, 1991.
Levanthal, J. M. Invited commentary: Twenty years later: We do know how to
prevent child abuse and neglect. Child Abuse & Neglect, 1996; 20(8): 647-653.
Olds, D., Henderson, C., Tatelbaum, R., Chamberlain, R. Preventing child abuse
and neglect: a randomized trial of nurse home visitation. Pediatrics. 1986; 78:
65-78.
Olds, D., Kitzman, H.. Can home-visitation improve the health of women and
children at environmental risk? Pediatrics. 1990; 86: 108-116.
U.S. Advisory Board on Child Abuse and Neglect. Creating Caring Communities:
Blueprint for an Effective Federal Policy on Child Abuse and Neglect. Second
Report. U.S. Dept. of Health and Human Services, Administration on Children
and Families. September 15, 1991.
Defense Science Board. Report of the Task Force on Quality of Life. U.S. Defense,
Office of the Undersecretary of Defense for Acqisition and Technology.
October, 1995
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003a. memo
Nicole Rabner to Agency Liaison re Request for Assistance (partial)
02/12/1998
P6/b(6)
(1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15416
FOLDER TITLE:
Home Visiting [1]
2012-1035-S
kc1055
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
[003a]
THE WHITE HOUSE
WASHINGTON
February 12. 1998
MEMORANDUM
TO:
Agency Liaison
FROM:
Nicole Rabner
Domestic Policy Council/Office of the First Lady
CC:
Alice Pushkar
Office of the First Lady
RE:
Request for assistance with health care
On Tuesday, February 10, the First Lady participated in a roundtable discussion in Alexandria,
Virginia to spotlight the success of home visiting programs to help support new parents and
improve child outcomes.
P6/(b)(6)
P6/(b)(6)
The First Lady was concerned about
what she learned from
P6/(b)(6)
about her health condition -- she reports that she is in
failing health, has been denied Medicaid health coverage because she owns a car, and has no
money for medical carc.
Mrs. Clinton asked me to bring this woman's case to your attention, and to ask that you follow
up with her directly.
P6/(b)(6)
I would appreciate
your letting me know about your progress with the case, so that I may let the First Lady know.
Please feel free to call mc at ext. 67263 to discuss this further. Thanks very much.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003b. memo
Nicole Rabner to FLOTUS re Home Visitation Event (1 page)
02/11/1998
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Domestic Policy Council (Nicole Rabner)
OA/Box Number: 15416
FOLDER TITLE:
Home Visiting [1]
2012-1035-S
kc1055
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)|
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.