Home visitation for pregnant women and parents of young children
D. L. Olds
Department of Pediatrics, University of Rochester Medical Center, NY 14642.
Many of the most pervasive, intractable, and costly problems faced by
high-risk women and young children in our society today are a consequence
of adverse maternal health-related behaviors (such as cigarette smoking,
drinking, and drug use during pregnancy), dysfunctional infant care giving,
and stressful environmental conditions that interfere with individual and
family functioning. These problems include low birth weight, child abuse
and neglect, childhood injuries, unintended and closely spaced pregnancy,
and reduced economic self-sufficiency on the part of parents. Evidence is
accumulating that these problems can be reduced with comprehensive programs
of prenatal and infancy home visitation by nurses. While we are witnessing
a renaissance of interest in home visitation as a means of addressing these
problems, the recommendations of various health and human service advisory
groups about the structure of proposed home-visitation initiatives are
uncoordinated and frequently inconsistent with the empirical evidence. Home
visitation is a promising strategy, but only when the program meets certain
standards. The more successful programs contain the following: (1) a focus
on families at greater need for the service, (2) the use of nurses who
begin during pregnancy and follow the family at least through the second
year of the child's life, (3) the promotion of positive health-related
behaviors and qualities of infant care giving, and (4) provisions to reduce
family stress by improving the social and physical environments in which
families live.
