Family home visits

The idea is inconceivable that government agents would come into homes to evaluate if parents are feeding and caring for their children properly; screen children and family situations to identify parenting practices, children’s weights or social-emotional development that fall short of state-approved standards; and report those children and parents for case management and treatment. For Americans who don’t follow legislation and public health policies, even talk of such programs might be considered conspiracy theories. Last year, two Acts were introduced into the U.S. House of Representatives that would grant the federal government unprecedented control over parenting and implement state home visits, targeting military families and poor families first. This week, these Acts were scheduled for debate.

Dr. Karen Effrem, M.D., is a pediatrician and researcher who has been following legislation that affects parental rights and the health of children. She wrote an article this week describing the lack of scientific validity and efficacy, costs, dangers and implications for parents, children and healthcare provider of the proposals in these pieces of legislations. This issue has little to do with politics but more the cautionary insights it offers about even well-meaning public health programs.

Summaries of the legislation sound good at first glance, until you dig into the fine print:

H.R. 3289: PRE-K Act addresses state preschool programs and puts the federal government in charge of what children learn and implements services to support healthy child development.

H.R. 2343: Education Begins at Home Act directs the Secretary of Health and Human Services to fund a State early childhood home visitation program and the Secretary of Defense to fund early home visitations for military families. It also revises Early Head Start programs and adds services to conduct home-based interventions and inform new parents of proper care for infants and children under five.

Dr. Effrem has read the fine print. In her article for Education News, as well as her statement to the Subcommittee on Education Reform, she raised a number of concerns:

These bills put the government in control as both parent and educator for children from birth to age 5. Both focus on poor families who have the least wherewithal to resist this government intrusion, but they also extend to military families. The home visiting bill calls for developmental screening, which includes mental screening, and the Pre-K Act promotes mental screening of all the children and their families in these programs. And of course, parental consent, choice, and control are never mentioned for any aspect of these bills.

These programs focus on “socioemotional screening, which is mental screening,” she said. “Mental health screening is very subjective no matter what age you do it. Obviously it is incredibly subjective when we are talking about very young children.”

The Pre-K Act calls for mental screening of all the children and their families enrolled in these programs and parental consent is never mentioned, she said. But, despite claims of effectiveness, she wrote:

[E]arly childhood programs are not effective and several studies have shown evidence of academic and or emotional harm.” For instance, illiteracy rates have actually increased in New Jersey where preschool for poor children was court ordered. And, data from several national studies and surveys performed by the federal government have shown very significant increases in defiant, disobedient, and aggressive behavior, as well as impaired social skills in children who are attend preschool and child care compared to children raised at home...

Now, as is happening in Minnesota and states around the nation, these subjective screening results are going into children's records, falsely labeling them as academically, socially, or mentally defective even before they begin their academic careers. This has the potential of affecting college, military service and employment and expanding the rolls of the overburdened special education system and government control in the schools.

Moreover, she sees these programs as not helping children, but using subjective behavior or emotional measures to identify children who can be given “the myriad harmful and ineffective psychotropic drugs that are being prescribed to children at alarmingly younger ages.” These mental health screening tests have been shown to incorrectly label large numbers of children and have been shown to have high false positives, she said.

One commonly used screening instrument has a 73% false positive rating, meaning that for every 27 children supposedly correctly identified as having an emotional problem on this screening test that follow admittedly "subjective" criteria that are "value judgments based on culture" according to the Surgeon General, other families are falsely told that something is wrong with their child and referred for further evaluation and treatment which more and more commonly involves ineffective and sometimes lethally dangerous drugs.

She referenced a Boston Globe letter from Dr. Daniel Fisher, a psychiatrists who has evaluated children in schools, who wrote: “These quick-fix screening tests invariably end up with quick fixes of kids by labeling them and placing them on medication, without a comprehensive psychosocial evaluation and assistance to the children and their interpersonal environment...I know that myriad factors can cause what appear to be symptoms of mental illness.”

In her statement to legislators, Dr. Effrem reviewed the research on the effectiveness of cognitive, language, social and emotional health screenings and intervention programs in young children.

· There are no recognized signs and symptoms of abnormal mental health in children because the very same indications are also often characteristic of normal development, according to the WHO 2001 World Health Report and the 1999 report of the Surgeon General.

· Dr. Benedetto Vitiello, director of Child and Adolescent Treatment and Preventive Interventions Research Branch for the National Institutes of Mental Health, admitted that “the diagnostic uncertainty surrounding most manifestations of psychopathology in early childhood” and that little research has been conducted on the effectiveness of interventions in young children. More importantly, “the long-term risk-benefit ratio of psychosocial and pharmacologic treatments is basically unknown.”

· According to a 2005 National Center for Infant and Early Childhood Health Policy report, “diagnostic classifications for infancy are still being developed and validated” and there was a “lack of longitudinal outcome studies.”

She goes on to describe the research on other home visit intervention programs that have been tried, such as the Nurse Family Partnership, which showed few, if any, statistically significant effects on child socioemotional development or behavior. Another national home visit program, begun with the goal of reducing child abuse, also failed to show evidence of success in significantly impacting child abuse rates or risks. And finally, she reviewed the body of international evidence on Head Start programs, which surprisingly and consistently “continue to show that improvements in academic performance are not sustained much beyond the third or fourth grade.”

While the available evidence for effectiveness of the proposals in these two pieces of legislation are lacking, moving forward without considering the adverse effects on children and families was especially disturbing. Many of the concerns and weaknesses are very similar to those seen in child and teen suicide prevention screening programs, covered here.

As she told World Net Daily: “There are privacy concerns because when home visitors come into the home they assess everything about the family: Their financial situation, social situation, parenting practices, everything. All of that is put into a database.” Reporter Chelsea Schilling went on to write:

Effrem said it does not specify whether parents are allowed to decline evaluations, drugs or treatment for their children once they are diagnosed with developmental or medical conditions. “How free is someone who has been tagged as needing this program in the case of home visiting — like a military family or a poor family?” she asked. “How free are they to refuse? Even their refusal will be documented somewhere. There are plenty of instances where families have felt they can't refuse because they would lose benefits, be accused of not being good parents or potentially have their children taken away.”

When WND asked Effrem how long state-diagnosed conditions would remain in a child's permanent medical history, she responded: “Forever. As far as I know, there isn't any statute of limitations. The child's record follows them through school and potentially college, employment and military service.”

Effrem said conflicts could also arise when parents do not agree with parenting standards of government home visitors.

Even when parents voluntarily enroll their children in government preschool, they have no say over the curriculum, said Dr. Effrem. “There's plenty of evidence of preschool curriculum that deals with issues that have nothing to do with a child's academic development...things that don't amount to a hill of beans as far as a child learning how to read.” (As we’ve seen, those include things like compulsory “nutritional assessments” to identify overweight toddlers and preschoolers, and mandated teaching them ‘healthy eating’ (defined as restricting sugars, calories and fats) and exercise to eradicate obesity. This is also the same early preschool program that this legislation would equip with home visit monitoring.)

When government programs promise to know better than parents how to take care of their children, taking a careful look might most help kids. That proverbial slippery slope feels increasingly steep.