Oregon lawmakers have noticed a health “emergency” in their state. Thousands of families have been missing an apparently vital service: home visits from nurses to check on their newborn babies. While household visits for new mothers are already applied across the U.S. in a limited capacity, Oregon’s governor and state legislature are considering turning it into a universal practice across the state.
The move has been welcomed by some as a step in the right direction for supporting the physical and mental health of children and parents, but others are worried about the potential for violation of both families’ privacy and liberty when it comes to raising children.
Oregon Governor Kate Brown’s proposed 2019-21 budget earmarks $8.7 million for investment in a universal home visit program for children and parents, and the state’s Legislative Assembly has a new bipartisan bill in the works, Senate Bill 526, which urges lawmakers to study universal home visits of new families by healthcare providers. The bill, which is currently in committee stage, provides little information as to what such a program would actually entail, but proposes that the research is “necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist,” meaning the matter must be settled by the end of 2019.
“This would be good for all kids,” said Patrick Allen, director of the Oregon Health Authority. “[Post-natal care] is not something that ‘people with problems’ need; it’s for everyone. It’s a big deal.”
According to the Beaverton Valley Times, which interviewed Allen about the proposal:
“When the program is complete, every new parent — this includes adoptions — would receive a series of two or three visits by someone like a nurse or other health care practitioner. The visits could include basic health screenings for babies; hooking parents up with primary care physicians; linking them to other services; and coordinating the myriad childhood immunizations that babies need.”
But not everybody is so gung-ho about the possibility of officials being allowed to enter their homes and weigh-in on how they raise their new children, with some accusing the government of using health as an excuse to intrude on parents’ rights and gain further control over kids at the earliest possible age. What exactly would happen if a parent refused entry to a government representative, or simply disagreed with state-sanctioned recommendations? So far, there is little clarity on whether the universal visits would be mandatory or not.
Michael Ramey, executive director of the Parental Rights Foundation, said in a statement:
“So, does ‘universal’ mean ‘universally available?’ Or does it mean ‘for every family without exception?’ The latter is the literal meaning of the word, and thus the cause for much alarm. But is that as the governor’s office intends? Ultimately, we do not know …
And make no mistake: home visits, even by licensed medical personnel, would constitute a violation of family privacy if the visit is unwanted. Licensed medical practitioners are by law mandatory reporters; once they are inside your home they are a de facto investigative agent of the State … That may create an adversarial medical relationship and introduce a level of stress unhealthy for any family.
Home Visits Helpful or Intrusive?
The federal government has already moved to institute home visits for some families, while some states are piloting universal (but not mandatory) programs.
The federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program was created in 2010 as part of the Affordable Care Act. MIECHV’s mission is to provide and fund “voluntary,” “evidence-based” home visits to at-risk pregnant women and new mothers. The program targets families who are evaluated to meet certain criteria for risk, with the goals of preventing abuse and neglect, improving mental and physical health of both parents and child, and promoting a positive relationship, among others. In financial year 2017, the program visited 156,000 families, with 942,000 total visits in 22 counties across the U.S.
While MIECHV may seem rather optimistic, given the small number of visits that families actually receive (between one and eight), it may indeed prove useful to those that do genuinely need help.
…when families were visited indiscriminately, there was no noticeable benefit.
One non-government program, Family Connects, operates in ten states that have selected counties for a trial run aimed at all families, regardless of income or background – but so far it has been voluntary. According to the website, “Universal reach reduces the feeling that there’s a stigma attached to receiving services. All families with a newborn are vulnerable; targeting demographic risk does not address all families with vulnerabilities and needs.”
But are visits to every home really a worthwhile pursuit, even if one disregards the privacy and liberty issues for those who may be unwilling? Healthy Debate, a site that covers Canada’s health care system, reported that studies have found positive effects from home visits to high-risk families – those with low income, low education, little family support – but when families were visited indiscriminately, there was no noticeable benefit.
Nevertheless, Michael Geary, chief of obstetrics and gynecology at St. Michael’s Hospital, told Healthy Debate that in order to reach those who need help, it’s necessary to screen everyone. “We’re very good at identifying the high-risk mom and baby and managing them, but the real challenge is identifying the high risk baby of the low-risk mom,” he said. Geary received much of his medical training in the U.K. and Ireland, where home visits from health visitors are widespread for new mothers.
Care Givers or Cops?
The U.K. currently mandates five universal health checks from the period of pregnancy until a child is 2.5 years of age. The practice isn’t without some controversy, however. In 2004, Britain’s Association for Improvements in the Maternity Services (AIMS) Journal published an article titled, “Health Visitors or Health Police?” which questioned “how health visiting is increasingly being dominated by surveillance, not support.” Mothers had complained that the visitors were aggressive, judgmental, uninformed, deceptive, or misleading about their aims, overzealous to detect abuse, and cared more about fulfilling paperwork targets than the family’s genuine wellbeing. The article opens with a true story:
“A young woman, expecting her first baby, hears a knock at the door. She opens it, and the woman standing there says she is a health visitor, and can she come in? The woman asks why, and the health visitor says, ‘Just to see how you are.’ The woman says she’s fine and doesn’t need a health visitor, thank you. The health visitor replies, ‘If you don’t let me in, I shall report you to Social Services.’”
The article reported that one couple who didn’t take up the offer for a post-natal health check was referred to social services. In another case, a family alleges they were harassed by the health services, questioned by the police, and put on file as possible child abusers due to “controlling,” “unusual,” and “strange” behavior – that is, simply for declining to let their assigned midwife home visitor perform a prick test (for allergies) on their baby, before researching the procedure for themselves.
Oregon Kids Better Off?
The Salem Reporter was quick to declare kids the “big winners” of Kate Brown’s proposed budget, but there is another interpretation. Children are indeed a focus of Brown’s, and nobody could doubt that she’s keen to bring them ever more under the protective wing of the government – for their own good, of course. Other gems in her budget include “intensive in-home behavioral health services,”“early intervention services in the K-12 system”, a longer school year, less time outdoors, investment in recruiting more child caseworkers, recruiting foster families, training for foster parents, a centralized child welfare screening operation, and, of course, the possibility that every infant will be confronted by the authority of the state mere days after birth.
Child welfare is a balancing act – how do you ensure the wellbeing of all children without infringing on family freedom? But given that Oregon has been noted for a failing child welfare system, rife with maltreatment of the kids in its care, what makes the state think it can do better than parents?
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