WASHINGTON — One aspect of the health-care reform legislation is a deal killer, as far as some family groups are concerned.

A low-profile provision within the 1,000-plus-page health-care overhaul bill in Congress is so controversial to some family-rights groups that they have opposed the overall health-care bill because the visitation program is included.

The provision would create the first federally funded program for home visits of expectant mothers and families with children under 6.

Home visitation programs, which have existed in various forms for several decades, have received funding from state and local governments and private entities. The programs have functioned with a variety of purposes, but they are frequently touted as a way to prevent child abuse and neglect by parents.

That goal has led more than 40 state governments to fund various types of voluntary home visitation programs that serve up to 500,000 children and their parents every year, according to estimates of researchers.

The push for the federal funding through the health bill — $750 million in the first five years — stems from the contention of visitation advocates that a massive boost is needed to reach millions of children at risk for abuse. President Obama’s proposed budget also has requested $8.6 billion for such programs.

“Home visitation programs have a proven track record of increasing the chances that a child will have a safer, healthier and more productive life,” said U.S. Rep. Jim McDermott, D-Wash., in a written statement in July.

McDermott sponsored home visitation legislation earlier this year, but it never advanced. Much of the language from the McDermott legislation, however, was rolled into the massive health-care overhaul bills that were approved in July by three committees in the House of Representatives.

Although family groups support the goal of reduced child abuse, they worry that the “voluntary” provisions of the home visitation legislation are poorly defined and that the program could easily morph into a mandatory invasive program for many parents, including those who home school.

“Once the federal government gives the money to the states, there is no oversight or even mandate that states make sure the programs are voluntary,” said Will Estrada, director of federal relations for the Home School Legal Defense Association, based in Purcellville, Va.

Estrada testified before Congress last year against similar provisions in earlier legislation over the concern that the home visitation programs could become required for parents who home school their children, or even most parents. Critics note that although the current legislation describes the home visitation programs as “voluntary,” the language does not specify whether they remain voluntary if a parent changes his mind after beginning the program.

Those concerns have led the Home School Legal Defense Association to urge its 85,000 member families to oppose the health-reform measures explicitly because the home visitation program is included in the bill.

‘Mandated Reporter’

The ability to secure the legal rights of parents when confronted with home visitation is in some doubt because the programs are nearly always staffed by so-called mandated reporters, who have blanket immunity from criminal or civil penalties for reporting suspected child abuse or neglect. The ability of visitation workers to report fabricated abuse or neglect allegations against any parent resisting such services is a “worst-case scenario,” but such government abuse has happened, Estrada said.

“If families want to choose these programs, that’s great. But if you have to let a government official in to teach you how to raise your children and to monitor that your children are developing, then you could easily lose control of your children and have them taken away,” he said.

The potentially coercive power of the people who operate home visitation programs was put in even starker terms by other critics.

“It’s putting the fox in the hen house,” said William Tower, president and CEO of the American Family Rights Association, in Fair Oaks, Calif. He testified before Congress in 2006 about families abused by government workers charged with preventing child abuse.

‘Sanctuary of the Family’

Supporters of home visitation maintain the programs effectively address a growing problem.

“The increase of child abuse and neglect cases in Washington state and nationally is a sobering sign that our efforts to date are insufficient,” said Joan Sharp, executive director of the Council for Children & Families, during a June congressional hearing on home visitation programs.

However, research on home visitation programs generally has found that the programs do not achieve the highly touted goal of preventing child abuse or neglect.

“Of those programs that look at child abuse and neglect directly (i.e., substantiated cases), only a few have reduced child abuse and neglect,” said Jeanne Brooks-Gunn, professor of child development at Teachers College and the College of Physicians and Surgeons of Columbia University, during the June congressional hearing.

Researchers in Ontario even identified one program in 2005 that greatly increased the rate of reports for child abuse and neglect. Critics of home visitation said such findings are not surprising since the programs place families under a months- or years-long microscope through intrusive regular visits to their homes.

Visitation programs “have the effect of bringing the state into the sanctuary of the family,” said Stephen Krason, president of the Society of Catholic Social Scientists.

Others are supportive of the goals of the program, even as they question the premise that programs are needed to prevent a nationwide wave of parental child abuse.

Richard Wexler, executive director of the National Coalition for Child Protection Reform in Alexandria, Va., highlighted the findings of home visitation researchers that child maltreatment is relatively rare in the general population, counter to the idea of an abuse epidemic.

“That’s worth remembering,” Wexler said, “amid the hype about an ‘epidemic of child abuse’ and all the damage that hype can do to children, as well as helping to explain why any reduction in maltreatment caused by home visiting will be hard to detect.”

Rich Daly writes

from Washington.