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The pluses and minuses of community-based programmes

Among society’s most valuable resources are parents, not only parents of young children but also older, more experienced parents. Throughout the ages communities have made good use of these resources. Parenting was celebrated and respected as an honourable profession in its own right because of its importance for the future of all society.

Behind every new parent were one or more older relatives in the extended family, encouraging, monitoring, supporting and guiding where necessary. A vast store of inherited knowledge about health care, sound nutrition and managing children’s behaviour was passed on from the extended family, and from other ‘wise women’ in the neighbourhood.

This knowledge was not always correct; some of it was based simply on past practice rather than logic, or even on superstitious beliefs, but much was founded on centuries of trial and error and the community’s stores of inherited cultural knowledge of basic child-rearing and child care, coupled with a desire to support the young parents. This wealth of traditional knowledge and common sense practice served to strengthen the understanding and competence of the new parents, and ensure a reasonable start in life for their children.

There were problems within this age-old structure. Poverty in poorer areas was unrelieved by State benefits, although churches and other benevolent organisations helped the most deprived. Men fulfilled their traditional role of providing for the family, but played little part in the rearing of the children - though possibly more than many do nowadays. Women were more restricted in their freedoms but in other ways they had more security.

The contrast with today’s families in the poorer areas of this society is stark. While there is more financial security for parents, and health and other services ensure a minimum standard of living, the family structures are more insecure and a significantly large minority of families in those areas are headed by single parents, usually mothers. Most parents do not have extended families close at hand and there is increasing pressure from the State on ‘failing’ families - usually it is the mothers who are targeted - to conform to minimum standards of child care.

In the absence of the extended family, many mothers, whether ‘failing’ or otherwise, rely for information and guidance on ideas shared with other young mothers. Faced by isolation and other challenges, some disadvantaged families turn to alcohol and drugs as temporary substitutes for the support they do not receive. Many face serious levels of depression and low self-esteem. These and other factors contribute to poor parenting for a great many children.

Today’s increasing pressure on State services to limit expenditure has meant that even the limited family support services which were once routinely available in disadvantaged areas, are now only provided when the latter become visibly trapped in their difficulties, with children the prime victims.

Understandably, but mistakenly, the State’s response to such crises is often focused on meeting the children’s needs in isolation from the parent(s). At worst, neglected or abused children are taken into care in the hope of restoring them in time to the parents if the latter are now seen to be more aware of their responsibilities. At best, health visitors and/or social workers advise and direct the parents as to how they should improve their child care. Both solutions - putting the children into care or making frequent service visits to try to remedy the inadequate parenting - are expensive and in many cases unsuccessful.

While various articles on this website deal with the ethos and strategies of the parent support programmes provided by professionals or para-professionals within the various State services, the less widely used community alternative needs to be looked at in some detail.

This alternative form of parent support was developed at an early stage in the life of the Early Childhood Development Centre. It aimed to create home support programmes based on experienced parent visitors - usually mothers - drawn from the same housing estates as the parents who were most in need of support. A number of these programmes have been developed over the past few decades. They vary in the levels of community involvement and control, from programmes entirely managed and trained by professional nurses or social workers, with field staff being recruited from the ranks of experienced mothers living in the same estates, to programmes with minimal professional oversight where the coordination and training of programme visitors are done by community parents selected and trained for that purpose.

In these alternative forms of parent support there is of course still an essential role for professionals, but those need to be a new breed of alternative professionals, whose expertise will be called on by community parent visitors to resolve difficult child-rearing situations where special knowledge and awareness are required, or who can be consulted by the community program visitors.

If such programmes became widespread, there would be much less need for the conventional form of professionally staffed home visiting programs, where status and cultural differences between advantaged visitors and disadvantaged parents can make the task of parent support a complicated and often unsuccessful process. Instead there could be a recognition that within every community, no matter how disadvantaged or culturally ‘different’, there are competent parents - mothers as well as fathers - with the necessary maturity, insight and empathy to be trained to provide holistic support and encouragement to young or struggling parents within those same communities.

Before exploring the pluses and minuses of community-based programmes it is worth summarising the existing reality and recent history of these programmes.

The development of community-based programmes

Following on the successful creation and evaluation of the original Child Development Programme (CDP) in England, Wales and the Republic of Ireland, steps were taken to establish field programmes in well over twenty health authorities, with the home visiting being based on professional home visitors - as it had been in the CDP itself. In one of the pioneer authorities, Dublin, the public health nurses who had been involved in the original programme felt that they wished to retain their ‘triple duty’ role of providing parent guidance, home nursing and community midwifery.

Accordingly the developer of the CDP proposed that, rather than end the programme in that city, experienced and carefully selected mothers should be trained to provide home visiting support to parents in the city’s poorer areas. After considerable debate and initial professional unease, the new model was agreed and a professional home support initiative came into being in the mid to late 1980s, known as the Community Mothers Programme.

The recruiting was done by public health nurses who were given special training for this task, and who in turn trained and managed the experienced women who became known as community mothers. Today the Dublin programme is one of the biggest in the world.

In parts of the UK similar community parent programmes were set up in the following years, and further community programmes - based on health and/or social services - were likewise developed in other parts of Ireland.

Most of these programmes adhered to the basic strategies of the CDP and used many of the same resources. The community mothers were given a similar but less professional form of training, and although the basic elements of their support visits were similar to those of professional visitors, and they used the same illustrated information materials, they did not provide the clinical nursing services normally provided by health visitors or public health nurses.

The community-based programmes set up in the UK were generally short-lived. Although a number of these programmes were started with the help of some very talented health or social professionals, and equally talented experienced mothers selected for their knowledge of and commitment to their communities, they had limited success. There were problems in recruiting sufficient community mothers, problems with getting sufficient families for them to visit (partly because of professional unease about giving access to families on their own caseloads), and the disappointing reality of a much more limited awareness of community in most UK housing estates. Consequently most of these programmes faded out.

It is interesting to note that the greater community awareness in Irish cities has made it easier to initiate and maintain the community programmes there. Two models are used in the Irish context. One is managed and trained entirely by public health nurses, with community mothers doing the home visiting. In the other model experienced and highly trained mothers have been promoted to become coordinators and trainers, while still retaining the support of public health nurse and health visiting management.

In Western Australia a different form of community mothers programme has been initiated by a health board in a large city in that country, with initial training and development provided by members of the UK’s Early Childhood Development Centre.

In the Netherlands a rather different community based programme has been developed, based partly on the ideas of the CDP’s community programmes, and also linked to a local community health service. Its success has resulted in a decision by the Dutch Government to encourage the further development of this programme across Holland. Community-staffed parent support programmes have also been developed independently in the United States, some based on community organisations.

In many developing societies there are a wide range of community bodies that provide some or most of the same forms of local support for parents. In these developing societies however there is usually a much greater degree of self-management of the community support.

The quality of training     The ECDC is particularly concerned with the quality of training and the need for any trainer, professional or community, to have herself (or himself) gone through the necessary training and had sufficient programme visiting experience before being recognised as a trainer. This is not an onerous requirement, but it does involve the potential trainer learning in depth about the strategies and philosophy of the programme. Programme skills are not simply a module, which can be added on to someone’s skills or qualifications, but rather an acceptance of a radical philosophy that challenges many of the basic tenets of professionalism as it is practised today.

The question of payment    This has always been a difficult issue, as many people, especially professionals, have considered that the community parent visitors should be prepared to do this work on a voluntary basis, on the grounds that they are helping their own communities. Justice suggests that that is not a reasonable approach. The reality is that, especially within a disadvantaged community, parents who are recruited for programme work will do so aware that there is a serious opportunity cost for them, as they could otherwise be obtaining paid work in the service industry or in other occupations that would give them the freedom of part-time work at regulated rates of pay. In most cases it has been possible to settle for a mid-way situation in which there is some part-guaranteed and part-time based fees that do not require official recognition of the community parents as paid employees of the services, but which nevertheless do reward the community parents for their work.

The advantages of community-based programmes

There are strong reasons why community-based programmes can be seen as an ideal form of parent support.

  1. The programme visitors are from the same communities and social strata as those they visit, with correspondingly greater acceptability.
  2. Over time there is a growing awareness of community ownership of the programme, provided the community parents are also seen to be involved in the management and training of their fellow programme visitors.
  3. The identification and training of key people in the community as coordinators and later as trainers of programme groups, enables health or other authorities to become more aware of the wider social, health and educational issues within that community.
  4. For parents who struggle to deal with their children’s behavioural, health, nutritional and other problems, discussing these problems with programme visitors who are not only seen as equals but known to come from the same backgrounds, makes it possible to look more frankly as their own limitations.
  5. The use of people drawn from the community to undertake programme visiting is inevitably less costly than using highly qualified professional visitors, and also frees up those professionals for more work requiring particular health or social work skills.

The challenges of community programmes in highly professionalised societies

There are some equally powerful reasons for questioning community-based programmes and acknowledging the challenge they pose to hierarchically governed societies.

  1. The existence of groups who self-manage and self-train programme visitors is inevitably seen as threatening by service management structures, accustomed to layers of hierarchy and responsibility in which staff can be formally controlled and disciplined, instead of relying on the more ad hoc methods of control in community-run groups.
  2. The levers of control over aberrant behaviour are not as strong as in the professional services and this can in theory lead to conflict with top management, although in fact well-run community organisations would be able to deal adequately with such behaviour themselves.
  3. The fact that community parents are not recognised as full employees of the services, but paid fees for their work, means that there will always be a high turnover of most of these workers, with the need for regular training of new recruits to replace those who leave after a few years.
  4. A particular challenge arises with the duty of community parents to report situations where a child’s well-being is threatened by harsh or neglectful treatment. The reality has been that community parents have not hesitated to report such instances in order to get help for the child and the parents. An equal reality is that the nature of the parent support programme means that in nearly all cases the regular visiting of a community parent, and the methods she uses, enable problems to be identified at an early stage and dealt with by the parent(s) themselves, so that child abuse is much reduced.
  5. Without adequate control over these programs, both at the community level and at the supervisory management level, authoritarian or mechanistic practices, reinforcing dependency rather than empowerment, could emulate the worst rather than the best of professional practice. But those are the kinds of problems which adequate models of community empowerment could avoid or minimise.

At this stage it is difficult to offer a consensus on this movement towards greater community management and control over a community’s own parent support services. In theory this movement should be welcomed as offering some form of replacement for the rapidly reducing level of extended family involvement in parenting, especially in less advantaged communities. In practice they could represent a serious challenge to the over-professionalised human services that play such a large part in the lives of communities across much of the English-speaking world.

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