Lloyd deMause asked me to describe how to start a Community Parenting Center to prevent child abuse. Because every community is different all I can do is describe what we did to create ours in Boulder, Colorado. I've described this in four previous articles.1,2,3,4 There are hundreds of parenting programs all over the United States and we have all gradually improved the way children are raised in our neighborhoods. Some of the evidence for this is in our steadily decreasing infant mortality rates. This yardstick measures the number of children dying in the first year of life per 1000 live births. Infant mortality rates have gone down all over the world. Sweden had the lowest rate for many years, but after World War II Japan took steps to improve their relative status and by 1996 they were lower than Sweden.. The United States was once 14th but other countries passed us and by 1996 we were 22nd. 5 By 2001 Sweden's rate was 3.1, Japan's was 3.4, Singapore's was 2.5 and the U.S. rate was 7.2 During this time world military expenditures began to decrease in 1983, and the number of worldwide armed conflicts began to decrease in 1994 4.
These improvements in childrearing have coincided with the women's movement, which includes women getting the right to vote, receiving equal pay for equal work, and other forms of equality, which often required intense struggles. These changes followed the Civil Rights movement, which helped people of color move toward equal rights.
Our efforts to improve parenting in Boulder began after a dramatic child murder. A young mother, Elizabeth Manning, and her boyfriend, Danny Arevalo, killed and buried her three year old son, Michael, in 1982, despite several visits by the Child Protection Team of Social Services. The boy friend had gone to junior high two blocks from my medical office. A teacher told me he had been looked in the broom closet every day because of discipline problems.
Judy Talaba, a Community Hospital nurse and I started bimonthly community meetings in the parish hall of St. John's church, to talk about what we might do to prevent child abuse. We learned of a controlled experiment done 30 miles away in Denver in 1970-72 at the Kempe Center,6 They videotaped a large number of deliveries and selected 100 families they suspected might become abusive because the mothers didn't want to handle their babies at the time of birth. Over the next 17 months they provided home visiting for 50 of these 100 mothers. Two young social workers visited the mothers approximately every week and a woman pediatrician phoned the mothers weekly.
With the assisted group there was no abuse, but 5 children had to be hospitalized because of injuries among the 50 control families who were not visited. A few years later I asked Dr. Brandt Steele, one of the faculty members of the Kempe Group, "What changed in Denver after you learned how to prevent abuse?" He said, "Nothing changed, because our grants ran out."
After a year of community discussions in Boulder, our first action was to publish a New Parents Directory. This was a one page sheet listing a variety of resources available to new mothers. Today it is a 36-page booklet printed by the Health Department. Then our community discussion group persuaded the Boulder County Commissioners to give the Mental Health Center a $60,000 grant which was used to start weekly home visiting for 30 mothers in 1983. Janet Dean, who had been one of the original home visitors for Henry Kempe in Denver, was the director of this program and she still has that job 20 years later. She credits the writings of Selma Fraiberg for providing the inspiration for training the visitors. Fraiberg was a psychoanalyst who realized many years ago that their therapy for new mothers was more effective when they treated the mother in the home with the baby present. The mother was reminded of her own childhood by what her new baby went through.7 This program is called the Community Infant Project (CIP), and they now visit 190 Mothers a year and treat over 400 families in their offices at a yearly cost of $900,000. Approximately 4200 babies are born in Boulder County every year and the Community Infant Project's efforts are the major part of our child abuse prevention programs. What is usually called home visiting could also be called home therapy.
The rest of our 1983-4 discussion group felt we had to do something for the all the other 3000 plus new mothers each year in Boulder County. Otherwise we might be thought to be scapegoating a few mothers. A young mother, Susan Malmsbaugh, had moved to Boulder from Vancouver, Canada, (which has lower infant mortality than the USA). As Susan described their programs, there were four centers where new mothers gathered in one room while someone watched their babies in the next room. She had worked in one of the centers, and after her baby was born she returned as a client.
After eighteen months of discussions, we opened the doors of the Community Parenting Center in the recently vacated half of my duplex office building in October, 1984. I had practiced internal medicine in the other half of the building for over twenty years. My office secretary, Kathy Linden, served as our first unofficial director. She had a new daughter, Sydney, who was nursing and came to work with her every day. We were open five mornings a week and at first almost no one came in. Gradually we began attracting new mothers with infant massage classes and puppet shows. Clancy Sheehy began puppet shows every week. Clancy was born with osteogenesis imperfecta (or brittle bone disease) and was significantly deformed after 40 childhood fractures. Because of his fragility he'd been babied and protected by his parents and his child rearing was the opposite of child abuse. He had an amazing outgoing personality that helped him finish college and adjust to a serious disability. Clancy was one of our original Board of directors and remained active with us until his death in 2001 at age 71.
Boulder had the only massage school between the Mississippi and the West Coast and several different massage therapists got us off to a good start by volunteering and encouraging mothers to massage their babies.
Our original guidelines were:
- Don't offer therapy but utilize other resources in the community.
- Offer education and entertainment in a supportive setting.
- Keep programs free so they would be open to everyone.
- So-called "normal" mothers would predominate and would assist distressed mothers by absorbing them in their midst.
To our surprise when we started we were not universally popular. After we began the mayor of Boulder, (who had been my patient) was very supportive and made sure our grant requests were met. The city gave us $5000 the first year and our total budget was $6000. The next year the city gave us $10,000 and we raised another $20,000 and then the mayor retired. Her successor visited our Center and said, "I don't know why you are babying these mothers. I had to walk three miles to school every day when I was young." We received $970 from the city that year, and their yearly funding fluctuated from $10,000 to zero over the past twenty years. The county commissioners gave us $7500 in 1987 and their funding grew steadily to $42,000 in 2003.
I got the sheriff and district attorney to be on our Board and that helped our reputation. We had an adequate supply of both prominent and ordinary citizens on our Board of Directors. Elise Boulding was nominated for a Nobel Peace Prize during her term on our Board, and there have been approximately 160 Board members in our first 20 years.
Shortly after opening we started mailing out a monthly calendar of events which was also distributed by a diaper service. It began as a one page sheet, illustrated by Kathy Linden's daughter Stephanie. It gradually grew to a 14-page paper, distributed to 4000 people. The advertising pays the editors' salary.
We outgrew the 880 square feet of our first site in two years and moved into an old schoolhouse a few blocks away. We stayed there for two years and moved into St. John' basement for three years. Then we helped the YWCA obtain a grant to remodel their building and moved in there in 1991. In 2004 the YWCA remodeled again and we moved into the nearby Baptist Church.
When we began Kathy Linden was our first hostess who met the mothers, introduced them to each other and facilitated the discussions. With the city's money after a few months we hired one of the new mothers to be a part time director. Barbara James was 28, had a young son, and they had just moved to Boulder from California. Kathy Linden and I hired her in large part because of the way she was raising her son, J. T.
Barbara's mother was alcoholic and schizophrenic and her father was manic-depressive. She had two brothers and ran her household growing up because of her parents problems. She loved our job which helped her overcome her loneliness in Boulder. After 18 months we hired another mother, Carol Dressally, to work part time and help Barbara with the stress. After two years Barbara quit, when she remembered being abused.
Infant massage therapists gradually disappeared, and we began a variety of other programs. These included talks on setting limits for toddlers, nature hikes, play groups for mothers and children, how to talk to your chil- dren about sexuality, and pot luck dinners. Today we mainly sponsor drop- in sessions for mothers and children, including half days sessions for Spanish speaking parents, Japanese groups, Chinese groups, German, French, and Korean groups. We have single moms group and fathers groups. We provide needed services such as food, clothing, furniture, toys, books, and a warm atmosphere. We have helped start two other parenting centers in Longmont and Lafayette, two smaller cities in Boulder County. Our present director has two full time assistants and frequent volunteer assistants. They create an atmosphere that is supportive and reassuring for new mothers and over 100 families come in each week. Fran Eichenauer, age 54, commented, "This is the best job I've ever had after raising two sons, working as a preschool teacher, in the welfare department, and in a community house for low income families."
Psychohistorian John Fanton spent one summer with us when he was in medical school. Since then he has completed residency training in pediatrics and psychiatry and is moving from Pittsburg to Amherst, Mass. where his wife has a teaching position. He has recently become a father, and I hope that he will see ongoing significant improvements in parenting practices allover the world in his career. Several years ago we changed our name to Parenting Place and we have changed our mission statement several times. It now reads, "The mission of Parenting Place is to relieve isolation, reduce the stress of parenting and prevent child abuse and neglect by providing outreach and a place where families can receive support, education and develop a sense of community." Measuring the results of our efforts numerically is very difficult, but older mothers often tell us how much help we were when they brought their children in to our center.
The number of children, 6 years and under, who were murdered in Boulder County is as follows, from 1974 to 1983, 3 deaths, from 1984 to 1993,9 deaths and from 1994 to 2003, 7 deaths. The county population has doubled in that time, (between 1970 and 2000) from 131,889 to 291,288 so the murder rate of young children has gone down.
The Bright Beginnings Warm Welcome program provides one free home visit to all new parents who are interested. These county wide volunteers visited 1600 families last year out of the 4200 new babies born in our county. This is separate from the Community Infant Program that visits mothers frequently who might become abusive. One single visit by an untrained volunteer is of minimal help for potential abusees.
It has been over 30 years since Gray, Cutler, Dean, and Kempe showed that child abuse was preventable. Since then numerous other research programs have shown similar results. David Olds, PhD, started a controlled study of home visiting by nurses in rural New York State around Elmira. When C.Henry Kempe retired, David OIds moved to Denver and took over the direction of the Kempe Prevention Research Center. In 1997 and 1998 he reported favorable results in this study after a 15 year follow-up.8,9
It will probably take longer to eliminate child abuse than the 180 years it took to eliminate smallpox after Jenner discovered vaccination in 1796. But we know a little bit about how to prevent abuse, and hopefully we will learn more as we go along. I don't believe there is any correct way to start a parenting program, and if one starts one they will soon find they have started something that benefits new mothers, their children, and the whole community. The important thing is to start. I will be available as a consultant, either by telephone or in person (see end of article for numbers to reach me) to assist anyone who wants to begin a parenting program. The Federal Government is unlikely to get involved in this and if we are to create more improvements in parenting programs, it will have to be done one community at a time, supported by local funding. Because David Olds, et aI, showed that home visiting of newborns could reduce arrests when the children became teenagers, We might be able to obtain crime prevention money from the Federal government. Primary prevention of crime is rarely accomplished and this may be the best way. 9 In 2000, John Leventhal reported on the variety of home visiting programs that had begun nation- wide and the difficulty in evaluating the results of these efforts.10
Our nation struggled and stumbled toward "all men are created equal" in 1776 in our Declaration of Independence, and then in 1863 we finally emancipated slaves. As people of color and later women struggled toward equal rights, so we now hope to achieve equal rights for babies and children.
Robert B. McFarland, MD, lives at 2300 Kalmia Ave. Boulder, Colorado, 80304, (303)442-173S. email@example.com
1. Robert B. McFarland and Kathleen Linden, "Psychohistory in Action," J. of Psychohistory, 17(1) Summer, 1989, p73-82.
2. Kathleen Linden and Robert B. McFarland, "Community Parenting Centers in Colorado," J. of Psychohistory, 21(1) Summer 1993, p7-18.
3. Robert B. McFarland and John Fanton, "Moving Towards Utopia: Prevention of Child Abuse," J. of Psychohistory, 24(4) Spring 1997, p 320-331.
4. Robert B. McFarland, "Peace on Earth; Good Will toward Children," J. of Psychohistory 27(2) Fall 1999 5. Robert B. McFarland, "Infant Mortality Rates as a Guide as How Nations Treat Children," J. of Psychohistory, 17 (4) Spring, 1990 p.417-423.
6. Jane Gray, Christy Cutler, Janet Dean, and C. Henry Kempe, "Prediction and Prevention of Child Abuse and Neglect," Child Abuse and Neglect, 1972: 1: 4S-48.
7. Selma Freiberg, The Magic Years, New York, Charles Scribners' Sons, 1959. Selected Writings, Chapter 4, edited by Louis Freiberg, Columbus, Ohio, Ohio State University Press, 1987.
8. "Long-term Effects of Home Visitation on Maternal Life Course and Child Abuse and Neglect, Fifteen-Year Follow-up of a Randomized Trial," David L. Olds, PhD, John Eckenrode, PhD, Charles R. Henderson, Jr. Harriet Kitzman, RN, PhD, et al, Journal of the American Medical Association, August 27, 1997, Vol 278, No.8.
9. "Long-term Effects of Nurse Home Visitation on Children's Criminal and Antisocial Behavior, 15-year Follow-up of a Randomized Controlled Trial," David OIds, PhD, Charles R. Henderson, Jr, Robert Cole, PhD, John Eckenrode, PhD, Harriet Kitzman, RN, PhD, et aI, Journal of the American Medical Association, October 14,1998.
10. "The prevention of child abuse and neglect: successfully out of the blocks," John M. Leventhal, Child Abuse & Neglect, 25 (2001) 431-439.
The Journal of Psychohistory 32 (4) Spring 2005
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