Mary Hernandez peers anxiously about as her car pulls up in front of Juanika Hickman's duplex in the crime-ridden east end of Davenport, Iowa.
The week before, Ms. Hernandez arrived to find the street clogged with police cars. Juanika's mom, a crack addict, had been stabbed during a fight on the sidewalk, trying to protect Juanika.
Throughout the ruckus, Juanika's six-month-old baby, Travon, was left alone inside the house. "What happens next time there's a confrontation?" Hernandez asks before stepping out of her car to greet Juanika. "I don't want the baby in danger."
Hernandez is now one of a handful of people working to keep Juanika's roly-poly baby, nicknamed "fat man," safe. As a home visitor, she is part of a pioneer program in Iowa that is gaining attention nationwide as an effective means of preventing child abuse.
In 1995 alone, more than 3.1 million children were reported abused and neglected, according to the Chicago-based National Committee to Prevent Child Abuse.
Many experts believe home visitation offers a common-sense and compelling solution: Send trained adults on regular visits to support at-risk mothers and fathers in coping with the difficulties of parenthood and a range of life crises, and thus help keep parents from mistreating their children. If the visitors see signs of abuse, they must notify child welfare officials.
One of the most effective and far-reaching home-visitation initiatives is the Healthy Families America program, started in 1992 by the NCPCA. The widespread anecdotal evidence of its success has led a growing number of US communities to experiment with the approach. In the past two years, the number of states participating in the program has grown from 19 to 30, while program sites across the country have mushroomed from 31 to 186.
Home visitation has been endorsed as the most critical element in a comprehensive approach to prevention by the US Advisory Board on Child Abuse and Neglect.
But experts caution that the quality of home-visitation programs is not uniform. "There is tremendous variation," says David Olds, a University of Colorado professor who has studied the programs.
The best results tend to be achieved by programs that use highly trained professionals such as nurses, provide frequent visits starting before birth to promote healthy pregnancies, and help parents not only with child-rearing but also …