Lessons from nursing for nannies.

 Lessons from nursing for nannies.

 Lessons from nursing for nannies.

Snapshots of life at home.
Dec. 7 2006 5:11 PM

Invasion of the Supernannies?

Lessons for the British from the American front.

Jo Frost. Click image to expand.
Super Nanny's Jo Frost

Supernanny is a word replete with possibilities. It can bring to mind adventures with Mary Poppins, the brisk routines of TV problem-solver Jo Frost, or an interfering old biddy who bullies you and your children into submission. British Prime Minister Tony Blair had the Frost model in mind—he cited her show—when he announced last month that his government would send "dedicated parenting experts" to the aid of families in 77 poor areas of the country. He promised not to interfere with "normal family life." But he pointed out that, "Life isn't normal if you've got 12-year-olds out every night drinking and creating nuisance on the street with their parents not knowing or even caring."

Emily Bazelon Emily Bazelon

Emily Bazelon is a staff writer at the New York Times Magazine and the author of Sticks and Stones

By calling them supernannies, Blair got his corps of experts lots of attention on both sides of the Atlantic. He fed the fantasies of beleaguered parents everywhere ("Can I have one?" a few of my friends wondered longingly), and also prompted libertarian grumbling about government incursion into the family sphere. This seemed like a fair criticism in light of Home Secretary John Reid's statement that parents who shut the door on the supernannies might find themselves facing a court order to open it.

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In the end, though, all of the fuss may be a bit off the mark. The government plans to spend all of 4 million pounds, or less than $8 million, on its supernanny delegation and some other services for parents. Libertarian fears about government meddling with poor families may be deserved, especially if court orders are really involved. But good research shows that sending experts into the home helps disadvantaged kids and mothers. One of the best-studied efforts involves nurses in the United States who make home visits. Nurses are not nannies, of course, but their experience offers lessons for Blair's effort.

In the 1970s, David Olds worked at a day care center with 3- and 4-year-olds and concluded that many of them already had problems that he couldn't see how to address. He went on to become a developmental psychologist and came up with an extremely specific idea for improving kids' health and well-being. His program would work with only first-time parents. It would be conducted at home. The visiting professionals would be nurses because of their medical expertise and because poor women seemed likely to trust them. The nurse visits would begin during pregnancy. Olds' goals were threefold: To improve prenatal health and outcomes at birth; to improve child health and development by reducing bad or abusive parenting; and to help mothers space out future pregnancies, go to school, and find jobs.

Olds started his first visiting-nurse program with 400 families in Elmira, N.Y., beginning in 1977. He is a rigorous, even obsessive, tester of his model. Two hundred families, most of them white, rural, and poor, were randomly assigned to nurse home visits. Another 200 got transportation for prenatal care, children's doctors visits, and screening services, but no nurses. The program ran from pregnancy until the children's second birthday. Fifteen years out, the Elmira children visited by nurses had 56 percent fewer doctor and hospital visits for injuries at age 2 and 48 percent fewer incidents of abuse and neglect. By the time their children were 4, the mothers visited by nurses were 83 percent more likely to be working than the mothers with no visits. At 15, the children had 69 fewer convictions for juvenile offenses.

This is the kind of success that makes governments swoon—and then try to replicate your program while blithely cutting corners. Olds resisted. He wasn't sure if the nurse visits would work as well for a different population. In 1991, he tested the program on a group of black women in Memphis, Tenn. The early results were promising—fewer hospital visits for child injuries again and for mothers, more spacing between pregnancies. Now there was more clamoring to expand Olds' program, but with the notion of using cheaper "paraprofessionals" instead of nurses.

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In 1993, Olds moved to Denver to become a professor of pediatrics, psychiatry, and preventive medicine at the University of Colorado. He tested his program a third time, in this case with a group of mothers who were about half Hispanic. And, in addition to the usual control group, another group of mothers received home visits from paraprofessionals (who had a high-school education but no other training on child or maternal health and development) rather than nurses. For a third time, the nurse-visited mothers and kids benefited. But the paraprofessional-visited ones didn't. In these families, "mothers interacted better with their children and showed some reported reduction in psychological distress, but those were essentially the only measurable improvements," according to this report by the Robert Wood Johnson Foundation, a longtime Olds funder.

So with justification, Olds has stuck to his original model and has not heeded calls for rapid expansion. The Nurse-Family Partnership, as it came to be called, now reaches 20,000 kids in 20 states. That's a lot, but it's still a small fraction of the 2.5 million American children under the age of 2.

What does this mean for England? Blair's government is interested in launching a version of Olds' program as part of its effort to end child poverty by 2020 and halve it by 2010. (Goals that the United States, notably, has not set.) The recent "supernanny"  splash targets a different population of older kids. Olds says there is good research to support a home-based effort to help parents manage disruptive behavior. "These kinds of strategies have been implemented in many different contexts and with different family types," Olds says. "And some of them have moved into what we call effectiveness testing, in community settings. So there is reason to be optimistic that these kinds of interventions can work outside of lab-controlled trials."

Nor does Olds' strikeout with paraprofessionals mean that nonnurses will fail in a very different program aimed at a different age group. But he cautions that as a general matter, programs fall apart when they skimp on training and support or expand too fast. The qualifications of Blair's "dedicated parenting experts" aren't clear. "Have they ten kids apiece?" the skeptical Western Morning News in Plymouth asked. When the British pilot Olds' program, they will use nurses and midwives. They will start small. And they will test and retest. Will the supernannies be held to the same standard, and will they have good support? "Those are the real questions," Olds says.