COLUMN ONE : Parents Get an Ounce of Prevention : Home visitors act as extended families for stressed-out mothers and fathers in a bid to curb child abuse. Hawaii’s program is the prototype, as other states try to replicate the results.

At the Kapiolani Medical Center, where half of all Hawaii’s births take place, new parents leave the hospital with a baby and a promise. If things at home become too stressful, parents are told, they can call for help.

That can make a world of difference.

The offer to assist families with the challenges of being a parent is at the heart of a novel child abuse prevention strategy that has brought this isolated state to the attention of health and social service workers nationwide.

While abuse and neglect cases are soaring in most states, Hawaii has greatly curbed child abuse by attempting to mimic the days long ago when relatives and neighbors flocked to a young family’s home to lend assistance and support.

“Many other societies have extended families; seldom are people alone in raising a family as they are in this country,” said Gail Breakey, director of the Hawaii Family Stress Center and a pioneer of the state’s program. “We started to look at domestic violence as a result of this isolation.”

Although the era of the extended family is long gone, the concept of helping new parents--for free--has been updated and reinvigorated in Hawaii.

The program works this way:

* When children are born, as many families as possible are screened--with their agreement--in the hospital for well-known risk factors that can lead to child abuse or neglect. The families considered at risk are offered assistance.

* The assistance comes from a home visitor: a trained worker who helps the family deal with the situations and stresses that can lead to the harming of a child. Home visits usually take place weekly and are offered over a period of years.

Hawaii’s success is so talked about that desperate health and child welfare representatives from almost every state have sought a blueprint of the program and have lured Hawaii’s experts to the mainland for training workshops and conferences.

Last year, almost 3 million U.S. children were reported to child protective services as alleged victims of maltreatment, a 7.8% increase over the previous year and a 50% jump from 1985.

“There isn’t a lot known about how to prevent child abuse. But we know that if we can intervene early, before there is abuse, we can make a big difference,” said Leslie Mitchel, of the Chicago-based National Committee for Prevention of Child Abuse. The agency is organizing one of the largest home visitation programs in the nation, called Healthy Families America.

Following the Hawaii model, Healthy Families America has 22 programs under way in 16 states. Programs are in the planning stage in almost every state, including California.

The Hawaii program began in a low-income part of the island in 1975. Like officials from every state, social services workers there were appalled at the relentless increase in child abuse cases. As with other states, Hawaii had numerous programs to deal with families after abuse was reported, but officials began to feel that the programs were like patches on a badly fraying fabric.

They began to think about the causes of child abuse, said Gail Breakey, director of the Hawaii Family Stress Center and a pioneer of the state’s program. What they came up with was the extended-family approach.

“By the end of the 1970s, we knew what we were doing was working,” Breakey said. “Families were so satisfied and there was no abuse or neglect.”

By the late 1980s, a state-funded study of the program showed a 1% abuse rate compared to a 20% rate usually seen in high-risk families nationwide.

Convinced of its value, the Hawaii Legislature institutionalized the program--setting up the goal of screening every family of every newborn by as early as 1995, and offering assistance to those who need it. Now, about half of all families statewide are screened and 10% of those enter the program.

During screening, trained social workers in Hawaii look for such risk factors as unmarried parents, substance abuse, unemployment, lack of prenatal care and inadequate family income. For those without the multitude of stresses linked to low income, risk factors can include poor parenting skills, not wanting the baby, and a history of mental illness, said Betsy Pratt, a home visitation expert with the Hawaii Family Stress Center.

“We can’t look at a family and say this family is at risk for abusing a child. But we can divide families into two groups. One we are reasonably sure will do OK. The other group will need extra support to do well,” she said.

Nationwide, there are about 4,000 home visitation programs, although not all have attempted to duplicate Hawaii’s program because they lack the funds for such extensive, long-term service. At least 200 programs are operating in California, according to Healthy Families California, a nonprofit, privately funded program that helps interested communities plan home visitation programs.

By offering parent training classes, friendly advice and emotional support to parents of young children, proponents believe they can prevent most child abuse, which usually victimizes children under age 1.

“People don’t want to abuse their children,” said Sherry Glueck, a Contra Costa County mother who started a home visitation program modeled on Hawaii’s. “But many are overwhelmed, hungry, tired and alone. This is what causes child abuse. But if you send in someone to provide warmth and support, one-on-one, it is inspiring.”

Others are wary of the movement. They see home visitation as Big Brother telling people how to parent. Even some proponents of home visitation wonder if Hawaii’s success can be replicated elsewhere. Hawaii officials credit at least part of their success to the strong emphasis on family--or ohana --that exists in island culture. Hawaii is also unique in that it offers universal health coverage to all its residents, and that makes it easier to extend preventive services, such as the child abuse prevention program.

The ways families raise their children in Southern California, however, are as diverse as the many cultures that populate the region. And a method like Hawaii’s may not translate to some cultures.

“We like the Hawaii model, but we have concerns about how it might work in South-Central L.A.,” said Linda Smith, director of Health Families California.

Hawaii’s home visitors help in many ways. A visit might include teaching a parent how to discipline a toddler without spanking or simply how to feed a sleepy newborn. Or, the visitor might tell a single mother how to apply to receive food stamps or how to get her toddler into Head Start.

“There is so much you can do for these families,” said Mary Sokup, a home visitor who on this day is visiting the home of Yvette Medeiros and Garrett Wells, and their two children, ages 3 years and 4 months. “We take the families on outings, teach them songs to sing with their children, bring them diapers or a toothbrush, help them fill out paperwork. At some houses, you say, ‘Give me a broom and a bucket.’ We try to provide whatever they need to make their lives less stressful. Sometimes, we are just there to listen.”

Sokup is pleased with the progress of this family, which lives in a two-room, government-subsidized apartment in the run-down Aiea section of Honolulu. Medeiros and Wells are unmarried and unemployed, and the stresses of raising a fussy baby and active toddler in the tiny apartment can frazzle nerves.

With Sokup’s help, the family located a secondhand washing machine. Sokup--whom the family calls “Auntie,” a term of endearment in Hawaii--tipped off Garrett about a possible job. She has coaxed the couple to hold the baby more often instead of putting him in the crib with a propped-up baby bottle. Yvette has followed Sokup’s advice to enroll Joshua, the precocious toddler, in preschool.

Sokup does not do the legwork for the couple, however. A goal of all home visitors is nurturing a family’s sense of independence, pride and confidence.

“We are there to share with the family, not to tell them what to do,” said Cristina Nealon, a home visitor in Oahu.

Home visitors recognize that being a parent does not come instinctively to everyone.

“Some need support in parenting because their parenting skills are pretty poor,” Pratt said. “With others, we can teach them how to cope with stress so they don’t feel so oppressed by it. Basically, the grandmother who lived two blocks away used to provide what a home visitor provides.”

But home visitation is not without criticism. Even though families voluntarily accept the services of a home visitor, there will be a stigma attached to asking for help with parenting, some warn. Others fear that the programs will dictate what parents must do and what values to instill in children.

“People are going to say: ‘The government is going to teach you how to be a parent?’ ” said Andrea Camp, an aide to Rep. Patricia Schroeder (D-Colo.). “We’re in favor of home visitation. But I fear that, in a political arena, where things are simplified, this idea can be misinterpreted and seen as politically explosive. I think it might be shot down.”

The heavy burden on the home visitors is another criticism of the concept. Some family service organizations wonder if visitors will be safe in certain neighborhoods.

“It’s scary to some people,” said Lorraine Lima of the Bienvenidos Children’s Center Family Services Division in East Los Angeles, where home visitation is offered. “They wonder how their workers will be treated in the home.”

Governments might also hesitate to divert precious social services funds into prevention programs, where the benefits may not become apparent for a decade or longer.

Although the method employs a decidedly soft touch, it is the hard numbers that have impressed child advocates nationwide.

A New York program for teen-age mothers modeled after the Hawaii concept recorded a 4% rate of abuse or neglect among mothers who received visitation, while a Sacramento visitation program recorded a 1% abuse rate among its high-risk mothers--both similar to Hawaii’s statistics and far below the 20% national rate for high-risk families.

Officials for Healthy Families America, which was launched last year with funding from Ronald McDonald’s Children’s Charities, say 46 states have expressed interest in the program and 22 of those have set up demonstration sites. Legislatures in Iowa, Minnesota and Utah have passed bills to provide a steady source of funds for the projects. Similar proposals are pending in Texas, Maine, Massachusetts and Illinois.

“We are realizing now that we will never stem the tide of child abuse until we intervene at the earliest point in a child’s life,” said Deanne Tilton, a member of the U.S. Advisory Board on Child Abuse and Neglect, which called for widespread implementation of home visitation in a 1991 report. “If we wait for the official child protective system to get involved, it’s too late.”

One-third of confirmed cases of child abuse fail to receive any type of rehabilitative service, such as court-ordered counseling, visits from a social worker or placement of the child in foster care, studies find. Children who have been abused are at much greater risk for school problems, medical problems, juvenile delinquency and criminal behavior in adulthood.

The cost merely to investigate and provide short-term treatment for a single case of abuse is $2,000, according to the National Center on Child Abuse and Neglect. A significant number of abused or neglected children end up in foster care at a yearly cost of $4 billion to the nation.

“The roots of many of our social problems are in very, very bad childhood situations,” said Hawaii’s Breakey. “We have to start thinking about early childhood.”

Although prevention of child abuse clearly saves money, home visitation also costs money--lots of it. Programs vary, but a fairly intense visitation program costs about $2,000 per family per year--considered costly for a prevention program. And, statistically, four out of five of those high-risk families would not abuse or neglect their children anyway.

In order to justify the costs, advocates are shifting away from the notion of home visitation as solely a child-abuse prevention tactic. In Hawaii, programs receiving state funding must also immunize children, discuss family planning options and enroll a significant percentage of their families in prenatal home visitation programs to reduce the incidence of low-birth-weight and drug-exposed infants.

The expansion of services has also worked well, perhaps in part because Hawaii has a universal health care plan. Hawaii’s home visitation programs achieved a 98% immunization rate among 2-year-olds last year, far above the national average of 50%.

“This is not just ‘how many bruises have we prevented?’ ” said Smith, of Healthy Families California. “We have to look at what else we can do with home visitation. We have to look at enhancing the child’s health, optimizing child development and strengthening families. What we are finding, more and more, is that if we want to protect the child, we have to strengthen the family.”