Child Abuse Prevention:
A Perspective on Parent Enhancement Programs from the United States
Marianne JamesSenior Research Officer
Australian Institute of Criminology
CONTENTS
- Introduction
- Consequences of Child Abuse
-
Juvenile delinquency
Problems in school
Psychiatric illness and related problems
- Responses to Child Abuse
- Evaluation and Experience Indicate that Prevention Works
- University of Colorado Study
- Family Support Center in Yeadon, Pennsylvania
- Elmira Prenatal Early Infancy Project
- Hawaii's Healthy Start
- Webster Avenue Family Resource Center (New York)
- Birth to Three (Oregon)
- Family Support Program (California)
- Studies of Costs and Benefits
- Conclusion
- References
- Prevention Programs in the United States of America
Child abuse and neglect are worldwide problems. Over the last twenty years there has been an increasing level of concern with, and a corresponding degree of research into, the causes and correlates of child abuse and neglect. Historically, the United States has been the leader in all aspects of this research, including extensive incidence and prevalence studies. This has resulted in a greater emphasis on preventative measures with appropriate programs being put into place at an empirical level. As many similar intervention and prevention programs are now being practised in Australia, it is important to understand the context as well as the content of both programs and evaluations in the United States, so that Australian policy and procedures can benefit. This paper will therefore provide a background to child abuse and neglect in the United States and examine one perspective on child abuse preventative strategies - parent enhancement programs.
In the United States, child abuse and neglect is defined as the physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child by a person who is responsible for the child's welfare, under circumstances which indicate that the child's health or welfare is harmed or threatened (The Child Abuse Prevention and Treatment Act, P.L. 100-294, 25 April 1988). Each year, there are officially more than 800,000 substantiated cases of child abuse and neglect. About 160,000 of these children suffer life-threatening injuries or long-term impairment, and an estimated 1,100 to 5,000 - most of them under 1-year-old - die annually from the abuse they receive (United States General Accounting Office 1992, p. 10). Incidence and prevalence studies have, however, varied in their findings over the years. For example:
- A study published in 1962 (Kempe et al. 1962 cited in US General Accounting Office 1992, p. 10) identified and discussed the 'battered child syndrome' and estimated that, on the basis of surveys of hospitals and district attorneys across the country, the number of cases of serious abuse nationwide was perhaps in the hundreds.
- In the 1970s, it was estimated that about 60,000 children per year received serious injuries as a result of abuse (American Association for Protecting Children 1986 cited in US General Accounting Office 1992, p. 10).
- The American Humane Association documented that reports of child abuse nationwide totalled about 669,000 in 1976 and increased more than 300 per cent to 2,086,000 by 1986. This represented an increase from about 10 children per 1,000 reported in 1976 to about 33 children per 1,000 in 1986 (American Association for Protecting Children 1986 cited in US General Accounting Office 1992, p. 10).
- A study by the National Center on Child Abuse and Neglect (1988 cited in US General Accounting Office 1992, p. 11) sponsored by the Department of Health and Human Services estimated that the number of cases of child abuse stood at 625,100 in 1980 and rose to slightly more than 1 million in 1986 - an increase of 37 per cent. This study also found that the percentage of these cases that were substantiated or investigated further by social and health care professionals also increased, from 43 per cent in 1980 to 53 per cent in 1986.
- The National Committee for Prevention of Child Abuse (1992 cited in US General Accounting Office 1992, p. 11) estimated that in 1991 there were over 2.6 million cases of child abuse and neglect.
While reports of child abuse in the United States have more than tripled in the last 15 years, it is not clear how much of the increase reflects an actual rise in the number of abuse cases and how much represents increased reporting. The authors of the Health and Human Services sponsored study (National Centre on Child Abuse and Neglect 1988 cited in US General Accounting Office 1992, p. 11) suggested that the increase they reported was probably due more to a greater recognition of abuse than to an increase in its actual occurrence. This same study acknowledged, however, that reported cases are only the tip of the iceberg because many cases are never brought to the attention of the authorities.
Juvenile delinquency has been closely associated with abuse. A study comparing young males who had been abused or neglected as children and those who were from homes described by the authors as 'loving' found that 20 per cent of those from abusive or neglectful homes had been convicted of serious crimes, compared with 11 per cent of those from loving homes (McCord 1983, cited in US General Accounting Office 1992, p. 12). Data from another study involving 297 families showed the percentage of adolescents who had spent time in prison was about twice as high among those who had been abused as among those in a comparison group (Herrenkohl et al. 1991, cited in US General Accounting Office 1992, p. 12). A 10-year study of 411 boys found that by the time they had reached 18 years of age, 27 had been convicted of violent offences. Of these violent delinquents, 62 per cent had been exposed to harsh parental discipline compared with 7 per cent of the non-delinquent boys in the study (Farrington 1978 cited in US General Accounting Office 1992, p.13).
Problems with academic performance and social adjustment at school are also associated with abuse. A study of 8,600 public schoolchildren found the academic achievement of maltreated children was significantly lower than that of a similar group of children who had not been maltreated. The effects observed across all grade-levels included lower test scores and grades, as well as the increased likelihood of disciplinary problems and a higher rate of suspensions (Eckenrode et al. 1990 cited in US General Accounting Office 1992, p. 13).
Psychiatric illness and related problems
Studies also link abuse to high rates of psychosis, depression, developmental delays, violence and social aggression, and deficient social skills. For example, one study of abused children found that 40.6 per cent exhibited self-destructive behaviour (such as biting, burning, head banging and suicide attempts), compared with 6.7 per cent of the control group (Green 1978 cited in US General Accounting Office 1992, p. 13).
In the United States, efforts to address abuse have been described as
a continuum of care. At one end of the continuum are activities to prevent
abuse before the first incident occurs. Treatment for abused children
and their families constitutes the next portion of the continuum. These
efforts are typically the responsibility of local protective service agencies.
The agencies work with children and families to solve their problems and,
if possible, preserve the family unit. The remaining services on the continuum
are those involved with removing children from dangerous abusive environments
and placing them in foster care or adoptive homes.
Prevention programs, the first part of this continuum, include primary
and secondary efforts. Primary prevention programs are aimed at the population
in general. These include programs available to all schoolchildren and
campaigns to raise public awareness using radio or television messages.
Secondary prevention programs are directed at specific populations identified
as being at increased risk of becoming abusive. As is the case in Australia,
prevention programs are important, not only because they aim at averting
- rather than treating - the human suffering caused by abuse but also
because they reduce the need for other types of programs which specifically
address the long-term consequences of abuse.
In 1974, the US Child Abuse Prevention and Treatment Act established the
National Center for Child Abuse and Neglect as a federal focal point for
prevention and treatment efforts. Emphasis was placed on abuse prevention
programs and, accordingly, programs which attempted to reduce parental
stresses caused by risk factors such as low self esteem and poor parenting
skills were put into place. It was also envisaged that these populations
would benefit, through increased parental employment and healthier children.
Child abuse prevention programs in the United States therefore became
closely related to other types of prevention and family support programs,
such as public health nurse visitor and peer support activities. The shared
goal of all these programs is to strengthen and improve the general family
environment rather than solving individual specific problems. By assisting
with elimination of factors such as social isolation and financial difficulties,
family or individual well-being is promoted.
In the United States, program evaluations along with nearly two decades of program experience indicate that prevention programs can be effective. Rigorous evaluations measuring the impact of programs on child abuse and neglect using control or comparison groups have been rare, but findings from those that have been undertaken have been positive. The more common evaluations of the programs' short-term effects - such as client satisfaction, parenting skills, and incidence of reported child abuse - have also shown positive results. Taken together with evidence provided by other studies and reports, the indications are that the parent enhancement programs can prevent abuse (United States General Accounting Office 1992, p.15).
Few studies have evaluated abuse prevention services from a cost benefit perspective. The evidence from the studies carried out suggests, however, that abuse prevention programs can save money by reducing future costs associated with abuse. Because prevention programs often link parents with health and social services, they can improve child and parent well-being in other less direct ways, such as by helping to increase the employability of low-income families or guiding them to obtain needed health services.
In 1992, the General Accounting Office examined several prevention programs in various parts of the United States. They focused on prevention activities that take place before the first instance of abuse. The General Accounting Office specifically intended to gain a clearer picture of how federal programs provide incentives for - or impediments to - effective intervention. The objectives were to determine:
- the extent to which child abuse prevention strategies have been evaluated and shown to be effective;
- whether obstacles exist that inhibit program implementation and operation and, if so, are there alternative approaches that could overcome these obstacles;
- the types of programs that provide families with services to prevent abuse before it occurs and the extent to which these programs are coordinated at the federal and state levels.
In 1971, a team of researchers at the University of Colorado began a study, using groups of 150 new mothers, to predict which parents were at risk of becoming abusive and to determine how to prevent the abuse. The team published a report in 1979 discussing the feasibility of predicting the potential for child abuse and other abnormal parenting practices (Gray 1979 cited in US General Accounting Office 1992, p.á18). The team found that prevention services provided to parents who were at risk of becoming abusive could significantly improve the infants' chances of avoiding serious physical injury requiring hospitalisation.
Family Support Center in Yeadon, Pennsylvania
This evaluation - published in 1981 - studied 46 families and their 74
pre-school age children in Yeadon, Pennsylvania, participating in a program
to reduce child abuse (Armstrong 1981 cited in US General Accounting Office
1992, p.19). The families selected were considered at risk of abuse based
on a stress index developed by the program. Services were provided on
a voluntary basis. Families received a combination of services that began
with weekly nurse or social work home visits - continuing for an average
of 10 months. After the first 3 months of home visits, families joined
a family education and activity group, which met at a community church
twice a week for 14 weeks. At the conclusion of this activity, parents
joined peer support groups, which met once a month in parents' homes.
During the 10 months of the program, there were only four incidents of
abuse or neglect. Using a comparison group of at-risk parents from a previous
study, the program reported that this represented a reduction in the abuse
rate from an expected 18 per cent to about 5 per cent.
Elmira Prenatal/Early Infancy Project
This research project at the University of Rochester (Olds 1992 cited
in US General Accounting Office 1992, p. 25) is one of two recent studies
providing particularly strong empirical evidence that child abuse prevention
works. This project, which was completed in the early 1980s, evaluated
a program of prenatal and postnatal visits by nurses to rural homes in
the vicinity of Elmira, New York. The project reported that families who
received home visiting had an abuse rate 50 per cent lower than those
who did not receive the services. Among the high-risk group of low income
sole parent families headed by teenage women, who received home-visiting
services until their children were 2-years old, the abuse rate was 4 per
cent compared to a rate of 19 per cent for a similar high risk group who
did not receive the home-visiting services.
The program is designed to begin during pregnancy and continue until the
child is 2-years-old. The home visits centre on three major activities:
providing parent education, enhancing social support by family and friends,
and linking the family with other health and human services. In addition
to reducing child abuse, the project reported improvements in the lives
of the poor sole parent families headed by women who received home visits.
These included almost doubling the number of months they were employed
and a 40 per cent reduction in subsequent pregnancies within 4 years after
the birth of the first child.
The researchers report that such programs have the greatest chance of being effective, if they:
- are based on a model that addresses the interaction of a variety of factors (for example social, economic, psychological) that influence maternal and child behaviour;
- are designed to intervene during pregnancy and early child-bearing years with nurse home visitors who visit often and develop a supportive relationship with the families; and
- target families at greater risk for problems due to poverty and lack
of personal and social resources.
Healthy Start accepts pregnant women and mothers with children
up to the age of 3 months. Clients are identified primarily through an
early identification process conducted in the hospital at the time of
birth. Clients may also be identified prenatally through referrals from
physicians and public health agencies (US General Accounting Office 1992,
p. 50). It began in 1985 as a 3-year demonstration project in one area
of the main island of Hawaii in response to growing numbers of reports
of child abuse. In 1988, Healthy Start received approval as a state program
and expanded its services to other locations. About 55áper cent of the
families in Hawaii with a newborn baby were screened in 1992 and it is
expected that this figure will rise to 90 per cent by 1995.
Services covered by Healthy Start are voluntary and continue until children
are 5-years-old. The frequency of the home visits range from weekly to
quarterly, depending on the clients' assessed level of need. Services
include counselling and assistance in obtaining needed resources - such
as housing, financial assistance, medical aid, nutrition, respite care,
employment and transportation. In addition, lay home visitors promote
positive child development by focusing on parent-child bonding to assure
social and emotional growth in the infant and early childhood stages.
Webster Avenue Family Resource Center (New York)
The Webster Family Resource Center in New York, provides a variety of
programs, including parent education and support, social events, child
care, and counselling (US General Accounting Office 1992, p. 21). The
programs are aimed at improving parenting skills and reducing risk factors,
such as isolation and low self-esteem, which are often associated with
child abuse. Webster Avenue Center periodically evaluates its programs
and staff from the perspective of its clients and has collected and analysed
parent feedback since 1988.
The responses indicate a very positive client view of program results.
For example, 84 per cent of the clients stated that the programs helped
them to better understand their child a lot or quite a bit, 88 per cent
said the programs helped them feel a lot or quite a bit better about themselves
as parents, and 97 per cent said they made new friends (United States
General Accounting Office 1992, p. 22).
Birth To Three (Oregon)
Birth to Three is a centre-based parent support program in Eugene, Oregon,
that has been in operation since 1978 and is open to the public. Under
an evaluation requirement imposed by the state, which helps fund the program,
a random list of 100 participants per quarter is submitted to the state's
Child Protective Services (CPS) office and compared to the names on reports
of abuse (US General Accounting Office 1992, p. 22). The program director
said that, of the most recent 600 names submitted, only 1 had been reported
to CPS for child abuse an incidence rate less than one-tenth the estimated
average national reporting rate, according to the 1988 national incidence
study published by the Health and Human Services Department (National
Center on Child Abuse and Neglect cited in United States General Accounting
Office 1992, p. 10).
Family Support Program (California)
The Family Support Program in Sacramento, California, provides volunteer
mentors and parenting education to families at risk of abuse. Mentors
make weekly home visits to provide parenting and nutrition suggestions,
respite care, and transportation. They also teach parents about the development
and growth of their children. Most participating families volunteer to
receive services and, according to the program director, 80 per cent have
incomes below the poverty level. Fewer than 10 per cent of all program
participants have later been reported for abuse, and fewer than 1 per
cent of those who receive a mentor remain in the high-risk category (United
States General Accounting Office 1992, p. 22).
The General Accounting Office (1992) identified four studies that suggest
that although prevention can be costly, it can pay for itself in the long
run.
The most thorough analysis the General Accounting Office found of the
immediate and long-term monetary effects of not preventing abuse was carried
out by Daro (1988 cited in US General Accounting Office 1992, p. 24).
This study examined research on a variety of outcomes of abuse, such as
juvenile delinquency and the need for special medical services and educational
programs. Using conservative estimates of abuse and treatment prevalence
rates from several studies, it calculated the potential dollar costs resulting
from abuse. For example, assuming a 20 per cent delinquency rate among
adolescent victims, the study estimated that it would cost over US$14.8
million if these youths required an average of 2 years in a correctional
institution. It estimated that if 1 per cent of severely abused children
suffered permanent disabilities, the annual cost of community services
for treating developmentally disabled children would increase by US$1.1
million. Finally, it estimated that the cost in future lost productivity
of severly abused children is US$658 million to US$1.3 billion annually,
even if their impairments limited their potential earnings by just 5 to
10 per cent.
The cost of not preventing abuse may be best demonstrated using a specific program. For example, program projections for Hawaii's Healthy Start indicate that in 1993 the cost to provide the full 5 years of service to a family would be about US$7,800. However, this cost may be justified in cost-benefit terms because of the cost of child abuse which includes, but may not be limited to, the costs of the immediate consequences of child abuse, such as hospitalisation and foster care. The cost of hospitalising an abused child for 1 week ranges from US$3,000 to US$15,000 while providing foster care for 1 year costs more than US$6,000 (US General Accounting Office 1992, p. 24). Adding the costs of the potential long-term consequences of abuse could raise this amount substantially. For example, the Hawaii program estimates the cost of incarcerating a juvenile for 1 year at about US$30,000, the cost of providing foster care to an abused child to age 18 at US$123,000, and the cost of institutionalising a brain-damaged child for life at US$720,000 (United States General Accounting Office 1992, p.24).
In addition to the benefit of reducing the direct cost of abuse, the
program delivers other benefits. Potential savings resulting from improved
family health and improved education and employment opportunities for
the parents - goals of the program that can benefit not only those who
would have become abusive, but the other participants as well - increase
the likelihood that the total savings can offset total costs (General
Accounting Office 1992, p. 24).
The Michigan Children's Trust Fund recently compared the costs of preventing child abuse with the costs resulting from maltreatment (US General Accounting Office 1992, p. 25). The analysis estimated the annual cost of a child abuse prevention program that starts prenatally to educate and support parents, and works intensively with them during the first year of their child's life. It noted that this kind of program not only reduces abuse, but can also help children come into the world healthier, creating additional cost savings by reducing the number of low birthweight babies. The analysis estimated the annual costs to address the results of maltreatment, which included the costs associated with medical treatment for injuries sustained by abused children, special education, foster care, adult and juvenile criminality, adult psychological problems and lost productivity. The study showed that the costs associated with dealing with the results of child abuse is nearly 20 times the cost of the education and home visitor programs.
Another recent cost study also suggests that prevention can pay for itself. A 1990 report on the Elmira Prenatal/Early Infancy Project (Olds et al. 1992 cited in US General Accounting Office 1992, p. 25) - discussed earlier - suggests that program costs can be offset in a relatively short time. The study concluded that by supporting children from low-income families the program's cost could be offset within four years. It also suggested that frequent home visiting by nurses during pregnancy and the first 2 years of the child's life can significantly reduce many health and social problems - including child abuse - commonly associated with childbearing among adolescent, unmarried, and low-income parents.
The more significant question for future evaluations is not so much whether prevention works, but rather which approach is most effective for a certain population, under a given set of circumstances. Experts agree that there is no single cause of child abuse. Therefore, there can be no single program model or strategy that will work for everybody. Factors that increase an individual's vulnerability to abuse, both as individuals and perpetrators, can differ considerably among different populations. As a result, evaluations need to address program effectiveness under constantly changing social and economic conditions, as well as the effectiveness of successful models that are implemented in different locations. To the extent possible, this research should be longitudinal - so that the long term program effects can be measured - and should use control comparison groups - so that program benefits can be measured (United States General Accounting Office 1992, pp. 43-4).
Measurements of the cost benefits of preventing child abuse is another area of evaluation that needs emphasis. Prevention can be costly, though the limited analysis and research conducted do suggest that such programs can pay for themselves in reducing the need for a wide range of services, including special education, law enforcement and health care. Rigorous evalu-ations are necessary to provide evidence that prevention programs reduce child abuse and save money by eliminating some of the social costs associated with troubled families. More social research is needed. It is important to keep in mind, however, that cost savings should not be the only criterion for measuring program worth. Policy makers also need to consider the human benefits of preventing child abuse and neglect. Programs that provide such benefits can be worthwhile public investments (US General Accounting Office 1992, p. 44).
Note: All the references in this paper are as cited in United States General Accounting Office 1992:
American Association for Protecting Children 1986, Highlights of Official Child Abuse and Neglect Reporting, American Humane Association (in conjunction with the National Center on Child Abuse and Neglect), Denver, Colorado.
Armstrong, K.A. 1981, A Treatment and Education Program for Parents and
Children Who Are at Risk of Abuse and Neglect, Child Abuse and Neglect,
vol. 5, pp. 167-75.
Daro, D. 1988, Confronting Child Abuse: Research for Effective Program
Design, The Free Press, Macmillan Inc., New York.
Eckenrode, J., Laird, M. & Doris, J. 1990, Maltreatment and the Academic and Social Adjustment of School Children, Cornell University, Ithaca, New York.
Farrington, D.P. 1978, 'The family background of aggressive youths',
in Aggression and Anti-Social Behaviour in Childhood and Adolescence,
eds L.A. Hersov & M. Berger, Pergamon Press, New York.
Garberino, J. 1990, 'Child abuse: Why?' The World and I, June.
Green, A.H. 1978, 'Self destructive behavior in battered children', American
Journal of Psychiatry, May.
Gray, J. et al. 1979, 'Prediction and prevention of child abuse and neglect',
Journal of Social Issues, vol. 35, no. 2, pp. 127-39.
Herrenkohl, R. et al. 1991, The Relationship Between Early Childhood Abuse
and Neglect and Adolescent Deviance, Centre for Social Research, Lehigh
University, Bethlehem, PA.
Kempe et al. 1962, 'The battered child syndrome', Journal of the American
Medical Association, vol. 181, no. 1, July.
McCord, J. 1983, 'A 40-year perspective on effects of child abuse and
neglect', Child Abuse and Neglect, vol. 7, pp. 265-70.
National Center on Child Abuse and Neglect 1988, Study Findings, Study
of National Incidence and Prevalence of Child Abuse and Neglect, Department
of Health and Human Services, Washington DC.
National Center for Prevention of Child Abuse 1992, Current Trends in
Child Abuse Reporting and Fatalities: The Results of the 1991 Annual Fifty
State Survey, Chicago, Illinois.
Olds, D. 1992, What Do We Know About Home-Visitation as a Means of Preventing
Child Abuse and Neglect? Department of Pediatrics, University of Rochester
School of Medicine and Dentistry, Rochester, New York.
Strauss, M.A. 1978, Family Patterns and Child Abuse in a Nationally Representative
American Sample, University of New Hampshire, Durham, NH, Child Abuse
and Neglect Second International Congress, London September 12-15.
Acknowledgment
This paper has been adapted from the United States General Accounting
Office report, Child Abuse Prevention Programs Need Greater Emphasis,
with permission. This publication is held in the Library of the National
Child Protection Clearing House.
Birth to Three
3411-1 Willamette
Eugene, Oregon. 97405
Brehon Institute of Human Services, Inc
425 East Call Street
Tallahassee, Florida. 32301
Early Parenting Project
San Francisco General Hospital
Department of Pediatrics
1001 Potrero Avenue, Room 6D-40
San Francisco, California. 94110
Families First
Michigan Dept of Social Service
Office of Child and Family Services
235 South Grand Avenue
Lansing, Michigan. 48909
Family Enhancement Program
Illinois Department of Children
and Family Services
406 East Monroe
Springfield, Illinois. 62701
Family Service Agency
1757 Waller Street
San Francisco, California. 94117
Family Support Program
3701 Branch Center Road
Suite 115
Sacramento, California. 95827
First Steps Program
Washington Department of Social and Health Services
Division of Children and Family Services
Olympia, Washington. 98504
Foster Grandparent Program
Woodhull Medical and Mental Health Center
760 Broadway
Brooklyn, New York. 11206
Harborview Medical Center
325 Ninth Avenue, Room 635
Seattle, Washington. 98104
Healthy Start
Hawaii Department of Health
Family Health Services Division
Maternal and Child Health Branch
741-A Sunset Avenue, Room 204
Honolulu, Hawaii. 96816
Healthy Start
Florida Department of Health and Rehabilitative Services
1317 Winewood Boulevard
Tallahassee, Florida. 32399
Hephzibah Children's Association
946 North Boulevard
Oak Park, Illinois. 60301
Insights - Teen Parent Program
1811 Northeast 39th Avenue
Portland, Oregon. 97212
Medina Children's Services
123 16th Avenue
PO Box 22638
Seattle, Washington. 98122
Memphis New Mothers Study
Shelby County Health Department
814 Jefferson Avenue
Memphis, Tennessee. 38105
Mini O'Beirne Crisis Nursery
423 North Seventh Street
Springfield, Illinois. 62702
North Lawndale Family Support Initiative
c/- National Committee for Prevention of Child Abuse
322 South Michigan Avenue
Suite 1600
Chicago, Illinois. 60604
Parent Place
600 Broadway
Longview, Washington. 98632
Parent Aide Program
Children's Hospital and Medical Center
4800 Sand Point Way Northeast
PO Box C5371
Seattle, Washington. 98105
Parent to Parent
2990 Experiment Station Drive
Hood River, Oregon. 97031
Parents Too Soon
Illinois Department of Children and Family Services
406 East Monroe
Springfield, Illinois. 62701
Parents Anonymous
PO Box 4295
Tallahassee, Florida. 32315
Parents Anonymous
1305 4th Avenue
Suite 310, Cobb Building
Seattle, Washington. 98101
Parent Outreach Program
4800 Northeast 74th
Portland, Oregon. 97218
Passage House
c/- New York State Department of Social Services
40 North Pearl Street, 11th Floor
Albany, New York. 12243
Program for Early Parent Support (PEPS)
4649 Sunnyside Avenue North
Room 346
Seattle, Washington. 98103
Project Safety Net
Florida Department of Health and Rehabilitative Services
1317 Winewood Boulevard
Tallahassee, Florida. 32399
The Ounce of Prevention Fund of Florida
123 North Monroe Street
Tallahassee, Florida. 32301
The Parent and Child Place
2211 Wabash Avenue
Springfield, Illinois. 62704
Washington Heights - Inwood Coalition, Inc
652 West 187th Street
New York, New York. 10033
Webster Avenue Family Resource Center
283 Webster Avenue
Rochester, New York. 14609
Well Family Project
PO Box 1067
Okanogan, Washington. 98840
(Source: US General Accounting Office 1992)
Copyright, National Child Protection Clearing House, 1994
ISSN 1321-2540
ISBN 0 642 22241X
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