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Without these services, in a residual and targeted system with severely limited
public programs, that professional couple may have been eligible for no service beyond
sporadic visits to their paediatrician. The Spanish-speaking single mother may have
struggled to understand the confusing information provided by a unilingual anglophone
nurse or physician; not comprehending the health and social service systems, she may
have withdrawn from services and experienced additional hardship and isolation. The
teenage couple may have qualified for, and benefited from, targeted public health
nursing; however, if they were concerned about the possible stigma or risk associated
with a targeted public-sector program, they may not have accepted that service. In that
case, they may have struggled, alone, with the challenges of new parenthood and
longstanding family problems, leaving two young parents and their vulnerable infant in
a conflictual, low-income, and chronically high-stress environment.
As research on the Community Mothers Programme has shown, a very high
percentage of families in a community can be included in this universal-plus approach,
even those families with considerable barriers and challenges. This is something with
which even our most prized universal programs, such as public education, struggle. In
the residual and targeted systems in which these home visiting programs operate, it is a
very rare accomplishment indeed.
8.4.3 How Might ‘Volunteer-Only’ Programs Manage Without Paid Visitors?
This study is not a comparison of different types of home visiting programs, and
questions of how volunteer home visiting programs meet families’ more complex needs
are beyond its scope. However, on this topic there are two points that are useful to
raise, in the context of the present study:
1. Availability of other services to serve families with more complex needs
In their 2004 international review of evaluations of 14 volunteer home visiting
programs, Black & Kemp (2004) reported that families whose needs were too complex
for the participating volunteer visiting programs were referred to local professional
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