Are community mothers the new para-professionals?

Various kinds of home visiting support programs for parents of exist across the world, principally for those struggling to cope with disadvantage.

In economically developed countries most are provided by professionals, who are regarded as having the status and training to fit them for the task. In developing countries where budgets are tighter they are more likely to be provided person-to-person within local communities or by community-based organizations relying on donor funding.

Where non-professional parent support is provided in developed countries, the spiraling costs of professional support are likely to figure prominently among the motivating factors.

But there is also an argument that goes beyond economics: community mother programs are based on reasoning that more experienced parents are in a unique position to provide skilled support. There is also a psychological hypothesis: that parents are more likely to be empowered to help themselves if support is provided by people who share and so are genuinely in tune with their circumstances.

The first community mothers program was started in Dublin in the mid-1980s, following development in six centres in the UK and Ireland of a professional (health visitor/public health nurse) program pioneered by Bristol’s Early Childhood Development Centre [1] (ECDC). The Dublin initiative is by far the biggest and has been a powerful trend setter. [See: Ireland's community mothers take the pressure off family life [2]]

The Bristol center subsequently set up a number of other community-based programs in the UK and abroad. Most in the UK have not survived or struggle to exist as limited endeavors. In Ireland small but successful ventures remain in Kerry and in Derry; in both cases the coordinators and trainers are community mothers who run the local programs with the support of their local health boards.

Farther afield, the biggest program is Moeders Informeren Moeders [3] (Mothers Informing Mothers), which was also based on the original ECDC proposals. This has now spread across the Netherlands and is managed largely by the mothers themselves, with the support of Dutch health and social services.

A smaller venture is operating in Perth, Western Australia, where, after initial training from the ECDC, community child health nurses manage and train community mothers. The Perth model is similar to Dublin’s.

Some challenges have yet to be resolved regarding the future of the various models.

The most important is the extent to which experienced community mothers should be promoted as managers and trainers, given that they are not qualified professionals. This factor may be vital to the concept of empowering not only the visited parents, but also community mothers themselves. The fact that the Dublin and Perth programs are maintaining numbers and achieving highly positive results raises questions as to whether non-professionals can or should routinely be trained to the level of managers and trainers.

Two more fundamental questions: can programs managed by community mothers achieve the same or better results as those managed by professionals, and, if so, in modern society is it right that only those with professional qualifications are entitled to power or status within personal service occupations?

• David Olds and colleagues (2004, "Effects of home visits by para-professionals and by nurses", Paediatrics, 114, pp1560-1568) argue, on the basis of three randomized trials, that professional nurses are superior to para-professionals in delivering his parent support program. The Olds model is not strictly comparable with community mother programs, but there are questions about whether the very strong health focus of the Olds program makes it a health education initiative rather than a genuine parent empowerment initiative.