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Journal Issue: Home Visiting Volume 3 Number 3 Winter 1993

Home Visits: Necessary but Not Sufficient
Heather B. Weiss

Pertinent Lessons from the Distant Past

America's first relatively large-scale experience with home visiting occurred in the late nineteenth century when private charity organizations dispatched friendly visitors to the homes of the urban poor to transform their character and behavior, and thereby to attack the growth of urban poverty, class antagonism, and social disintegration. In the 1890s, more than 4,000 volunteer middle- and upper-class women were regularly visiting poor families in the tenements of major cities to provide guidance and to serve as models of how to live right.15 These visits took place in a country undergoing urbanization and industrialization, but one without a public welfare, public health, or unemployment insurance system to buffer the effects of poverty. Examining the rationale and evolution of friendly visiting in this earlier period points up several enduring strengths and problems with home visit strategies for helping poor families.

As historian Paul Boyer has noted, the charity organization movement of the 1880s and 1890s that spawned the friendly visitors rested on a series of interconnected assumptions.15 Specifically, the cause of increasingly threatening urban poverty lay in the character flaws of the poor, and the solution lay in correcting them. To do so required the commitment and coordination of charitable organizations—"scientific charity"—and the provision of an appropriate treatment—home visitors—to provide moral and behavioral guidance so that the poor would change their ways. The architect of the charity organization concept, S. Humphrey Gurteen, described the responsibility of these volunteer friendly visitors this way: "The 'chief need of the poor today,' he asserted, was 'not almsgiving, but the moral support of true friendship—the possession of a real friend, whose education, experience, and influence, whose general knowledge of life, or special knowledge of domestic economy are placed at the service of those who have neither the intelligence, the tact, nor the opportunity to exact the maximum of good from their slender resources."16

Because the charity organizations at the outset believed that poverty was the result of individual failings and character flaws correctable by a home visitor's friendship, no economic assistance (material relief, access to employment, and the like) or other services (access to health care or jobs with livable wages) were deemed necessary. There is a long history of setting up home visiting as a silver bullet—the panacea for poverty—and of subsequent disappointment, reconsideration, and revamping of the role home visits can play in ameliorating the effects of poverty.

In the 1890s the cycle of disappointment and reconsideration involved spirited discussion and criticism of the limits and ethical dilemmas still inherent in the home visitor's role. First, the visitor was to provide personal service, not material relief, although, because she had access to the home, she was to report on family circumstances to those responsible for dispensing aid. In a 1902 book, Democracy and Social Ethics, an indictment of the charity organization effort, settlement house leader Jane Addams argued that the visitor's dual responsibility for providing friendship and obtaining information for relief decisions compromised the poor because they had to appear to welcome the visitor and comply with her suggestions to get other aid.15 Another criticism was that the visitors invaded the privacy of the families and provided unsolicited advice. Finally, other contemporary critics, as well as later historians, questioned whether it was possible to provide meaningful friendship and interpersonal support from such an explicit posture of superiority on the friendly visitor's part.l5,17,18 Mary Richmond's widely used 1899 manual on home visiting, Friendly Visiting Among the Poor, tried to deal with this question by emphasizing a more positive attitude about the poor and by encouraging acknowledgment of their positive attitudes and behaviors. Social historian Michael Katz summarized these sometimes still-conflicting dimensions of the friendly visitor's role by noting that she was "to be at once a sympathetic friend, an official, a teacher, and a spy."16 Vigorous and healthy debates about coercion and ethical dilemmas inherent in the home visitor's complex role and relationships with families continue to this day19-22 and are now dealt with more explicitly in home visitor training.23,24

The revamping began to take place where the friendly visitors' high-button shoes hit the tenement floors. It is not hard to imagine the visitors, yesterday's front-line workers for the poor, confronting the reality of widowed or unemployed slum families and deciding that friendship and a good example were not enough. The visitors began to expand their roles beyond the limits envisioned by the theoreticians of charity organization. They began to act as mediators, brokers, and advocates. Helping families access services, find better housing and jobs, Katz argues, meant that friendly visitors became "experts on urban survival" and thus rare, accessible, and valuable sources of support for the poor.25 The friendly visitors revamped their role—that of linchpin, connecting the axle of the family to the wheel of existing community services—to add a dimension that remains critically important to their success.

There was also a fledgling effort to build home visiting into a broader and more comprehensive strategy to improve the lives of the poor. In response to growing criticism that friendly visitors failed to deal with the economic and environmental causes of poverty, some of the more progressive charity organization leaders argued that these visitors could extend their roles even further to include efforts at social reform and advocacy against such evils as child labor, sweat shops, and inadequate wages. At a national meeting of charity organizations around the turn of the century, one Chicago group described how the friendly visitors had moved beyond individual intervention to a broader community development approach in an immigrant ward by helping to establish a neighborhood employment committee, a savings bank, a women's workroom, and a cooperative vegetable garden.15

By the turn of the century it was clear that even the revamped conception of friendly visiting was an inadequate response to urban poverty. The serious depression of 1893 had overwhelmed the resources of private charity, underscored the need for public relief, and showed the economic and industrial causes of poverty and unemployment. The charity organizations had increasing difftculties attracting volunteers and began to depend on paid visitors. They had problems working with the newly arrived, non-English-speaking immigrants. Finally, they were challenged by the somewhat broader vision of the causes and cures for poverty posed by the growing settlement house movement. As historian Paul Boyer argues, settlement leader Jane Addams "simply inverted a classic charity organization formulation: the moral defects of the poor were not the cause of their poverty... but a consequence of the 'struggle for existence, which is so much harsher among people near the edge of pauperism.'" This inversion shifted the next century's discussion of the causes of poverty from exclusive focus on the individual to environmental defects.26

Volunteer friendly visiting gave way to the settlement house movement and to the newly emerging profession of social work, with its rules of detachment and its emphasis on specialization and often office-based casework.18 As social work evolved in the twentieth century, the emphasis was on development of a profession distinguished by its special knowledge and its impersonal and objective stance to the client. Two noted authorities on social welfare and social work practice argued in 1965, for example, that social workers should not make friends with clients and that providing service in the office rather than the home helped to avoid problems of personal involvement.27 When home visiting did occur, it was conducted by specialists deployed from institutions such as schools, hospitals, or service agencies who were anxious to improve their effectiveness by changing the social and familial environments of their clients.18

Until the reappearance of home visiting as a major strategy to address the effects of poverty on disadvantaged children and families during the war on poverty in the 1960s, two important functions provided by the earlier friendly visitors were largely neglected in social service provision. The first was the emphasis on a personal and generalist helping relationship based on a less hierarchical, more holistic, and friendlier interaction between participant and professional. The second was the linchpin function of connecting families to services. The linchpin role has grown to be even more important given the twentieth-century growth in the number of services and the hurdles to access them.

Although home visiting never disappeared entirely, the war on poverty in the 1960s began another major round of home visiting programs designed to help disadvantaged children and families. As this article's next sections will argue, in this recent round of research and experience with home visits, we have rediscovered both the importance and the limits of friendly visiting. We have been through another cycle of high expectations and reconsideration and are now challenged to take what has been learned to position home visiting so that it can play a key role as part of a comprehensive strategy to help disadvantaged families create a better life for themselves and their children.