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Early childhood home visiting programs

Health Factors: Family & Social Support Community Safety
Decision Makers: Local Government State Government Grantmakers Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

In early childhood home visiting programs trained personnel regularly visit at-risk expectant parents and families with young children and provide them with information, support, and/or training regarding child health, development, and care based on families’ needs. Home visitors can be nurses, social workers, parent educators, paraprofessionals, lay workers from within the community, or others. Home visiting often begins prenatally and continues during the child’s first two years of life, but may also begin after birth, last only a few months, or extend until kindergarten (HRSA-MIECHV 2017, Sama-Miller 2017).

Expected Beneficial Outcomes

Reduced child maltreatment
Reduced child injury
Improved cognitive skills
Improved social emotional skills
Improved parenting
Improved birth outcomes
Improved maternal health
Improved economic security
Improved prenatal care
Reduced hospital utilization
Reduced rapid repeat pregnancies
Increased use of contraception
Reduced intimate partner violence

Evidence of Effectiveness

There is strong evidence that early childhood home visiting programs prevent child maltreatment (Sama-Miller 2017, Casillas 2016, Selph 2013, Peacock 2013, Sweet 2004, MacLeod 2000, CG-Violence) and injury (Cochrane-Kendrick 2013, Roberts 1996), and improve children’s cognitive and socio-emotional development (Sama-Miller 2017, MDRC-Michalopoulos 2017, Peacock 2013, Goyal 2013, Sweet 2004). Early childhood home visiting programs have also been shown to improve birth outcomes (Sama-Miller 2017, Peacock 2013, Issel 2011), maternal health (Sama-Miller 2017), parenting behaviors and attitudes (Sama-Miller 2017, Goyal 2013, Kendrick 2000, Sweet 2004), and increase family economic self-sufficiency (Sama-Miller 2017, MDRC-Michalopoulos 2017). Effects are often sustained until children reach age 7 (MDRC-Michalopoulos 2017).

Home visiting programs have been shown to reduce maternal postpartum depression in the US (Sama-Miller 2017) and internationally (Cochrane-Dennis 2013). Home visiting begun prenatally may increase use of prenatal care (Sama-Miller 2017, Issel 2011), improve infant health, increase vaccination (Sama-Miller 2017, El Fadl 2016, Peacock 2013, CG-Violence), and reduce infant visits to the emergency room (RAND-Kilburn 2017). Some home visiting programs for preterm babies appear to improve physical growth and reduce hospitalization (Goyal 2013). Visits begun postnatally may improve infant health and increase exclusive breastfeeding, particularly with frequent visits; however, they may not reduce child mortality or improve maternal health (Cochrane-Yonemoto 2017).

Programs for teenage mothers may reduce rapid repeat pregnancies (Cochrane-Lopez 2015, Maravilla 2016), and increase use of contraception (Cochrane-Lopez 2015). Home visiting programs for mothers who have been abused appear to reduce intimate partner violence (Prosman 2015, Sharps 2016). An evaluation of the Family Spirit program suggests home visiting can improve child development, school readiness, maternal health, and parenting practices among American Indian families (Mraz Esposito 2017). Home visiting programs may not be successful, and may even be harmful, when participants abuse drugs or alcohol (Cochrane-Turnbull 2012).

Longer term and more intense interventions, supervision of home visitors, and fidelity monitoring appear to increase positive effects on child maltreatment (Casillas 2016, Selph 2013, CG-Violence) and cognitive outcomes (Sweet 2004). Programs delivered by licensed professionals appear to have stronger effects on children’s cognitive outcomes than programs delivered by paraprofessionals or non-professionals. However, research regarding home visiting and child maltreatment does not consistently indicate that one type of provider delivers the most effective interventions. Additional evidence is needed to confirm the most effective method of implementation for any particular outcome of interest (Casillas 2016, Selph 2013, Sweet 2004, CG-Violence).

Home visiting interventions are cost-effective in the long term, benefiting disadvantaged families and increasing economic sufficiency and stability (MDRC-Michalopoulos 2017).

Implementation

United States

The federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), administered by the Health Resources and Services Administration provides states, territories and tribal communities with funding to implement early childhood home visiting models that have been approved through the US Department of Health and Human Services’ (DHHS) Home Visiting Evidence of Effectiveness (HomVEE) review (HRSA-Home visiting). In fiscal year 2016, 893 counties received grants from the MIECHV program; about a half of grantee counties were rural (HRSA-MIECHV 2017).

As of August 2017, 20 home visiting models that meet DHHS criteria for evidence-based program models (Sama-Miller 2017), for example, Healthy Families America (HFA), Nurse-Family Partnership (NFP), Parents as Teachers (PAT-Home visiting), and Early Head Start-Home Visiting (EHS-Home based).

Wisconsin

The Wisconsin Family Foundations Comprehensive Home Visiting Program supports home visiting programs for at-risk pregnant women and parents of children from birth to age five (WI DCF-FFHV, WI DHS-FFHV). As of 2017, 18 rural counties and 9 non-rural counties in Wisconsin provide early childhood home visiting programs funded by federal grants from Maternal, Infant, and Early Childhood Home Visiting Program (HRSA-HV state).

Implementation Resources

DC HealthCheck - District of Columbia's HealthCheck Training & Resource Center. Home visiting toolkit. Accessed on February 23, 2018
HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting. Accessed on February 22, 2018
US DHHS ACF-Tribal HV - US Department of Health & Human Services (US DHHS), Administration for Children & Families (ACF). Tribal home visiting (HV). Accessed on February 22, 2018
US DHHS-Home visiting - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Home visiting. Accessed on February 23, 2018
US DHHS-HomVEE - US Department of Health and Human Services (US DHHS). Home Visiting Evidence of Effectiveness (HomVEE). Accessed on February 23, 2018

Citations - Description

HRSA-MIECHV 2017 - Health Resources and Services Administration (HRSA). The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Partnering with parents to help children succeed. MIECHV program national program brief 2017. Accessed on February 23, 2018
Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017. Accessed on February 23, 2018

Citations - Evidence

Casillas 2016* - Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse and Neglect. 2016;53:64-80. Accessed on February 22, 2018
CG-Violence - The Guide to Community Preventive Services (The Community Guide). Violence. Accessed on February 23, 2018
Cochrane-Dennis 2013* - Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2013;(2):CD001134. Accessed on February 22, 2018
Cochrane-Kendrick 2013* - Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database of Systematic Reviews. 2013;(3):CD006020. Accessed on February 23, 2018
Cochrane-Lopez 2015* - Lopez LM, Grey TW, Hiller JE, Chen M. Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews. 2015;(7):CD001863. Accessed on February 23, 2018
Cochrane-Turnbull 2012* - Turnbull C, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews. 2012;(1):CD004456. Accessed on February 23, 2018
Cochrane-Yonemoto 2017* - Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Cochrane Database of Systematic Reviews. 2017;(7):CD009326. Accessed on February 22, 2018
El Fadl 2016 - El Fadl RA, Blair M, Hassounah S. Integrating maternal and children’s oral health promotion into nursing and midwifery practice - A systematic review. PLOS ONE. 2016;11(11):e0166760. Accessed on February 22, 2018
Goyal 2013* - Goyal NK, Teeters A, Ammerman RT. Home visiting and outcomes of preterm infants: A systematic review. Pediatrics. 2013;132(3):502-516. Accessed on February 22, 2018
Issel 2011 - Issel LM, Forrestal SG, Slaughter J, Wiencrot A, Arden H. A review of prenatal home-visiting effectiveness for improving birth outcomes. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011;40(2):157-65. Accessed on February 23, 2018
Kendrick 2000* - Kendrick D, Elkan R, Hewitt M, et al. Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. Archives of Disease in Childhood. 2000;82(6):443-51. Accessed on February 23, 2018
MacLeod 2000* - MacLeod J, Nelson G. Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse & Neglect. 2000;24(9):1127-49. Accessed on February 23, 2018
Maravilla 2016* - Maravilla JC, Betts KS, Abajobir AA, Couto e Cruz C, Alati R. The role of community health workers in preventing adolescent repeat pregnancies and births. Journal of Adolescent Health. 2016;59(4):378-390. Accessed on February 22, 2018
MDRC-Michalopoulos 2017 - Michalopoulos C, Faucetta K, Warren A, Mitchell R. Evidence on the long-term effects of home visiting programs: Laying the groundwork for long-term follow-up in the Mother and Infant Home Visiting Program Evaluation (MIHOPE). Washington, DC: Manpower Demonstration Research Corporation (MDRC). 2017. Accessed on February 22, 2018
Mraz Esposito 2017 - Mraz Esposito A, Coughlin R, Malick S, et al. Assessing the research on home visiting program models implemented in tribal communities - Part 1: Evidence of effectiveness. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017. Accessed on February 23, 2018
Peacock 2013 - Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health. 2013;13:17. Accessed on February 23, 2018
Prosman 2015* - Prosman GJ, Lo Fo Wong SH, van der Wouden JC, Lagro-Janssen ALM. Effectiveness of home visiting in reducing partner violence for families experiencing abuse: A systematic review. Family Practice. 2015;32(3):247-256. Accessed on February 22, 2018
RAND-Kilburn 2017* - Kilburn MR, Cannon JS. Home visiting and use of infant health care: A randomized clinical trial. Pediatrics. 2017;139(1):e20161274. Accessed on February 22, 2018
Roberts 1996 - Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomised controlled trials. BMJ. 1996;312(7022):29-33. Accessed on February 23, 2018
Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017. Accessed on February 23, 2018
Selph 2013 - Selph SS, Bougatsos C, Blazina I, Nelson HD. Behavioral interventions and counseling to prevent child abuse and neglect: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine. 2013;158(3):179–90. Accessed on February 23, 2018
Sharps 2016* - Sharps PW, Bullock LF, Campbell JC, et al. Domestic violence enhanced perinatal home visits: The DOVE randomized clinical trial. Journal of Women’s Health. 2016;25(11):1129-1138. Accessed on February 22, 2018
Sweet 2004* - Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development. 2004;75(5):1435-56. Accessed on February 23, 2018

Citations - Implementation

EHS-Home based - Early Head Start National Resource Center (EHS). Home-based option. Accessed on February 22, 2018
HFA - Healthy Families America (HFA). Great childhoods begin at home. Accessed on February 23, 2018
HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting. Accessed on February 22, 2018
HRSA-HV state - Health Resources and Services Administration (HRSA). Home visiting program: State fact sheets. Accessed on February 22, 2018
HRSA-MIECHV 2017 - Health Resources and Services Administration (HRSA). The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Partnering with parents to help children succeed. MIECHV program national program brief 2017. Accessed on February 23, 2018
NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed. Accessed on February 23, 2018
PAT-Home visiting - Parents as Teachers (PAT). Universal access home visiting. Accessed on February 23, 2018
Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017. Accessed on February 23, 2018
WI DCF-FFHV - Wisconsin Department of Children & Families (WI DCF). Family Foundations Home Visiting Program (FFHV). Accessed on February 22, 2018
WI DHS-FFHV - Wisconsin Department of Health Services (WI DHS). Family Foundations Home Visiting Program (FFHV). Accessed on February 22, 2018

Page Last Updated

February 14, 2018

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