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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 visit parents and children in their homes. Visitors provide parents with information, support, and/or training regarding child health, development, and care. Programs vary widely; visitors can be nurses, social workers, paraprofessionals, lay workers from within the community, or others. Programs often begin prenatally and continue during the child’s first two years of life, but may also begin after birth, last only a few months, or extend through entrance into formal schooling. 

Expected Beneficial Outcomes

Reduced child maltreatment
Reduced child injury
Improved cognitive skills
Improved social emotional skills
Improved parenting
Improved prenatal care
Improved birth outcomes
Reduced rapid repeat pregnancies
Increased use of contraception

Evidence of Effectiveness

There is strong evidence that early childhood home visiting programs prevent child abuse, maltreatment (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 (Peacock 2013, Sweet 2004). Such programs may also improve parenting behaviors and attitudes (Kendrick 2000, Sweet 2004). Home visiting begun prenatally may lead to increased use of prenatal care (Issel 2011), improved birth outcomes (Peacock 2013, Issel 2011), and infant health (Peacock 2013). Programs for teenage mothers may reduce rapid repeat pregnancies and increase use of contraception (Cochrane-Lopez 2015, Meade 2005). Home visiting programs may not be successful, and may even be harmful, when participants abuse drugs or alcohol (Cochrane-Turnbull 2012).

Home visiting programs vary substantially in implementation and target a variety of outcomes. Such programs can be delivered by licensed professionals (e.g., nurses or social workers), paraprofessionals, and non-professionals, and can start both before and after a child is born. Longer term and more intense interventions appear to have stronger effects on maltreatment (Selph 2013, CG-Violence) and cognitive outcomes than programs that are shorter or less intense (Sweet 2004). Positive effects appear to increase over time, even after visiting ends (MacLeod 2000).

Programs delivered by licensed professionals appear to have stronger effects on children’s cognitive outcomes than programs delivered by paraprofessionals (Selph 2013) or non-professionals (Sweet 2004). However, research regarding home visiting and maltreatment does not consistently indicate that one type of provider delivers the most effective interventions. A review with a wide focus on various home visiting outcomes indicates that paraprofessionals are more effective than professionals or non-professionals (Sweet 2004). Conversely, a Community Preventive Services Task Force review focused on violence prevention shows higher level providers yield the strongest effects, but paraprofessionals can be effective in programs lasting at least 24 months (CG-Violence).

Additional evidence is needed to confirm the most effective method of implementation for any particular outcome of interest. 

Implementation

United States

Home visiting programs have been around since the late 1970s and are implemented in at least 40 states. There are many different models available.

The Patient Protection and Affordable Care Act (ACA) provides funding for home visiting models that have been approved through the US Department of Health and Human Services’ (DHHS) Home Visiting Evidence of Effectiveness (HomVEE) program (OPRE-Avellar 2012). DHHS-approved models as of August 2013 include programs such as Healthy Families America (HFA), Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse-Family Partnership (NFP), Child First (CF), and Parents as Teachers (PAT-Home visiting). HomVEE’s review process is described here: (US DHHS-HomVEE Methods).

Implementation Resources

DC HealthCheck - District of Columbia's HealthCheck Training & Resource Center. Home visiting toolkit. Accessed on December 8, 2015
HRSA-Maternal and child health - Health Resources and Services Administration (HRSA). Maternal, infant, and early childhood home visiting program. Accessed on February 24, 2016
US DHHS-Home visiting - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Home visiting. Accessed on March 13, 2017
US DHHS-HomVEE - US Department of Health and Human Services (US DHHS). Home Visiting Evidence of Effectiveness (HomVEE). Accessed on September 28, 2017

Citations - Evidence

CG-Violence - The Guide to Community Preventive Services (The Community Guide). Violence. Accessed on December 19, 2016
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 December 10, 2015
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 April 27, 2017
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 December 14, 2015
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 24, 2016
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 March 1, 2016
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 March 2, 2016
Meade 2005* - Meade CS, Ickovics JR. Systematic review of sexual risk among pregnant and mothering teens in the USA: Pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Social Science & Medicine. 2005;60(4):661–78. Accessed on January 12, 2016
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 May 24, 2016
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 May 24, 2016
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 November 9, 2015
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 May 24, 2016

Citations - Implementation

CF - Child First. Strong families...healthy children. Accessed on December 8, 2015
HFA - Healthy Families America (HFA). Accessed on February 24, 2016
HIPPY - Home Instruction for Parents of Preschool Youngsters (HIPPY). Accessed on February 24, 2016
NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed. Accessed on September 28, 2017
OPRE-Avellar 2012 - Avellar S, Paulsell D, Sama-Miller E, Del Grosso P. Home Visiting Evidence of Effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), US Department of Health and Human Services (US DHHS); 2012. Accessed on March 2, 2017
PAT-Home visiting - Parents as Teachers (PAT). Federal home visiting program. Accessed on January 20, 2016
US DHHS-HomVEE Methods - US Department of Health and Human Services (US DHHS). Home visiting evidence of effectiveness (HomVEE) review process. Accessed on March 3, 2017

Page Last Updated

May 7, 2014

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