Early childhood home visiting is a type of family support targeted to expectant parents and parents of children birth to age 5. Trained home visitors provide services and support for parents and their children in their homes, where they may feel most comfortable. Parents who choose to participate in home visits may receive information on child development, health, and well-being, and on sources of support for parents themselves. Parents also learn about available services such as developmental screenings, and enrollment in any benefits they—or their children—may need.
States use a mix of federal, state, and foundation funding to support home visiting programs, and expenditures nationally may now exceed $1 billion. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is one federal effort that facilitates the implementation of evidence-based home visiting programs. In fiscal year 2015, MIECHV-supported home visiting programs served 165,500 parents and children in every U.S. state, the District of Columbia, five territories, and 25 tribal entities.
There has been a great deal of research, over many decades, examining the use of home visiting to reach vulnerable children and families. Based on this research, here are five things to know:
Research on early childhood models has demonstrated impacts for children and families across different outcome areas. There are many different home visiting models, serving children of different ages or targeting different outcomes (e.g., health, education, child abuse, employment, etc.). Some models target only one outcome while others try to improve a wide range of outcomes. Improving many outcomes versus one is not necessarily better or worse, in terms of effectiveness. Most evidence-based home visiting models (i.e., those with evidence of effectiveness) demonstrate favorable impacts on child development, school readiness, and positive, supportive parenting practices. Evidence-based home visiting models have shown positive long-term impacts on children in the long term, via increased school readiness, reduced child maltreatment, and reduced lifetime arrests and convictions. Evidence-based home visiting programs also show positive impacts for families, such as increased parental income and increased percentages of parents who live together.
Evidence-based home visiting programs use a wide range of recommended numbers of visits over different time spans. Models such as Family Connects and Family Check Up recommend three visits with a family. Other models, such as Healthy Families America and Nurse Family Partnership, begin seeing families in pregnancy or early infancy and may continue for multiple years. The frequency of visits may vary by the age of the child and the needs of the family. However, more research is needed on the optimal number and length of visits, generally.
Some home visiting models have a specific curriculum or specific measures they want home visitors to use with families. Some models specify staffing requirements, such as level of education or experience. Other models allow for flexibility in all or some of the program elements. Some implementing agencies (which may be nonprofits, hospitals, universities, county health departments, etc.) find it helpful to have everything packaged and ready to begin implementing, while others want more flexibility. However, there is currently little research on the extent to which giving implementing agencies the ability to be flexible and tailor their programs is related to greater impacts for families.
Dads have reported home visiting programs helped them with their parenting skills and ability to co-parent, and with information about services to help them find jobs and participate in job training. However, research has shown that it is not always easy to include dads. Staff who work in home visiting programs may not have training on the best ways to include fathers in home visits. Sometimes dads are seen as less involved because they may not be present at the visits. However, if dads see the benefits of participating to learn about child development and ways to be better parents, this way of serving families may be a great way to reach fathers.
Research suggests that in the process of choosing a home visiting model, there are benefits to assessing your community’s needs, goals, and available resources, and the fit of the evidence-based model you are considering. If the chosen model is not a good fit for a community, it may not achieve the outcomes desired, even if it has been effective in other settings. There is growing research examining model selection, the fit of a model to a community, and adaptations of models to meet unique program or community needs.