Summary

Pursuant to a congressional request, GAO reviewed home visiting, focusing on: (1) the nature and scope of home-visiting programs in the United States and Europe; (2) its effectiveness; (3) strategies critical to the design of programs that use home visiting; and (4) federal options in using home visiting.

GAO found that: (1) some programs using home visiting improved the health and well being of families and children; (2) home visiting reduced the need for more costly services, but minimal research has compared its cost-effectiveness to other early intervention strategies; (3) some programs using home visiting failed to meet their objectives, primarily due to fundamental program design and operation problems; (4) successful programs usually combined home visiting with center-based and other community services adapted to their target group's needs; (5) the Department of Health and Human Services (HHS) and the Department of Education support home visiting through both one-time demonstration projects and ongoing funding sources, but are not coordinating and focusing their efforts; (6) Congress focused its home-visiting interest on maternal and child health initiatives, and considered legislation amending Medicaid to explicitly service pregnant women and infants, but did not pass the proposed legislation; (7) the legislation would have caused additional Medicaid costs, ranging from $95 million for optional home-visiting services to $625 million for mandatory services from fiscal years 1990 through 1994; and (8) the federal government could strengthen program design and operation for home visiting by communicating the knowledge developed at the federal, state, and local levels.