Home Visiting Evidence of Effectiveness

The promotion of child development and school readiness is an important goal for some of the home visiting models in the HomVEE review. Models address this goal by engaging parents in activities designed to improve child functioning across developmental areas, educating parents about child development and strategies to enhance school readiness (such as literacy activities), and promoting positive parent-child interactions. Some also link families to center-based early childhood care and education experiences.

Due to the significant influence of child health on other developmental outcomes, some of the home visiting models in the HomVEE review address the promotion of child health in some way. Program models that begin during a mother’s pregnancy aim to improve birth outcomes by linking mothers to prenatal health care and providing them with information about fetal development. Following the birth of the child, programs ensure that children have access to health care, receive appropriate well-child care and immunizations, and receive appropriate medical care for illnesses and injuries. Some programs also provide information to parents about ways to support physical health, such as the importance of nutritious meals and physical activity.

Some home visiting models in the HomVEE review have a goal of improving the self-sufficiency of participating families. To achieve this goal, models facilitate parents’ engagement in educational and training programs, and encourage their pursuit of employment. Some program models also help families access family support services such as temporary cash assistance and supplemental food programs. Home visitors accomplish these tasks by providing information about services in the community and linking families to self-sufficiency programs. Some may directly provide educational and training services (such as GED classes).

Coordination with and referrals to other community resources and supports is a possible outcome of some of the home visiting models, even if such coordination and referrals are not an explicit model goal. For example, program staff may directly refer participating families to places in their community where they can receive additional financial, in-kind, medical, or social support services. If programs do not provide direct referral, frequent exposure to home visiting staff may have the indirect result of educating or motivating participating families to seek these services on their own.

Improving maternal health is a goal of some home visiting models in the HomVEE review. To achieve this goal, models provide mothers with health information and guidance during pregnancy and after the child’s birth. Some also link mothers to prenatal and postpartum health care providers. In addition, some models link mothers to treatment facilities for mental health and substance issues, or may directly provide preventive mental health intervention or other services that promote their psychological well-being.

Most home visiting models included in the HomVEE review are designed to promote positive parenting practices. Parenting education is often provided, either through didactic or experiential approaches. Some models use a structured curriculum to provide these services; others take a more flexible approach by addressing specific parenting needs identified during home visits. To a lesser extent, home visiting program models integrate parenting interventions that have been found to improve specific parenting behaviors (for example, responsive interactions and positive behavioral support). In addition, home visitors may provide information to parents about child development or safety practices in the home.

Because young children are more likely than older children to be maltreated, the goal of some of the home visiting models in the HomVEE review is to prevent or reduce the incidence of child abuse and neglect. To achieve this goal, home visitors typically work with parents to improve knowledge, skills, and behaviors that are associated with maltreatment. For example, they may educate parents on how to interact with their children in a more responsive manner, teach them alternative ways to discipline their children, or provide strategies for meeting their children’s developmental needs. They may also attempt to decrease the numbers of stressors that may make families vulnerable to inappropriate parenting. For example, home visitors may work to enhance children’s functioning by improving child health and development or connect families with community resources (such as mental health and substance abuse services).

Most home visiting models included in the HomVEE review do not have an explicit goal of reducing juvenile delinquency, family violence, and crime. Some, however, seek to reduce risky parental behaviors in ways that are similar to those of program models that explicitly target these goals. For example, some models try to address parental mental health, self-efficacy, and self-sufficiency either directly or through linkages with other service providers. Provision of these services may affect families’ long-term well-being and reduce the likelihood of adult criminal behavior and family violence. Many home visiting models provide parenting education and parent-child interaction activities, which may improve parents’ capacity to manage their children’s behaviors and set children on a trajectory in which they are less likely to engage in later risky behaviors such as juvenile delinquency.