Stories from the States

Based on interviews with representatives from four national home visitation organizations, this issue brief describes their challenges to sustain, evaluate and replicate programs that support pregnant women and families with young children.

Home visiting programs that support pregnant women and families with young children have proliferated in recent decades. Several program models have established national offices that support the expansion of their program in new states. As the number of establishments has grown, they have also instituted state-based systems which deal with collective concerns such as funding, advocacy and quality assurance within their particular state's circumstances. This study looks at the experience of developing state-based home-visiting systems. We conducted interviews with state and national representatives from four of the large national home visiting models: Healthy Families America, the Nurse-Family Partnership, Parents as Teachers, and the Home Instruction Program for Preschool Youngsters. The characteristics of state-based home visiting systems vary from one state to another and from one home-visiting program to another, depending on the way they were implemented, the state's particular administrative structure and political climate, and the home-visiting program's traits, among others. Despite differences in their initial implementation and context, state-based home visiting systems confront similar challenges with respect to sustainability: they have to secure funding that supports services and system functions without compromising quality or the model's design; they have to be able to demonstrate the efficacy of their model and its implementation; and they need to ensure that new programs are able to reproduce the model with quality, embracing those characteristics that have made programs successful in the past.

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