Home Visiting: The Expansion of an Idea
Investing in home-based services for pregnant women and new parents is a topic of high interest. Of the myriad ways to reach out to young children and their parents, home visiting has surfaced as a uniquely promising approach for promoting the early intervention mission.
These features include:
Reaching new parents in a nonstigmatizing manner: Outside of public education, prenatal and obstetric care are among the most broadly accessed services in the United States. Offering home visiting within a health care framework engages new parents without requiring them to be singled out as facing unique difficulties. Similarly, all parents share a common interest in preparing their children for later learning and insuring they are well positioned to nurture their child’s healthy development and early learning.
Minimizing barriers to accessing service: Accessing any intervention can be daunting, particularly for parents lacking experience and skills in navigating complex service delivery systems. Home visiting helps parents overcome barriers to service access and connects families with appropriate supports in a timely manner.
Individualizing the message: Home visiting providers tailor their messages to fit a parent’s specific knowledge, skills, cultural beliefs, and learning style. Personalizing services is particularly important given the racial, ethnic, and socioeconomic diversity of a state’s new parent population.
Opportunities to evaluate the home environment and engage other caregivers: Delivering services within a participant’s home offers a unique opportunity to determine the physical safety of a child’s most proximate environment. Repeated home visits allow for a more nuanced assessment of the home’s general stability, relationships among family members, and availability of informal and formal supports.
Since the early 1970s, home visiting programs have proliferated in the United States. They have been promoted as a strategy to engage parents in their young child’s early learning, to insure a new mother and her infant have access to a high-quality medical home, and to address parental and contextual challenges that place a young child at risk for child maltreatment or poor developmental outcomes. Changes to federal policy in 1989 allowed states to use Medicaid dollars to support early home visiting. Over the past 40 years, several states, such as Arkansas, Delaware, Florida, Hawaii, Kentucky, Minnesota, Missouri, Rhode Island, Vermont, and West Virginia, have used these funds, and state-generated resources, to expand home visiting programs they found promising or establish at least one new parent initiative to support a parent concerned about how she might best care for her children. Federal investments in home visiting also were available through the Child Abuse Prevention and Treatment Act (CAPTA). In the 2003 CAPTA reauthorization, voluntary home visiting was identified as one of the core Community-Based Child Abuse Prevention (CBCAP) program services included in Title II of the Act.
In 2010, Congress passed the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) as part of the Patient Protection and Affordable Care Act (ACA). The bill provided for a $1.5 billion public investment to assist states, territories, and tribal entities in replicating evidence-based, targeted home visiting programs and building a comprehensive early childhood system to promote the health and safety of pregnant women, children ages 0–8, and their families. This legislation, while dramatically increasing home visiting services across the country, benefited from the early replication work achieved by states, often working in partnership with one or more national home visiting models.
This video provides a visual of how home visiting has spread throughout the country as seen through the lens of five evidence-based home visiting models. These five include four of the oldest and most widely available models in the country (Healthy Families America, Home Instruction for Parents of Preschool Youngsters – HIPPY, Nurse Family Partnership, and Parents as Teachers) as well as one of the newer models gaining increased attention (SafeCare). The video does not represent all investments—either state or federal—in home visiting at any point in time. Rather, it illustrates the date at which each model’s current affiliate agencies began enrolling families. Collectively, the video illustrates how these five models have expanded over the years and how communities increasingly gained access to a greater array of home visiting options.
The continued expansion of home visiting and the ability to provide families with access to an array of strategies is essential if the approach is to achieve its goal of providing all parents the capacity they need to insure their child’s healthy development and safety.