A Brief Overview of the Home-Visiting Field

Nurse-Family Partnership Program

Field of Work: Home-visiting programs aimed at helping families and young children.

Synopsis of the Work: In 1979, the Robert Wood Johnson Foundation supported a demonstration project in Elmira, N.Y., that used registered nurses to take preventive health services into the homes of young, low-income pregnant women and first-time mothers. Randomized controlled trials conducted in Elmira and subsequently Memphis, Tenn., and Denver showed the home visits yielded positive health and developmental outcomes for children and mothers.

In the Spring/Summer 1999 issue of the journal the Future of Children published by the David and Lucile Packard Foundation, the editors estimated that the number of home-visiting programs had grown into the thousands. According to the journal, as many as 550,000 children participated in major visiting programs, including the one developed by David Olds.

Story Told: Much of this growth occurred in the 1990s and was in part due to the availability of funding from the federal government and private foundations. In their article ("Home Visiting: Recent Program Evaluations—Analysis and Recommendations"), the journal editors cited two other factors:

  • New research showing the important impact that the earliest years have on development.
  • The positive results that Olds reported from his Elmira demonstration. In essence, the success of the Elmira trial promoted the use of visitation programs generally.

The Spring/Summer 1999 issue of the Future of Children examined the results of studies assessing six major home-visiting programs. The six were among only a few such programs that had been evaluated through rigorous randomized trials, according to the journal editors.

The journal singled out the Olds program as the only one of the six that had demonstrated marked benefits in maternal life course. Also, it was the only one that showed benefits in changing children's behavior, and the editors said it produced "the clearest evidence for the potential of home visiting to prevent child abuse and neglect."

Still, the editors said the evidence suggests "that no home-visiting model produces impressive or consistent benefits in child development or child health." They added that perhaps that is not surprising given the difficulty of changing behavior, especially in the context of broad community-wide problems associated with entrenched poverty.