Early Childhood Home Visiting Programs And Health

Home visiting programs support new and expectant parents, promote good maternal and child health, home safety, food security, and positive parenting.

What's the Issue?

The transition to parenthood is a time of celebration as well as potential stress and worry—particularly for parents with low income and limited education, single or teenage parents, and families facing other types of adversity. It is during this period that children are most vulnerable. Six out of 1,000 babies in the United States die before their first birthday, with unintentional injuries as a leading cause. In 2017, one in four children younger than age six visited a hospital emergency department, often because of an accident or injury. Many infants are at risk before they are even born: 6 percent of women delivering in the United States report having no or delayed prenatal care, and 8 percent report using tobacco while pregnant.

This brief focuses on early childhood home visiting programs, which are explicitly designed to improve maternal and child health. With roots dating back to the late nineteenth century, when private charities sent “friendly visitors” to provide guidance and model healthy behaviors to the urban poor, home visiting programs have evolved and expanded in recent decades in the United States. With a strong and growing evidence base, home visiting programs have the advantage of intervening very early in child development to support healthy family functioning and positive parenting.

What's Next?

Several important questions regarding home visiting remain. First, funding aside, services cannot be scaled up without a pipeline of qualified workers. How can institutions of higher education play a role in preparing the future workforce? Multiple programs employ nurse home visitors or licensed clinicians with master’s degrees who demand higher salaries. Emerging evidence of staff turnover because of low compensation, poor benefits, and lack of career advancement opportunities is concerning and warrants further attention.

Second, with so many models, there is a need to identify the "active ingredients" of effective models, to know why home visiting is effective and for whom. The evidence on this issue is sparse. Ongoing research in this area will shed light on this question and help identify program strengths.

Third, the field needs to learn more about universal programs. For example, what are the benefits of targeting all newborns in a high-needs community to move the needle on population-level outcomes (and to remove the stigma of social service program participation) versus targeting high-needs pregnant women and parents in a broader community? What approaches work best in which types of communities? Given the challenge some programs report with participant recruitment, how does screening for income or other eligibility criteria at enrollment affect participant enrollment and retention? Is there greater political will to support universal or targeted programs?

Lastly, several states are beginning to explore ways of integrating early childhood data systems to connect home visiting data with other child services and outcomes. These exciting efforts will give states the capacity to track impacts past service end dates, using state administrative data, and to better coordinate services across programs and state agencies. Building states’ data and research capacity is a prominent area for future investment, as richer and more precise evidence is needed to inform funding decisions and quality improvement initiatives.