Babies are born eager to learn. Children grow, develop, and learn at a tremendous rate during their early years, and families play a critical role in helping their children prepare for success in school and in life (Sroufe, Coffino, & Carlson 2010). Families across the country are participating in home visiting (also known as family support) programs just like Jason’s family. This article will describe home visiting programs and how they fit into the communities they serve.

What is the purpose of home visiting programs?

Home visiting programs provide family-focused interventions for pregnant women, infants, toddlers, and preschoolers in the family’s home. The aim of these programs is to enhance parents’ capacity to head their households and support their children’s development while keeping them safe (HRSA 2018). Home visiting services have been supporting families facing challenges for more than 100 years (Weiss 1993). Currently, more than two million children and their families in the United States receive home visiting services (Lanier, Maguire-Jack, & Welch 2015).

Activities during visits are designed to promote children’s healthy growth and development by showing parents how to help their children learn. Home visitors also facilitate parental health and self-sufficiency by connecting families to community resources (Pew Charitable Trusts 2015). Home visiting programs embrace a family-centered, culturally responsive philosophy built on research showing that loving, responsive, parent–child interactions occurring in the context of daily routines provide optimal learning opportunities (Shonkoff 2017).

Young children are learning all the time, and babies’ interactions with their primary caregivers (generally parents but also grandparents, other family members, and fictive kin) influence attachment, emotional regulation, communication, physical development, and ability to engage in learning (Sroufe, Coffino, & Carlson 2010). Positive parent–child relationships form the foundation for children’s future relationships and affect children’s emotional well-being, coping skills, and problem-solving abilities (Lerner et al. 2002; Zeman et al. 2006). Supporting families, especially those who are facing challenges due to poverty, disabilities, or compromised health, can enhance children’s development dramatically.

The benefits of home visiting programs

Home visitors collaborate with families to facilitate healthy and enjoyable parent–child interactions. Home visitors help families identify goals, explore ways to reach those goals, and address any issues they face along the way (HRSA 2018). Let’s return to Tamika’s visit.

Tamika supports Jennifer’s engagement with Jason by drawing on—and sharing—her knowledge of child development to facilitate positive parent–child interactions (McCollum & Yates 1994; Hughes & Peterson 2008). Importantly, Tamika also recognizes and builds on Jennifer’s competence, offering suggestions that enhance Jennifer’s ability to promote Jason’s development.

Home visiting programs have facilitated an array of positive child and parent outcomes across families with diverse characteristics, in various communities, and across different areas of development and parenting (Sweet & Appelbaum 2004; Avellar & Supplee 2013). Programs have increased family self-sufficiency, reduced health care costs for children and families, and reduced the need for remedial education services (Pew Charitable Trusts 2015). Let’s look at a few examples: Early Head Start, the Nurse Family Partnership, and Healthy Families America.

In Early Head Start’s home-based option, home visitors support parents during weekly sessions, much like Tamika supports Jennifer. In addition, children, families, and visitors come together for monthly group sessions. Children participating in home-based Early Head Start programs showed stronger vocabulary development at age 2 and better engagement with their parents during play at age 3 when compared with community peers not enrolled in the program. In addition, parents provided more stimulating home environments and reported less parenting stress and greater involvement in education and training activities than their community peers (ACF 2006). Positive impacts of Early Head Start’s home visiting program persisted; at kindergarten entry, children were more likely to display positive approaches to learning, less likely to exhibit behavior problems, and more likely to have attended a formal preschool setting (2006).

In the Nurse Family Partnership model, registered nurses provide intensive prenatal and postnatal home visitation to first-time mothers with low incomes (Olds 2006). The program’s main goals are to improve (1) women’s prenatal and pregnancy outcomes; (2) children’s health and development through increased parental caregiving skills and sensitivity; and (3) parents’ abilities to meet their goals by helping parents plan future pregnancies, meet their education goals (such as earning a high school diploma or college degree), and find sustainable employment (2006). The Nurse Family Partnership has improved mothers’ abilities to provide responsive and competent care for their children while increasing the amount of time between pregnancies (Miller 2015). As compared with community peers, participants have reduced rates of intimate partner violence and decreased reliance on government assistance programs (e.g., Supplemental Nutrition Assistance Program, Medicaid, and Temporary Assistance for Needy Families [2015]). In addition, participants’ children have improved early language development, fewer childhood injuries, and reduced rates of maltreatment, youth crime, and substance abuse (2015).

The Healthy Families America model seeks to improve parenting skills, reduce child maltreatment, support children’s social and emotional health, and promote school readiness (Daro & Harding 1999). While this program has a core set of service options and quality standards, it emphasizes flexibility. The services offered are determined by families’ and communities’ unique needs (1999). Healthy Families America participants, as compared to nonparticipant community peers with similar characteristics, have decreased rates of low-birth-weight babies, reductions in child maltreatment, increased positive parenting behaviors, improved birth outcomes, improved child development, and reduced child behavior problems at age 2 (Caldera et al. 2007; Avellar & Supplee 2013).

To learn more about home visiting programs and their evidence of effectiveness, visit http://homvee.acf.hhs.gov. The key takeaway is that when they are carefully designed and well implemented, home visiting programs greatly improve parent–child interactions, resulting in a cascade of long-term benefits.

Home visiting programs: The community context

To address families’ diverse needs, it is best for home visiting programs to collaborate with other programs serving families, including child care, school-based preschools, and social service and health programs (HRSA 2018). Jennifer and Jason, for example, participate in a home visiting program and receive services from the Women, Infant, and Children supplemental nutrition program. Jennifer also attends the local community college—she enrolled soon after Tamika shared information with her about the college’s low-cost child care for students. Let’s meet two more families to explore additional opportunities for programs to coordinate.

Home visiting programs offer distinct services; they differ from center-based programs by delivering services and supports in the family’s home, enabling participation by families who might otherwise have difficulty accessing resources. Additional benefits include opportunities to facilitate and coach parenting and life skills in the home environment, build supportive relationships among the provider and family members, and tailor services to meet each family’s specific needs, provided by the one-to-one interaction unique to the home visiting model (Gomby 2005).

High-quality home visiting programs individualize services, strengthen families, and connect them with a variety of community resources. Developing and implementing a new home visiting program requires extensive planning—especially to ensure that the program is well integrated with existing services for families and is meeting local needs. Program model developers use a variety of data to identify community strengths, needs, and service gaps to maximize available resources. Ongoing analysis of both program components and system-level implementation is critical to sustaining high-quality home visiting programs. See “Key Components of High-Quality Home Visiting Programs” for the most critical details, including community support, well-trained staff members, and ongoing evaluation (Johnson 2009).

Conclusion

The inherent flexibility of home-based programs makes them ideally suited to address each family’s individual needs in the context of their most comfortable setting. But fewer than 20 percent of families living below the federal poverty line are being served (Lanier, McGuire-Jack, & Welch 2015). Advocacy for universal home visiting programs has been growing over the past two decades (Pew Charitable Trusts 2015) as evidence of effectiveness continues to build (Sama-Miller et al. 2017). Truly supporting all families, however, will require communities to develop a preventive system of care that expands access to evidence-based programs and provides a diverse array of programs. Such a system may be the only way to optimize the strengths and address the specific needs of each family. An increase in both public and professional awareness of the service options in a community allows for the creation of a continuum of early childhood services that can connect families to home visiting programs (Johnson 2009) and to related services. The goal of all home visiting programs is to build a partnership with each family and tailor services to the family’s unique needs to enhance child health and development and increase family self-sufficiency. Home visiting programs are an investment in the future of each child and family, encouraging nurturing relationships and enriching experiences that allow each family to flourish.

Key Components of High-Quality Home Visiting Programs

• A community that understands the program and supports its development
• Program staff that are well trained and supported through high-quality supervision
• Strong administrative support
• Ongoing evaluation of program implementation so that quality issues can be addressed in a timely manner
• An environment in which the need for the program is clearly understood and local services are coordinated across programs and providers to maximize use of resources
• A spirit of collaboration with other early childhood programs
• Strong local leadership to nurture the development of the services

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