Revisiting Home Visitation: The Promise and Limitations of Home-Visiting Programs

Limitations of Home-Visiting Programs T use of home visitors to deliver services designed to improve the well-being of children and their families has drawn the increasing interest of policymakers, including President Barack Obama, who last year proposed a federal investment of more than $8 billion over the next 10 years in programs that use home visitation as a method of service delivery. Meanwhile, debate continues over the effects that homevisiting programs have on parenting behaviors, parent-child relationships, child health, cognitive development, child abuse and neglect, and other important domains. In almost every domain, studies document positive outcomes in some programs but not in others. In many cases, reported effects are restricted to certain subgroups of families, meaning that those do not occur for the entire population of families who were served. While the reported results are clearly mixed, the picture is not that simple. Comparing the results of home-visiting programs is complicated by differences in program goals, populations served, models used, the skill and training of staff, the degree to which individual programs adhere to the theoretical model on which they are based, and other factors. Researchers have made considerable progress in understanding home-visiting programs in the past two decades. Although questions remain, the body of evidence suggests home-visiting programs can provide parents and children with important benefits, such as improvements in parenting practices, home environment, and, to some extent, children’s cognitive development. Whether they actually do produce these benefits depends on several characteristics, including whether home visitation is more effective when joined with additional support programs as part of an integrated, system-level approach toward improving the well-being of at-risk children and families. Home Visitation Home visitation is a method of service delivery used to reach at-risk children and families with a wide range of supports. In the United States, it is estimated that home-visiting programs serve between 400,000 and 500,000 children, about 5 percent of the estimated 10.2 million American children under the age of 6 years who are living in low-income families. Several programs, national in scope, that use home visitation as a means of delivering services have been developed over the past three decades, including the Nurse-Family Partnership, Healthy Start, Healthy Families America, the Comprehensive Child Development Program, Early Head Start, and the Infant Health and Development Program. The general goals of programs that use home visitation include providing parents with information, emotional support, access to other services, and direct instruction on parenting practices. Although many programs share these goals and the same general method of service delivery, there are many variations among them.