State Child Welfare Policy Guide

1.2 Home visiting programs

By helping families with young children get off to the right start, home visiting programs have far-reaching benefits for positive child development, increased parenting capacity, and reduced child abuse and neglect.  Documented impacts include reductions in the frequency and severity of child maltreatment; enhanced parent-child interaction, parenting capacity, and parental functioning; improved access to preventive medical care; enhanced child development; and early identification of developmental delays. [i]   Investment in home visiting programs has been shown to reduce costs due to foster care placements, hospitalizations and emergency room visits, unintended pregnancies, and other more expensive interventions. [ii]  

A study of prevention and early intervention programs by the Washington State Institute for Public Policy found that some forms of home visiting programs that target high-risk and/or low-income mothers and children are also cost-effective, with a return on investment ranging from $6,000 to $17,200 per child. [iii]   Of all prevention and early intervention programs studied, the Nurse-Family Partnership, which features visits by a trained nurse from pregnancy through the child’s first two years, produced the greatest cost savings.  Controlled, randomized trials among low-income, racially diverse mothers demonstrated positive outcomes and cost benefits. [iv]

Home visitation programs offer a variety of voluntary services to pregnant mothers and to families with new babies and young children. Structured or informal visits in the family’s home focus on topics such as:

• Positive parenting practices and effective discipline techniques,

• Child development,

• Maternal and child health,

• Prevention of accidental childhood injuries through the development of safe home environments,

• Establishment of social supports and networks,

• Availability and accessibility of social services and other assistance, and

• Advocacy to help the parent, child, and family obtain the assistance they need. [v]

Six national home visitation models that have been evaluated include: the Nurse-Family Partnership, Healthy Families America, Parents as Teachers, Parent-Child Home Program, Home Instruction for Parents of Preschool Youngsters (HIPPY), and Early Head Start. [vi]   Depending on the program model, visits may be provided by nurses, other professional service providers, paraprofessionals or trained volunteers.  As programs have expanded and matured, they have found that training and professional development, supervision, and content development are critical to achieving positive outcomes for families.

Of 42 states responding to a 2001 survey regarding home visiting activities that was sponsored by the Commonwealth Fund, 37 states reported state-based programs, and three more states provided state-level assistance to help local visiting programs. [vii]  

Policy Options:   States can authorize and fund home visiting services using 1, 2, or 3 of the following standards of eligibility:

• Home visiting services with evidence-based components are available from pregnancy until the child is at least two years of age.

• Home visiting services with evidence-based components are available statewide to all low-income mothers.