Early childhood home visiting programs

In early childhood home visiting programs, trained personnel visit parents and children in their homes. Visitors provide parents with information, support, and/or training regarding child health, development, and care. Programs vary widely; visitors can be nurses, social workers, paraprofessionals, lay workers from within the community, or others. Programs often begin prenatally and continue during the child’s first two years of life, but may also begin after birth, last only a few months, or extend through entrance into formal schooling. 

Expected Beneficial Outcomes (Rated)

  • Reduced child maltreatment

  • Reduced child injury

  • Improved cognitive skills

  • Improved social emotional skills

Other Potential Beneficial Outcomes

  • Improved parenting

  • Improved prenatal care

  • Improved birth outcomes

  • Reduced rapid repeat pregnancies

  • Increased use of contraception

Evidence of Effectiveness

There is strong evidence that early childhood home visiting programs prevent child abuse, maltreatment (Selph 2013, Peacock 2013, , , CG-Violence) and injury (, Roberts 1996), and improve children’s cognitive and socio-emotional development (Peacock 2013, ). Such programs may also improve parenting behaviors and attitudes (, ). Home visiting begun prenatally may lead to increased use of prenatal care (Issel 2011), improved birth outcomes (Peacock 2013, Issel 2011), and infant health (Peacock 2013). Programs for teenage mothers may reduce rapid repeat pregnancies and increase use of contraception (, ). Home visiting programs may not be successful, and may even be harmful, when participants abuse drugs or alcohol ().

Home visiting programs vary substantially in implementation and target a variety of outcomes. Such programs can be delivered by licensed professionals (e.g., nurses or social workers), paraprofessionals, and non-professionals, and can start both before and after a child is born. Longer term and more intense interventions appear to have stronger effects on maltreatment (Selph 2013, CG-Violence) and cognitive outcomes than programs that are shorter or less intense (). Positive effects appear to increase over time, even after visiting ends ().

Programs delivered by licensed professionals appear to have stronger effects on children’s cognitive outcomes than programs delivered by paraprofessionals (Selph 2013) or non-professionals (). However, research regarding home visiting and maltreatment does not consistently indicate that one type of provider delivers the most effective interventions. A review with a wide focus on various home visiting outcomes indicates that paraprofessionals are more effective than professionals or non-professionals (). Conversely, a Community Preventive Services Task Force review focused on violence prevention shows higher level providers yield the strongest effects, but paraprofessionals can be effective in programs lasting at least 24 months (CG-Violence).

Additional evidence is needed to confirm the most effective method of implementation for any particular outcome of interest. 

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Home visiting programs have been around since the late 1970s and are implemented in at least 40 states. There are many different models available.

The Patient Protection and Affordable Care Act (ACA) provides funding for home visiting models that have been approved through the US Department of Health and Human Services’ (DHHS) Home Visiting Evidence of Effectiveness (HomVEE) program (OPRE-Avellar 2012). DHHS-approved models as of August 2013 include programs such as Healthy Families America (HFA), Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse-Family Partnership (NFP), Child First (CF), and Parents as Teachers (PAT-Home visiting). HomVEE’s review process is described here: (US DHHS-HomVEE Methods).

Implementation Resources

US DHHS-Home visiting - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Home visiting.

DC HealthCheck - District of Columbia's HealthCheck Training & Resource Center. Home visiting toolkit.

HRSA-Maternal and child health - Health Resources and Services Administration (HRSA). Maternal, infant, and early childhood home visiting program.

US DHHS-HomVEE - US Department of Health and Human Services (US DHHS). Home Visiting Evidence of Effectiveness (HomVEE).

Citations - Evidence

* Journal subscription may be required for access.

CG-Violence - The Guide to Community Preventive Services (The Community Guide). Violence.

Roberts 1996 - Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomised controlled trials. BMJ. 1996;312(7022):29-33.

Issel 2011 - Issel LM, Forrestal SG, Slaughter J, Wiencrot A, Arden H. A review of prenatal home-visiting effectiveness for improving birth outcomes. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011;40(2):157-65.

MacLeod 2000* - MacLeod J, Nelson G. Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse & Neglect. 2000;24(9):1127-49.

Sweet 2004* - Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development. 2004;75(5):1435-56.

Cochrane-Turnbull 2012* - Turnbull C, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews. 2012;(1):CD004456.

Kendrick 2000* - Kendrick D, Elkan R, Hewitt M, et al. Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. Archives of Disease in Childhood. 2000;82(6):443-51.

Cochrane-Kendrick 2013* - Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database of Systematic Reviews. 2013;(3):CD006020.

Peacock 2013 - Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health. 2013;13:17.

Selph 2013 - Selph SS, Bougatsos C, Blazina I, Nelson HD. Behavioral interventions and counseling to prevent child abuse and neglect: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine. 2013;158(3):179–90.

Cochrane-Lopez 2015* - Lopez LM, Grey TW, Hiller JE, Chen M. Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews. 2015;(7):CD001863.

Meade 2005* - Meade CS, Ickovics JR. Systematic review of sexual risk among pregnant and mothering teens in the USA: Pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Social Science & Medicine. 2005;60(4):661–78.

Citations - Implementation Examples

* Journal subscription may be required for access.

NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed.

PAT-Home visiting - Parents as Teachers (PAT). Federal home visiting program.

HIPPY - Home Instruction for Parents of Preschool Youngsters (HIPPY).

HFA - Healthy Families America (HFA).

OPRE-Avellar 2012 - Avellar S, Paulsell D, Sama-Miller E, Del Grosso P. Home Visiting Evidence of Effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), US Department of Health and Human Services (US DHHS); 2012.

CF - Child First. Strong families...healthy children.

US DHHS-HomVEE Methods - US Department of Health and Human Services (US DHHS). Home visiting evidence of effectiveness (HomVEE) review process.

Date Last Updated

May 7, 2014